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How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience.

ABSTRACT: Background: Despite repeated discussion of treatment safety, there remains little quantitative research directly addressing the potential of therapy to harm. In contrast, there are numerous sources of qualitative evidence on clients' negative experience of psychotherapy, which they report as harmful. Objective: To derive a model of process factors potentially leading to negative or harmful effects of therapy, from the clients' perspective, based on a systematic narrative synthesis of evidence on negative experiences and effects of psychotherapy from (a) qualitative research findings and (b) participants' testimony. Method: We adapted Greenberg (2007) task analysis as a discovery-oriented method for the systematic synthesis of qualitative research and service user testimony. A rational model of adverse processes in psychotherapy was empirically refined in two separate analyses, which were then compared and incorporated into a rational-empirical model. This was then validated against an independent qualitative study of negative effects. Results: Over 90% of the themes in the rational-empirical model were supported in the validation study. Contextual issues, such as lack of cultural validity and therapy options together with unmet client expectations fed into negative therapeutic processes (e.g., unresolved alliance ruptures). These involved a range of unhelpful therapist behaviors (e.g., rigidity, over-control, lack of knowledge) associated with clients feeling disempowered, silenced, or devalued. These were coupled with issues of power and blame. Conclusions: Task analysis can be adapted to extract meaning from large quantities of qualitative data, in different formats. The service user perspective reveals there are potentially harmful factors at each stage of the therapy journey which require remedial action. Implications of these findings for practice improvement are discussed.

SUBMITTER: Curran J

PROVIDER: S-EPMC6425860 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience.

Curran Joe J Parry Glenys D GD Hardy Gillian E GE Darling Jennifer J Mason Ann-Marie AM Chambers Eleni E

Frontiers in psychology 20190313

<b>Background:</b> Despite repeated discussion of treatment safety, there remains little quantitative research directly addressing the potential of therapy to harm. In contrast, there are numerous sources of qualitative evidence on clients' negative experience of psychotherapy, which they report as harmful. <b>Objective:</b> To derive a model of process factors potentially leading to negative or harmful effects of therapy, from the clients' perspective, based on a systematic narrative synthesis ...[more]

PMID: 30930805

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Project description:ObjectiveComputerised therapies play an integral role in efforts to improve access to psychological treatment for patients with depression and anxiety. However, despite recognised problems with uptake, there has been a lack of investigation into the barriers and facilitators of engagement. We aimed to systematically review and synthesise findings from qualitative studies of computerised therapies, in order to identify factors impacting on engagement.MethodSystematic review and meta-synthesis of qualitative studies of user experiences of computer delivered therapy for depression and/or anxiety.Results8 studies were included in the review. All except one were of desktop based cognitive behavioural treatments. Black and minority ethnic and older participants were underrepresented, and only one study addressed users with a co-morbid physical health problem. Through synthesis, we identified two key overarching concepts, regarding the need for treatments to be sensitive to the individual, and the dialectal nature of user experience, with different degrees of support and anonymity experienced as both positive and negative. We propose that these factors can be conceptually understood as the 'non-specific' or 'common' factors of computerised therapy, analogous to but distinct from the common factors of traditional face-to-face therapies.ConclusionExperience of computerised therapy could be improved through personalisation and sensitisation of content to individual users, recognising the need for users to experience a sense of 'self' in the treatment which is currently absent. Exploiting the common factors of computerised therapy, through enhancing perceived connection and collaboration, could offer a way of reconciling tensions due to the dialectal nature of user experience. Future research should explore whether the findings are generalisable to other patient groups, to other delivery formats (such as mobile technology) and other treatment modalities beyond cognitive behaviour therapy. The proposed model could aid the development of enhancements to current packages to improve uptake and support engagement.

Project description:Background and aimWhile many studies have examined outcome measurement as part of clinical trials and routine outcome collection at the person-level in alcohol and other drug (AOD) treatment services, there has been limited attention to measures required to assess performance at the service-level. In Australia, non-government services are primarily funded by government using public funds; however, there is no standardized approach to performance measurement. This study sought to establish a finite list of performance measures that represented consensus between funders, treatment providers and service-users.MethodA three-round Delphi process was undertaken with (i) funders of treatment (n = 10), (ii) treatment providers (n = 10) and (iii) treatment service-users (n = 10). Participants were asked to rate a range of measures on a 10-point Likert scale on how important they were to be included in contracts with funders. Measures with a median score > 7 and agreement among participants above 70% were the criteria for inclusion in the final set of measures. Qualitative data in the form of text responses provided by participants for their ratings in rounds 1 and 2 were also analysed.ResultsParticipants rated 93 measures in round 1, which reduced to 78 measures in round 2 and 32 measures in round 3. Fifteen service-level measures and two system-level measures met criteria for inclusion in the final set of performance measures. The final set of measures cover a range of measurement types: outcomes (n = 5), access (n = 3), structural (n = 3), experience (n = 2), input (n = 2), process (n = 1) and output (n = 1).ConclusionIn Australia, performance measures for alcohol and other drug treatment services that represent a consensus among service-users, providers and funders focus upon demonstrating accountability for public funds, improving services and communicating key measures of success to future service-users and the broader community.

Project description:BackgroundPerinatal depression is common in low and middle income countries (LAMICs). Task sharing interventions have been implemented to treat perinatal depression in these settings, as a way of dealing with staff shortages. Task sharing allows lay health workers to provide services for less complex cases while being trained and supervised by specialists. Randomized controlled trials suggest that these interventions can be effective but there is limited qualitative information exploring barriers and facilitators to their implementation. This systematic review aims to systematically review current qualitative evidence of process evaluations of task sharing interventions for perinatal depression in LAMICs in relation to the United Kingdom (UK) Medical Research Council (MRC) framework for conducting process evaluations.MethodsWe searched Medline/ PubMed, PsycINFO, Scopus, Cochrane Library and Web of science for studies from LAMICS using search terms under the broad categories of: (a) "maternal depression'" (b) "intervention" (c) "lay counsellor" OR "community health worker" OR "non-specialist" and (d) "LAMICs". Abstracts were independently reviewed for inclusion by two authors. Full text articles were screened and data for included articles were extracted using a standard data extraction sheet. Qualitative synthesis of qualitative evidence was conducted.Results8420 articles were identified from initial searches. Of these, 26 full text articles were screened for eligibility with only three studies meeting the inclusion criteria. Main findings revealed that participants identified the following crucial factors: contextual factors included physical location, accessibility and cultural norms. Implementation factors included acceptability of the intervention and characteristics of the personnel. Mechanisms included counsellor factors such as motivating and facilitating trust; intervention factors such as use of stories and visual aids, and understandability of the content; and participant factors such as shared experience, meeting learning needs, and meeting expectations.ConclusionsWhile task sharing has been suggested as an effective way of filling the treatment gap for perinatal depression, there is a paucity of qualitative research exploring barriers and facilitators to implementing these interventions. Qualitative process evaluations are crucial for the development of culturally relevant interventions.

Dataset Information

How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience.

Publications

How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience.

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