Deterioration as an outcome of therapy: A systematic case study group investigation

  • Stephen, S. (Speaker)
  • Laura Bell (Speaker)
  • Maha Khan (Contributor)
  • Ruth Love (Speaker)
  • MacIntosh, H. (Contributor)
  • Melanie Martin (Contributor)
  • Rebecca Moran (Speaker)
  • Emily Price (Speaker)
  • Brigid Whitehead (Contributor)

Activity: Talk or presentation typesOral presentation


Symposium presented at the BACP Research Conference, Belfast, UK.

Aims of the symposium
Deterioration as an outcome of counselling and psychotherapy is an under-researched area. In this group investigation we conducted a systematic case study series to explore the outcome of therapy for eight clients who accessed person-centred therapy at a UK-based university counselling research centre: four whose outcome data, measured using the Strathclyde Inventory (SI; Freire, 2007), suggested that they had reliably improved by the end of therapy (‘improvers’) and four whose SI data suggested that they had reliably deteriorated (‘deteriorators’).
Each individual case was examined by a researcher using the adjudicated Hermeneutic Single Case Efficacy Design (HSCED; Elliott, 2014). For the first time, researchers used an adapted form of the adjudicated HSCED method for those clients whose SI scores indicated deterioration during therapy.
Following the completion of the eight case studies, a metasynthesis of the case study series was carried out to identify and compare general and typical features of the therapeutic relationship, process, and outcome of therapy for the two groups in order to better understand the factors that may have contributed to the apparent deterioration at the end of therapy experienced by the group of ‘deteriorators’.
The aims of this symposium are to present what we have learned about deterioration as an outcome of therapy and to discuss the potential implications of our findings for practitioners and service providers.

Contribution of each symposium paper to the overall theme
In Paper 1 we will introduce the adapted HSCED method used in this investigation, illustrating the method with the case of Sofia. In Paper 2 we will discuss the challenges of evaluating therapeutic outcome for a client who appeared to have deteriorated in therapy, illustrating the process with the case of Luke. In Paper 3 we will present the key findings of our metasynthesis of the case study series, identifying key features that may offer an explanation for the different outcomes experienced.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice
This symposium highlights the complexity of therapeutic outcome. It emphasises the need for practitioners and researchers to increase understanding of aspects of therapy that can be experienced as difficult by clients and therapists leading to loss of hope and incomplete therapeutic processes.
Period18 May 2019
Event title25th annual BACP research conference
Event typeConference
LocationBelfast, United KingdomShow on map
Degree of RecognitionNational