Pluralistic therapy for depression: Acceptability, outcomes and helpful aspects in a multisite study

Counselling Psychology Review, Vol. 30, No. 1, March 2015 © The British Psychological Society – ISSN 0269-6975 ePRessIoN refers to a wide range of mental health problems characterised by the absence of a positive affect and low mood (National Collaborating Centre for mental Health, 2010). Diagnostic criteria for a major depressive disorder from the DSM-5 include low mood, decreased interest or pleasure, fatigue or loss of energy, feelings of guilt and worthlessness, and suicidality. It is the most common mental disorder in community settings (National Collaborating Centre for mental Health, 2010) and the fourth most common cause of disabilityadjusted life years (World Health organization, 2001). It is estimated that between four and 10 per cent of adults are likely to experience major depression in their lifetime (National Collaborating Centre for mental Health, 2010). For people with moderate or severe depression, evidence-based guidelines from the UK’s National Institute of Health and Clinical excellence (NICe) recommend a combination of antidepressants and a high intensity intervention, comprising either cognitive behavioural therapy (CBt) or interpersonal therapy (IPt) (National Collaborating Centre for mental Health, Objectives: The aim of this study was to assess the outcomes, acceptability and helpful aspects of a pluralistic therapeutic intervention for depression. Design: The study adopted a multisite, non-randomised, pre-/post-intervention design. Methods: Participants experiencing moderate or more severe levels of depression (as assessed by a score of 10 or greater on the Patient Health Questionnaire depression scale, PHQ-9) were offered up to 24 weeks of pluralistic therapy for depression. This is a collaborative integrative practice oriented around shared decision making on the goals and methods of therapy. Of the 42 participants assessed, 39 (92.9 per cent) completed two or more sessions. Participants were predominantly female (N=28, 71.8 per cent) and white (N=30, 76.9 per cent), with a mean age of 30.9. The principal outcome indicator was improvement and recovery on the PHQ-9 and Generalised Anxiety Disorder 7-item (GAD-7) scale. Results: Of the completer sample, 71.8 per cent of clients (N=28) showed reliable improvement and 43.6 per cent (N=17) showed reliable recovery. Effect sizes (Cohen’s d) from baseline to endpoint were 1.83 for the PHQ-9 and 1.16 for the GAD-7. On average, the clients found the PfD sessions helpful and valued the flexibility and collaborative approach of their therapists. Clients felt that change had been brought about by their own active engagement in therapy and through the therapists relational qualities, as well as their use of techniques. Conclusions: Initial indications suggest that pluralistic therapy for depression has acceptable outcomes, retention rates, and user satisfaction. Refinement and further testing of the approach is recommended.