A Qualitative Evaluation of the Role of Control and Choice in Psychological Therapies and Method of Levels Therapy for Bipolar Disorder

Abstract

The aim of this thesis is to explore and understand the role of choice and control in psychological therapies. Client reports of choice and control over therapy parameters may provide valuable information to clinicians and researchers about what elements of therapy are considered important to have choice and control over and how this might contribute to a reduction in psychological distress. This may help us to understand more about the key elements of effective and meaningful interventions, and further explain the processes through which these elements might operate to facilitate change. Paper one is a Meta-Synthesis focussing on the perceived benefits and risks of providing clients with choice and control over parameters in psychological therapy. A thematic synthesis of the 24 identified studies was conducted which revealed that clients experienced both risks and benefits of parameter choice and control across a range of therapeutic approaches. Parameter control was found to be context dependent and according to individual needs and expectations of therapy. The findings of the synthesis suggests that clients have profited from therapy when therapists facilitate choice and control over therapy parameters and ensure clients have opportunities to talk freely about a range of problems. Paper two is an empirical investigation of a client-led online therapy for people diagnosed with Bipolar Spectrum Disorder (BD). A qualitative study using Method of levels therapy (MOL) was conducted with ten participants across England with a diagnosis of BD. The study comprised of a novel methodology with qualitative measures to capture clients’ perceptions and experiences of MOL via videoconferencing. Participants were offered therapy over a two-month period, during which they were able to schedule their own appointments (both the frequency and duration of sessions) and choose what to talk about. An A-B design with follow-up was employed. All participants were retained in the study. Qualitative data analysis via thematic analysis (TA) identified themes of; Control Matters, The Freedom to Choose, Swings and Roundabouts, Adjusting to MOL, Unchartered Territory, and a cross-cutting theme; State-dependent Control. Participants described the importance of being offered choice and control over therapy parameters. However, highlighted the value of negotiating a balance of these constructs during certain mood states. The client’s perceived sense of control is shown to be an important process during therapy that is closely related to how much control they perceive to have over their mood symptoms. Overall, the findings suggest that people with BD respond well to a client-led, transdiagnostic approach. Paper three critically evaluates the meta-synthesis (Paper 1) and empirical study (Paper 2). The methodological strengths and limitations are discussed as well as the implications for future research and the plans for dissemination. This chapter provides a critical reflection on the work involved in the completion of this research project. It expands on the details and decision-making processes, and concludes with personal reflections on the research project as a whole.

Date of Award	1 Aug 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Sara Tai (Supervisor) & Warren Mansell (Supervisor)