Eleni Chambers

Ethical Issues in the Use of In-Depth Interviews: Literature Review and Discussion

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical.

Report on a Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy

This article reports on a systematic review to assess the efficacy and clinical effectiveness of group analysis and analytic/dynamic (A/D) group psychotherapy. Systematic literature searches were undertaken; 34 primary studies and 19 reviews met the inclusion criteria and their data was extracted. Of the primary studies, the randomized controlled trials provided evidence for the efficacy and clinical effectiveness of group therapy approaches in a range of clinical problems, but not for specific benefits of any particular theoretical approach. The controlled studies and observational studies gave support for the use of group psychotherapy in a variety of conditions. The review of reviews confirms that group therapies in general are more effective than wait list or standard care controls. Methodological challenges encountered and recommendations for further research are presented, along with a more detailed discussion of the implications of the review for the research community.

Clinical psychology service users' experiences of confidentiality and informed consent: A qualitative analysis

OBJECTIVES To explore and describe the experience of clinical psychology service users in relation to the processes associated with confidentiality and the generation of informed consent in individual therapy. DESIGN A qualitative interview-based study employing interpretative phenomenological analysis was conducted with service users. User researchers were active collaborators in the study. METHODS A focus group of four users was convened to explore issues related to confidentiality and consent, which then informed the development of the semi-structured interview schedule. Twelve users of community mental health clinical psychology services were interviewed by user researchers. A user researcher and a clinical psychologist undertook joint analysis of the data. A second clinical psychologist facilitated reflexivity and wider consideration of validity issues. RESULTS Four main themes were identified from the data: being referred; the participants feelings, mental health difficulties, and their impact; relationships with workers and carers; and autonomy. CONCLUSIONS The meaningfulness of processes of discussing confidentiality, and generating informed consent, can be improved by psychologists placing a greater emphasis on choice, control, autonomy, individual preferences, and actively involving the user in dialogue on repeated occasions.

What helps and hinders people with psychotic conditions doing what they want in their daily lives

It is important for people to do what they want in their daily lives and this is embedded in concepts of recovery, rehabilitation, social inclusion and quality of life. To research what helps and hinders people with psychotic conditions to do what they want, 24 people already engaged in a trial of occupational therapy were interviewed by a service user researcher. The qualitative methods used framework analysis. The findings described what the participants appreciated about occupational therapy and how other workers sometimes delivered occupational therapy type interventions. As well as therapy, multifarious factors appeared to have an impact on peoples choices and actions and these reiterated the findings from prior studies. These internal and external factors combined in complex relationships. People felt particularly vulnerable when staff behaved uncaringly and with disrespect because this replicated past traumas, stigmatisation and rejection. The participants revealed how important it was for staff to pitch their interventions right for them at the time. The study led to suggestions that occupational therapists refine their artistry in order to hone their interventions to suit the individual, follow guidance on developing therapeutic relationships and recovery-focused capabilities, enhance caring by getting support themselves and employ critical thinking to challenge organisational barriers and their professions rhetoric.

Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community

BackgroundThe purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression.MethodModelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs).ResultsThree service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty.ConclusionsCost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services.

Risk factors for negative experiences during psychotherapy

ABSTRACT Background: It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this. Aims: The aim of this study was to investigate the factors associated with patients’ negative therapy experiences. Method: The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis. Results: There was a Lack of fit between Patient needs, Therapist skills, and Service structures. This could result in Fault Lines, a tension between Safety and containment and Power and control. This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience. Conclusions: Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered. Clinical and methodological significance of this article: Estimates of “unwanted effects,” including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided.

Enablers and barriers for engaged, informed individuals and carers: left wall of the House of Care framework.

Engaged and informed individuals and carers can mean different things to different people. In this article we use the definition from the Coalition for Collaborative Care: ‘... people have the right support, knowledge, skills, power — and of course confidence — to [manage their care and support] and live the lives they want.’ 1 In the recent editorial on rhetoric and reality in person-centred care Mathers and Paynton provide a persuasive narrative as to why person-centred care (PCC) should be adopted as ‘the norm’ and how the introduction of collaborative care and support planning (CCSP), as a manifestation of this approach, will facilitate its implementation, particularly for people with long-term conditions (LTCs).2 Key to the delivery of both PCC and CCSP, are the four components of the House of Care (HoC): This article, the second in a series of four articles considering each of the four components of the HoC model, will address both the enablers and barriers pertinent to individuals and carers being engaged and informed, to enable the delivery of CCSP. There are over 15 million people with LTCs in England, whose care accounts for over 50% of all GP appointments and 70% of all inpatient episodes. In total, people with LTCs account for over 70% of the total NHS and Social Care expenditure, and as the number of people with LTCs is set to increase then these …