Gillian Hardy

The University of Sheffield | Sheffield · Department of Psychology (Faculty of Science)

Background: Despite anecdotal evidence that the out of pocket costs of OCD can be substantial in some cases, there is no evidence on how many people they affect, or the magnitude of these costs. Aims: This paper explores the type and quantity of out of pocket expenses reported by a large sample of adults with OCD. Methods: Data on out of pocket exp...

Aim: To investigate if therapists’ personality influences their patients’ treatment outcomes. Methods: N = 4,052 patients were treated by 69 therapists, including 36 Psychological Wellbeing Practitioners (PWPs) and 33 Cognitive Behavioural Therapists (CBTs). Therapists completed the NEO-PI-R personality inventory, they reported years of clinical ex...

Background Despite repeated discussion of treatment safety, there remains little quantitative research directly addressing the potential of therapy to harm. In contrast, there are numerous sources of qualitative evidence on clients’ negative experience of psychotherapy, which they report as harmful. Objective To derive a model of process factors po...

Background Despite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society. Objective The overall objective of t...

Background The Obsessive–Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive–compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive–behavioural therapy (CBT) treatment intensity formats. Objectives To determine...

Affect experiencing (AE), defined as the facilitation of client in-session bodily arousal and visceral experiencing of affect, is a distinct theoretical process presumed to contribute to therapeutic improvement. This study examined the role of AE in the treatment of major depressive disorder by exploring its association to client distress and thera...

Background: Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. "High-intensity" cognitive-behaviour therapy (CBT) from a specialist therapist is current "best practice." However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD sy...

Objectives: Evidence of the contribution of emotional processes to the emergence, maintenance, and experience of medically unexplained symptoms (MUS) suggests that clinical approaches which target these processes could be beneficial. In this study, qualitative methods were used to examine patients' perspectives and subjective experiences of emotio...

Our aim was to examine client mood in the initial and final sessions of cognitive-behavioral therapy (CBT) and psychodynamic-interpersonal therapy (PIT) and to determine how client mood is related to therapy outcomes. Hierarchical linear modeling was applied to data from a clinical trial comparing CBT with PIT. In this trial, client mood was assess...

Objective: People struggle to act on the goals that they set themselves, and this gap between intention and action is likely to be exacerbated by mental health problems. Evidence suggests that forming specific if-then plans (or 'implementation intentions') can promote goal attainment and a number of studies have applied such techniques in clinical...

Unlabelled: Paranoid personality disorder (PPD) presents as chronic and widespread interpersonal distrust, whereby the actions of others are interpreted as malevolent and malicious. This research details the assessment, formulation and treatment of a case of PPD within a 24-session contract of cognitive analytic therapy (CAT). The outcome methodol...

Purpose – The purpose of this paper is to explore the lived experience of having a diagnosis of Borderline Personality Disorder (BPD) in a forensic setting. Design/methodology/approach – Semi-structured interviews were conducted with eight women with a diagnosis of BPD in private secure units. The interview data were analysed using interpretative...

Background UK National Institute of Health and Clinical Excellence guidelines for obsessive compulsive disorder (OCD) specify recommendations for the treatment and management of OCD using a stepped care approach. Steps three to six of this model recommend treatment options for people with OCD that range from low-intensity guided self-help (GSH) to...

Case formulation (CF) is considered a core component of cognitive behavioural therapy (CBT). Despite this, few studies have explored the content and quality of CFs in routine practice and any associated impact on treatment outcome. Aims: This study investigated (1) the content, timing and quality of CF for patients ( N = 29) with Obsessive Compulsi...

Cognitive analytic consultancy involves mapping the dysfunctional procedures and relationships that exist between team and patient using cognitive analytic theory. The study showed no impact on patient outcomes, but a significant organizational impact in terms of team practices and relationships. Cognitive analytic consultancy offers promise in hel...

Objective: To investigate the psychometric properties of the Work and Social Adjustment Scale (WSAS) as an outcome measure for the Improving Access to Psychological Therapy programme, assessing its value as an addition to the Patient Health (PHQ-9) and Generalised Anxiety Disorder questionnaires (GAD-7). Little research has investigated these prop...

Objectives: This theory-building case study examined the zone of proximal development (ZPD) in psychotherapy within the assimilation model. Theoretically, the ZPD is the segment of the continuum of therapeutic development within which assimilation of problematic experiences can take place. Work within a problem's current ZPD may be manifested as a...

Objective: To explore the process of rupture resolution in cognitive behaviour therapy (CBT) with two good outcome clients with borderline personality disorder (BPD). Method: This study employed task-analytic methods to investigate whether the existing CBT rupture resolution model for depression could be validated. Quantitative analyses identifi...

