Abstract

Aims: The evidence base has heavily examined the processes of self-help that take place within a course of CBT. However, much less is known about the process of continuing with therapy beyond the point of discharge, and little research has been conducted in the area. Using qualitative idiographic enquiry, the study therefore aimed to develop an in-depth understanding of the lived experiences of clients who were discharged from a course of CBT and intentionally embarked on a process of structured self-therapy. The study explores the lived experiences of clients who were discharged from a course of CBT provided by an IAPT psychological therapies service and sought to explore their experience of structured self-therapy sessions post discharge including consideration of what helped and hindered the use of structured self-therapy.

Method: In-depth semi-structured interviews were carried out with ten clients who were discharged from a course of CBT provided by the Mindsmatter IAPT psychological therapies service in Lancashire at the point of discharge and at three-months follow-up.

Findings: Participant interviews were transcribed and analysed using Interpretative Phenomenological Analysis methodology. A comparison of accounts revealed both similar and contrasting experiences. The analysis produced five superordinate themes of ‘Balancing Agency and Dependency’, ‘Making It Work’, No Going Back’, ‘A New Me’ and ‘It’s Not All About Me’. Several subordinate themes sit within each of these superordinate themes. An interpretation of the participants’ interpretation of their own lived experience is presented within the findings.

Key findings in terms of what makes self-therapy meaningful centred around the 4 C’s of co-operation, craftwork, containment and collectivism. For many participants self-therapy was experienced as a craft that required a combination of time, dedication, skills and knowledge to result in a set of refined CBT skills (craftwork). For many, the development of this craft was a lonely journey. It wasn’t that participants always felt short-changed by the length of their therapy, in fact they were willing to ‘get on with it’ themselves. It was, however, a journey they would have wished to have shared with other people, for some a therapist; for others their peers, friends and family (co-operation). Participants also sensed that, alongside engaging in self-therapy with others, they would have been benefited from engagement in more distinct relapse prevention processes before discharge (containment). Finally, the findings revealed experiences of other-interest including the positive impacts for family members of clients who engage in CBT and a desire to share newly developed CBT skills with others or to make way for others to access the benefits of CBT (collectivism). The relational aspects of self-therapy were found to be of most importance. The participants didn’t necessarily want more therapy; they simply wanted more assistance to do their own self-therapy or shared-therapy. Consideration is given to these findings in relation to the wider literature.

Conclusions: This study has wider implications for the discharge process in CBT with the findings suggesting that it may be helpful for therapists to pay more attention to relapse prevention processes to enhance consolidation of learning and to serve as a reference point for the client in continuing their self-therapy. The findings may also be helpful for NHS Talking Therapies service managers and clinical leads to consider in scaffolding ongoing personal support post-therapy.

If the fundamental essence of IAPT, or NHS Talking Therapies as it is more recently known, is to increase access to psychological therapy for more people, then post-discharge supported self-therapy could serve as a valuable way of not only increasing the client’s therapeutic benefit beyond therapy, but also in the prevention of unnecessary, repeated referrals for CBT when supported self-therapy or shared-therapy would serve the client’s experience better. This would truly increase access to psychological therapy for those in need.