Presentation by Dr. Michael Barkham about practice-based evidence being used to establish an evidence-base for the practice of psychotherapy.

1. Michael
Barkham
Centre
for
Psychological
Services
Research
University
of
Sheffield
UK
m.barkham@sheffield.ac.uk
Calgary
Counselling
Centre
Conference:
December
2014

2.  Worth
the
effort
commi,ng
research
1me
to
inves1gate
phenomena/experiences
you
believe
are
theore1cally
or
prac1cally
important
 Devising,
adap1ng,
&
adop1ng
innova1ve
research
methods
 Science
needs
to
adopt
a
shared
frame
of
reference
that
has
prac11oners
as
equal
partners
 Strive
towards
a
level
playing
field
 No
single
research
method
can
develop
or
deliver
a
comprehensive
science
of
the
psychological
therapies
© University of Sheffield 12/10/14

3. © University of Sheffield 12/10/14

4. © University of Sheffield 12/10/14

5. • Adop1ng
a
boGom-­‐up
approach
• Measurement
system
at
its
heart
using
common
data
methods
• Willingness
to
collect
&
share
data
with
other
prac1ce
communi1es
 Use
data
to
improve
prac1ce
 Use
data
to
enhance
evidence
and
complement
trials
methodology
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6. © University of Sheffield 12/10/14

7. © Centre for Psychological Services Research
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8. © Centre for Psychological Services Research
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9. © University of Sheffield 12/10/14

10. © University of Sheffield 12/10/14

11.  Map
of
the
CORE
measures
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12. © University of Sheffield 12/10/14

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16. © University of Sheffield 12/10/14

17.  Outcomes
as
numbers
at
the
group
level
N
=
9761
61.9%
recovered
81.4%
improved
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18.  Same
data
as
9761
individuals
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23.  Caterpillar
plots
&
therapist
variability
 Dave
Saxon:
d.saxon@shefffield.ac.uk
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24. © University of Sheffield 12/10/14

25.  Therapist
effects
increase
as
a
func1on
of
pa1ent
ini1al
severity
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26.  Jo-­‐Ann
Pereira:
jopereira150@gmail.com
 Prac11oners’
descrip1ons:
 Empathy
is
key
component
for
prac11oners
-­‐
they
value
the
importance
in
having
a
capacity
to
understand
pa1ents’
personal
emo1onal
experiences
© University of Sheffield 12/10/14
 Personal
aspects
(quali1es)
prac11oners
bring
to
their
prac1ce
as
people
 Inves1ga1ng
the
role
of
prac11oner
resilience,
empathy,
and
mindfulness

27.  Less
effec1ve
prac1ce
rate
empathy
as
a
personal
aspect
higher
than
more
effec1ve
prac1ce
 But
more
effec1ve
prac1ce
rate
resilience
and
mindfulness
higher
than
less
effec1ve
prac1ce
 Personal
aspects
are
differen1ally
responsive
to
pa1ent
severity
 Combined
resilient
&
mindful
pracLce
© University of Sheffield 12/10/14
 Inves1ga1ng
the
role
of
prac11oner
resilience,
empathy,
and
mindfulness
 Self-­‐report
measures
of
Resilience,
Empathy,
&
Mindfulness

28. A
case
study:
Counselling
&
pa1ent
choice
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29.  Evidence for the efficacy of
counselling
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30.  Comprehensive
cohort
design:
Trial
nested
within
a
rou1ne
service
Sheffield IAPT service
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31.  Counselling
for
depression
vs.
CBT
 Funder:
BACP
Research
Founda1on
Caveats:
 Repe11ve/symptom
focus
 Value
of
missing
data
 Poten1al
mismatch
between
sta1s1cal
recovery
and
reports
of
pa1ents’
lives
as
lived
© University of Sheffield 12/10/14
Trial
pre-­‐
measures
Trial
post-­‐
measures
Sessional
measures
(PHQ-­‐9,
GAD-­‐7,
WSAS
mandated)

32.  Prac1ce-­‐based
methods
are
central
for
improving
prac1ce
 Place
prac11oners
as
central
in
integra1ng
prac1ce
and
science
 Prac1ce-­‐based
evidence
yields
good
enough
science
that
is
cost
efficient
–
but
there
is
an
argument
to
be
won
about
its
acceptance
 Argument
for
combining
both
prac1ce-­‐based
evidence
and
trials
methodology
in
comprehensive
cohort
designs
 Inves1ga1on
of
prac11oner
variability
will
help
inform
us
about
what
best
prac1ce
is
–
from
which
we
can
all
learn
 Improving
access
is
good
but
need
to
engage
and
retain
pa1ents
in
treatment
–
dropout
is
the
key
issue
to
address
© University of Sheffield 12/10/14