Background: The improving access to psychological therapy (IAPT) initiative aims to provide widespread evidence-based psychological treatments for common mental health problems in the UK. Individual services have implemented National Institute for Clinical Excellence guidelines in various ways; some provide group-based therapy, whilst others do no...

Background: Effective psychological therapies have been recommended for common mental health problems, such as depression and anxiety, but provision has been poor. Improving Access to Psychological Therapies (IAPT) may provide a cost-effective solution to this problem. Aims: To determine the cost-effectiveness of IAPT at the Doncaster demonstrat...

This study examined client perception of the therapeutic impact of two models of therapy delivered by mental health nurses and clinical psychologists respectively - psychodynamic interpersonal therapy (PIT) and cognitive behavioural therapy (CBT). A non-equivalent groups design was used in order to benchmark results against Llewelyn etal.: one grou...

This paper describes the profile of verbal response modes utilised in the expert application of Short-Term Dynamic Psychotherapy (STDP). One hundred and fifteen randomly selected segments from six treatments of STDP were analysed. Trained raters used a verbal response mode coding system to examine the individual speaking turns of an expert therapis...

This article reports the development and psychometric properties of two short forms of the 28-item Agnew Relationship Measure, the ARM-12 and ARM-5. For the ARM-12, results of previous research were used together with conceptual considerations to select three items to represent each of four ARM subscales: Bond, Partnership, Confidence, and Openness...

The aim of this research was to examine the relationship between therapist interventions and patient affect responses in Short-Term Dynamic Psychotherapy (STDP). The Affect Experiencing subscale from the Achievement of Therapeutic Objectives Scale (ATOS) was adapted to measure individual immediate affect experiencing (I-AES) responses in relation t...

The research evidence for Short-Term Psychodynamic Psychotherapy (STPP) in the treatment of personality disorders (PD) was examined through consideration of studies utilizing randomized controlled designs. An extensive literature search revealed eight published Randomized Controlled Trials (RCT) of moderate study quality. A critical review of this...

In a questionnaire study of 700 patients from a large UK National Health Service general hospital, proximal and organizational aspects of patient satisfaction were studied. Factor analysis revealed three components of proximal patient satisfaction: overall process of care in the hospital; improvement in and understanding of health; and psychologica...

The Government would like to support people to move off benefits and into work. Mental health problems such as depression and anxiety are among the commonest reasons why people cannot work. These are relatively easily treated by psychological therapy, but this is hard to find in the NHS. The NHS has funded two Demonstration Sites which will make ps...

This editorial marks the 50th volume of the, now, British Journal of Clinical Psychology, whose ?rst nineteen volumes formed part of a combined British Journal of Social and Clinical Psychology. A hallmark of the journal has always been its capture of the generic scope of academic clinical psychology nationally and internationally with a ?rm commit...

The Sheffield–Leeds Psychotherapy Research Program spans a 30-year period of work carried out at the University of Sheffield, Sheffield, England (Social and Applied Psychology Unit, 1977–1995); University of Leeds, Leeds, England (Psychological Therapies Research Centre, 1995–2007); and again at the University of Sheffield (Centre for Psychological...

Metacognitive theories describe relationships between mental-affective self-states, including the capacity of one self-state to reflect upon another self-state. The assimilation model is a metacognitive approach that understands self-states as made of traces of experiences at different levels of integration. Psychological problems are understood as...

Objective: To explore the experiences of therapists within their therapeutic work with drug-using clients, specifically what they found helpful and hindering. Design: Interpretative phenomenological analysis (a qualitative methodology) was used. Method: Eight semi-structured interviews were conducted with clinical psychologists who worked with subs...

This study investigated sudden reversals during cognitive therapy (CT), through the comparison of "in-session" activity and "out-of-session" life events. The sample comprised 20 clients who experienced sudden gains during CT for depression: 10 who subsequently suffered a reversal of this gain and 10 matched clients who maintained progress. Measures...

Clients (N = 105) presenting with mild depression were assigned to receive 2, 8, or 16 sessions of psychotherapy in a quasi-experimental design involving 2 clinical trials. Rates of recovery were estimated as the proportion of each group achieving reliable and clinically significant change at the end of treatment (shortly after the prescribed dose...

Developing and Delivering Practice-based Evidence promotes a range of methodological approaches to complement traditional evidence-based practice in the field of psychological therapies. Represents the first UK text to offer a coherent and programmatic approach to expand traditional trials methodology in the field of psychological therapies by util...

There is often difficulty in generalizing the results of randomized controlled trials (RCTs) to routine clinical practice given the rigid design features of such studies. The purpose of this study is to describe the effectiveness of routinely delivered, formulation-based cognitive behavioural therapy (CBT) within a publicly funded clinic for adults...

