City Research Online

Personalised treatments in CBT and the therapeutic alliance in IAPT

Sreenan, Brian (2013). Personalised treatments in CBT and the therapeutic alliance in IAPT. (Unpublished Doctoral thesis, City University London)


This study used a sequential mixed methods analysis to investigate the importance of the Therapeutic Alliance (TA) in an Improving Access to Psychological Therapies (IAPT) service.

The first part of this study used thematic analysis to analyse data collected from two focus groups, one containing seven qualified IAPT therapists and one containing five trainee IAPT therapists. The qualitative analysis resulted in three super-ordinate themes: 1) The impact of the IAPT trainee experience on the TA, 2) Equality in the relationship versus early IAPT protocol, and 3) Severity of client symptoms and impact on TA.

The second part of this study used a pantheoretical measure of the TA (Helping Alliance Questionnaire-II, Luborsky et al., 1979) along with measures of depression (PHQ-9, Kroenke et al., 2001) and anxiety (GAD-7, Spitzer et al., 2006), to answer three main questions raised by part 1 of the study: (1) Is there be a significant difference in TA scores between trainee therapists and qualified therapists? (2) Does IAPT protocol impact on the early TA? (3)Is symptom severity be correlated with the TA? A fourth question was generated as a result of the literature review: (4) Does early or late TA predict depression and anxiety scores? A total of 18 therapists, nine qualified and nine trainees, and their respective clients (n=37) took part in the quantitative section of the study. Quantitative results showed that there was no significant difference in TA scores between trainee and qualified therapists. Secondly, a strong TA was found across the two groups. Thirdly, symptom severity was not significantly correlated with client or therapist TA scores. Finally, end of treatment client TA scores along with baseline depression and anxiety scores were shown to be predictive of end of treatment change in depression and anxiety levels. Implications for practice and Counselling Psychology are discussed and avenues for future research are suggested.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: Doctoral Theses
School of Health & Psychological Sciences > Psychology
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
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