1. Society for Psychotherapy Research SPR(UK) Chapter Conference 14/03 - 16/03/2009 Ravenscar

2. Complex Clients or Worried Well? Who do UK Counsellors see? How well do they feel prepared for it? How much are they affected by it? Thomas Schröder, University of Nottingham & Sue Wheeler, University of Leicester

3. Outline: o Mapping GAF scores onto stepped care tiers o Describing the ISDP and UK samples o Reporting descriptive statistics for counsellor’s caseload o Reporting correlates of caseload complexity

4. Introduction: o Stepped care model introduced as part of IAPT initiative o Skills mix and remuneration linked to stepped care tiers o Training of new therapists aligned to stepped care model o Status of existing workforce unclear

5. GAF Scores & Descriptions GAFDescription >80 Absent/minimal symptoms 70-80 Symptoms present 60-70 Mild but enduring symptoms 50-60 Moderate symptoms 40-50 Serious symptoms 30-40 Significant impairment 20-30 Serious impairment <20 Real danger

6. GAF Scores & Stepped Care Tiers GAFDescriptionTier >80 Absent/minimal symptoms I 70-80 Symptoms present I 60-70 Mild but enduring symptoms II 50-60 Moderate symptoms III 40-50 Serious symptoms IV 30-40 Significant impairment V 20-30 Serious impairment V <20 Real danger V

7. The ISDP (International Study of the Development of Psychotherapists) o Collaborative effort by a group of practitioner-researchers (CRN). o Survey using Common Core Questionnaire (CCQ). o Comparative cohort, cross-sectional, and longitudinal perspectives. o Current database of 8000 therapists from 20+ countries.

8. The CCQ Main Sections Demographics Demographics Amount and types of training Amount and types of training Professional experience to date Professional experience to date Orientation of therapeutic work Orientation of therapeutic work Settings, modalities and clientele Settings, modalities and clientele Current, past, and overall development as therapist Current, past, and overall development as therapist Experience of personal therapy Experience of personal therapy Personal life and self- experience Personal life and self- experience Experienced quality of therapeutic work Experienced quality of therapeutic work

9. ISDP: UK Samples o Collaboration with BABCP (British Association of Behavioural and Cognitive Psychotherapists) N = 257 o Collaboration with BACP (British Association for Counselling and Psychotherapy) N = 660 o Total N = 957

10. The BACP Study - Two Samples – Accredited Counsellors and Therapists Other members Invited to opt into study N = 1500 (random sample) Invited to opt into study N = 1500 (random sample) Opt-in sample N = 681 (45%) Opt-in sample N = 440 (30%) Returned CCQs N = 454 (66%) 30% of total sample Returned CCQs N = 206 (47%) 14% of total sample

11. The BACP Samples Comparison with other Surveys CRN/BACP (N = 660) BACP Survey (N = 1451) BACP Survey (N = 3115) Female 82 % 80 % 81 % Age 24 – 45 45 – 55 55 – 65 16 % 38 % 31 % 12 % 40 % 32 % 23 % 36 % 34 % Practice Yrs. 0 – 10 10 – 20 > 20 53% 38% 9% 53% 38% 9% 62 % 27 % 8 % 61 % 27 % 8 % 61 % 27 % 8 %

12. GAF Bands and Total Caseload GAF Mean=14 (SD=9.1); Median=12 Tier >80.88 = 6 %.88 = 6 %I 70-80 2.33 = 15 % 21 % 2.33 = 15 % 21 %I 60-70 4.76 = 34 % 34 % 4.76 = 34 % 34 %II 50-60 3.81 = 28 % 28 % 3.81 = 28 % 28 %III 40-50 1.48 = 12 % 12 % 1.48 = 12 % 12 %IV 30-40.42 = 3 % 5 %.42 = 3 % 5 %V 20-30.11 = 1 %.11 = 1 %V <20.23 = 1%.23 = 1%V

13. Subgroups of respondents o 69 % do not report any cases in the ‘Tier 5’ category. o 5 % report a quarter or more of their cases in the ‘Tier 5’ category. o 38 % do not report any cases in the ‘Tier 1’ category. o 16 % report half or more of their cases in the ‘Tier 1’ category.

14. Correlates of weighted caseload ‘Stress index’ derived from weighting caseload by GAF category. Positive correlations with: o Ability to work with psychiatric disorder (r =.12, p <.005) o Ability to chose clientele (r =.12, p <.005) o Satisfaction as a therapist (r =.19, p <.001) o ‘Healing involvement’ (r =.30, p <.001)