1. BPS DC O P A NNUAL C ONFERENCE 2012 An Existential-phenomenological approach to short term psychotherapy in primary care Christian Koebbel - Mark Rayner - Meghan Craig - Tom Godsal - Andy Usher - Peter Bull 1

2. Introduction: Integration of existential thinking & psychotherapy, guided by research  Phenomenological enquiry  Relational stance  Anxiety as meaningful  Practice-based-evidence Response to local need  GPs increasingly take charge of service commissioning  Fill a gap in service provision 2 An Existential-phenomenological approach to short term psychotherapy in primary care

3. Context Current state of affairs  Most people suffer from mental health difficulties at some point in their lives  IAPT designed for these common mental health needs  Focus on efficacy and clear diagnostic criteria to determine treatment Is primary care equipped to deal with the demand?  Not everyone fits into the current system.  IAPT needs to be supplemented by additional services (IAPT D&I Group, 2010) An Existential-phenomenological approach to short term psychotherapy in primary care 3

4. Core Tenets An Existential-phenomenological approach to short term psychotherapy in primary care 4 Brief existential-phenomenological approach to psychotherapy Finding & owning meaning Anxiety RelatednessTemporality

5. Core Tenets: Relatedness & Anxiety Relational stance towards symptoms  Symptoms as meaningful attempts to grapple with concerns  Being able to recognise the meaning/purpose of symptoms enables clients to take ownership  Choice  Client change instead of symptom change! An Existential-phenomenological approach to short term psychotherapy in primary care 5 Anxiety RelatednessTemporality

6. Core Tenets: Anxiety 1.Psycho-educational component to EPT grounded in an exist.-phenom. perspective. 2.Finding meaning in the relational stance towards anxiety. Dimensions of exist.-phenom. therapy of anxiety: 1. Acknowledge the anxiety 2. Putting anxiety into context  ‘making the assumptions you make - anxiety seems a reasonable consequence’ 3. Creating an attitude of curiosity 4. Exploring the anxiety 5. Understanding the meaning of the anxiety 6. Ownership and choice 7. Recovery is to live courageously with anxiety An Existential-phenomenological approach to short term psychotherapy in primary care 6 Anxiety RelatednessTemporality

7. Core Tenets: Temporality How would you change the way you lived your life if you knew the exact date of your death? What if that date was in three months time? Finiteness creates urgency Urgency as important therapeutic tool homework An Existential-phenomenological approach to short term psychotherapy in primary care 7 Anxiety RelatednessTemporality

8. Implementation 8 Goal setting via CORE Goal Attainment form 1 assessment session, 6 weekly sessions (possibility of modular extension) Timely intervention  less than 3 weeks waiting from referral to assessment  less than 6 weeks from assessment to first session Routine Outcome Measures – session-by-session monitoring (CORE-OM, PHQ-9, GAD-7) Preliminary results are promising An Existential-phenomenological approach to short term psychotherapy in primary care

9. Results so far 9 An Existential-phenomenological approach to short term psychotherapy in primary care

10. Conclusion Next steps: evaluation of data, introduce specific measures, semi-structured manual A personal reflection: from therapeutic interventions to therapeutic service delivery Invitation to collaborate on data collection and piloting 10 An Existential-phenomenological approach to short term psychotherapy in primary care

11. Thank you! Christian Koebbel christian.koebbel@nhs.net Mark Rayner mark.rayner@beh-mht.nhs.uk 11 An Existential-phenomenological approach to short term psychotherapy in primary care