Home : Evaluating the Effectiveness of Psychological Therapies
Evaluating the Effectiveness of Psychological Therapies
The Mental Health Providers Forum has launched an initiative to address the question ‘how can you best evaluate the effectiveness of psychological therapies?', in doing so we're considering scientific, philosophical and service user perspectives.
The work will explore;
What therapies are available?
Do they work?
How do they work?
Why do they work?
Who do they work for?
When do they work?
How and where do we measure their effectiveness?
We have convened leading therapists, scientists, academics, social thinkers and service users to debate the value of a diverse range of psychological therapies to the individual and wider society.
This will be a unique opportunity, within and beyond the field of psychological health, for professionals representing different disciplines and orientations of practice to debate these issues.
This work is highly pertinent at this historic time for psychological therapies, with over £300 million invested in mainstreaming psychological therapies within the NHS through the Improving Access to Psychological Therapies (IAPT) initiative and acknowledgement within NICE guidelines that talking therapies are as effective as pharmaceutical alternatives. These are both developments that have been long awaited and much welcomed. It is vital that we set out on the right path in determining the nature of provision and evaluation of psychological therapies, creating a solid platform on which to build adequate services which meet the needs of a diverse general public. Over the last 70 years a broad range of therapies have developed, offering considerable choice to individuals who may have different requirements from psychological therapy at different stages of their lives.
Our work will consider;
Paradigms and orientations of practice
The broad range of therapies currently available; their benefits to the ‘patient' and contributions to our understanding of the human person and wider society
Research methodologies for the evaluation of psychological therapies
What patient choice means and the consequences of the loss of choice
Patient Choice
Patient choice is essential for individuals to benefit from psychological therapies. Different people respond better to different treatments at different stages of their lives. Success is more likely and greater when the treatment offered is in accord with the patient's ‘worldview'. Currently patients have access to over 14 different types of psychological therapy on the NHS. To ensure quality of service is important that all therapies offered by the NHS have an evidence base supporting their effectiveness.
NICE Methodology
The National Institute for Health and Clinical Excellence (NICE) is responsible for evaluating the effectiveness of psychological therapies offered by the NHS and produces guidelines recommending specific treatments for specific conditions.
NICE has a considerable task in collating and analysing research and assessing the cost effectiveness of therapies. MHPF supports the principle of evidence-based practice and the work of NICE and wishes to see NICE Guidelines, and thus practice within the NHS, based upon the best scientific evidence available. This is in the best interests of those who can benefit from psychological therapies as well as the commissioners and providers of services.
Currently our discussion regarding psychological therapy is in the context of debate surrounding the National Institute for Health and Clinical Excellence (NICE) Guidelines on Common Mental Health Conditions and NICE methodology for evaluating the effectiveness of psychological therapies. The Guidelines are seen by many to restrict patient choice and access to a broad range of established therapies, due to biases in research methodology rather than a lack of evidence base.
Controversies exist within the field of psychological therapies about what aspects of the psychotherapeutic process are key therapeutic factors, how to measure the effectiveness of these therapeutic factors, and research paradigms adopted to evaluate the evidence.
MHPF is concerned that the dominant methodology (Randomised Control Trials) adopted by NICE has biases towards a medical model of psychological therapy. The medical model emphasises the importance of specific mechanics of manualised interventions for treating specific diagnoses at the expense of the contribution of the therapist, the importance of the therapeutic alliance, and the preference of the client. ‘Contextual model' therapies put greater emphasis on the importance of the individual therapist and the therapeutic relationship and allow flexibility in therapeutic approach to meet client preferences and the progress of therapy. The dominance of the RCT methodology has yielded an evidence base whereby some therapies have been promoted to the exclusion of a broad range of other psychological therapies.
We are concerned that consequently the NICE guideline recommendations do not provide effective treatment for all, limit patient choice and fail to address the diverse needs and backgrounds of the general public.
MHPF Panels on the Evaluation of Psychological Therapies
We're calling for a more inclusive methodological approach to the evaluation of psychological therapies which includes the perspectives of service users. MHPF is working to ensure patient choice by facilitating debate, convening stakeholders with an interest in
Patient choice in accessing psychological therapies
Methodologies for the evaluation psychological therapies
The influence and value to society of a broad range of therapeutic approaches and paradigms.
How we relate to each other as human beings and how we maintain well being as individuals and communities
The aims of our work are to ensure;
Patient choice; access to a range of evidence based therapies to suits diverse needs
Appropriate methodology(s) for the fair evaluation of a broad range of therapies operating within different paradigms
We are working with Service Users, Mental Health Charities, Membership bodies, Scientists, Philosophers, Social Researchers and practitioners to explore the case for a more inclusive methodology that allows for the fair evaluation of a broad range of therapies that operate from both medical and contextual models. As a result of our consultations we are drawing together four Panels to debate and formulate proposals for alternative methodologies. The four panels and their broad tasks will be as follows:
Science Panel: To review the strengths and limitations of a range of methodologies and make recommendations for a more inclusive methodology combining quantitative and qualitative approaches
Philosophy Panel: To consider the value of a diverse range of psychological therapies and paradigms and their benefits to the individual and wider society, together with the consequences of the imposition one ‘state model' of the mind
Service User Perspectives Panel: To consider what patient choice means, outcomes from a patients perspective, and recommendations for a methodology to investigate patient perspectives
Campaigns Panel: To have oversight of the other panels, pulling together strands of our case and raising awareness of the issues
For further information about the Panels please click on the links below or contact Beth Collier, Project Consultant, who is coordinating this work
.
Share your experiences of how NICE guidelines are affecing the practice and provision of psychological therapies with our online survey, click here.