The aim of this study was to provide a detailed descriptive account of the large improvement seen over a single-session interval in psychotherapy, known as "sudden gain," by applying a process model of psychotherapeutic change. Passages from sessions before and after the sudden gain of five clients receiving cognitive therapy for depression were ra...

An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive-behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Re...

Randomized trials of the effects of psychological therapies seek internal validity via homogeneous samples and standardized treatment protocols. In contrast, practice-based studies aim for clinical realism and external validity via heterogeneous samples of clients treated under routine practice conditions. We compared indices of treatment effects i...

Theoretical literature in the intellectual disability (ID) field identified a mismatch between professional codes of practice (which assume clients to be 'autonomous') and the reality of fostering autonomy for people with ID (who at times are completely dependent on others). This research aimed to understand how professionals bridged this disjuncti...

To assemble and to appraise critically the current literature on tests and measures of therapist-patient interactions in order to make recommendations for practice, training and research, and to establish benchmarks for standardisation, acceptability and routine use of such measures. Major electronic databases (including PsycINFO) were searched fro...

Therapist focus, client experiencing, and client negative self-statements were examined in relation to both assimilation and treatment outcome based on the analysis of session transcripts from eight clients, four of whom received cognitive–behavioral (CB) and four who received psychodynamic–interpersonal (PI) therapy for depression. Two clients of...

We report a 15-item role-play competence measure. Ratings by three judges of 34 role plays from psychodynamic interpersonal therapy training showed good inter-rater (.73-.79) and internal reliability (.84-.96). Validity was supported as scores were statistically significantly associated with psychotherapy experience. Most participants achieved sati...

The aim of this study was to investigate the relationship among therapy outcome, premature termination, and client interpersonal style and therapeutic alliance. Of the 94 clients who began cognitive therapy for the treatment of depression, 24 did not complete their agreed-on number of therapy sessions, had poorer outcomes and alliance scores, and w...

Using the assimilation model, we describe a theoretical paradox in which interpersonally assertive parts of the depressed person's personality are dominated and suppressed by parts that are interpersonally submissive and passive. We examine the relevance of this paradox to therapeutic work, focusing on a particularly helpful session (according to t...

ABSTRACT There are few attachment-based measures designed for use by therapists to inform the clinical process of psychotherapy. The aim was to develop an attachment based interview schedule for use by mental health professionals. A draft interview schedule was developed through a review of the literature. Systematic analysis of case materials led...

There is substantial evidence to suggest that clinical psychology services are failing to meet the psychological and clinical needs of people from minority ethnic groups. This paper reviews current knowledge and understanding of factors that may be contributing to this, by examining the diversity of clinical psychology service provisions for minori...

The authors applied dialogical sequence analysis, a microanalytic method for tracing recurring maladaptive patterns, to study assimilation in the psychotherapy of a woman treated for mild depression in two weekly sessions plus a 3-month follow-up session. The very first exchange (four speaking turns each by client and therapist) enacted a pattern i...

This study compared the assimilation of problematic experiences in four good-outcome cases versus four poor-outcome cases of very brief psychotherapy (two sessions plus a follow-up) for mild depression. Clients' central problems were consensually formulated, and transcribed passages concerning these problems were rated on the Assimilation of Proble...

Interactions between six participants with a dementia syndrome were observed and recorded across an eight-week therapeutic group, using audio and video equipment. Sessions were analysed using ‘template analysis’ methodology. Three codes were used to describe participants' behaviour and discussion in the group. These described discussion of particip...

Clients (N = 77) undergoing cognitive therapy for depression were assessed before treatment with the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) and with the second version of the Beck Depression Inventory (BDI-II). The pre-treatment assessment also included the Hamilton Rating Scale for Depression (HRSD), the Beck Hopelessnes...

A substantial body of research has investigated the effects of work on the psychological well-being of employees. However, there has been little assessment of the ways in which workplace factors (such as job demands, working conditions, inter-personal relations and workplace change) interact with personal factors (such as work-life balance, family...

The aims of this study were to explore the relationship between therapists' self-reported attachment styles and therapeutic orientation with the self-reported general therapeutic alliance and therapist-reported problems in psychological therapy.A sample of 491 psychotherapists from differing therapeutic orientations responded to a postal questionna...

The aims of this study were to explore individual and collective understandings of psychological well-being among young Somali (black African Muslim) asylum-seeker or refugee women. Three groups and five individual semi-structured interviews were undertaken and themes were identified using Interpretative Phenomenological Analysis. Themes included r...

Of 76 clients receiving 8-20 sessions of cognitive therapy (CT) in a joint university and a national health service clinic, 31 experienced sudden gains that appeared very similar to those first reported in clinical trials of CT by T. Z. Tang and R. J. DeRubeis (1999) and subsequently replicated in other studies. The sudden gains appeared less stabl...

Objectives This review aims to show how people who are categorized as having intellectual disabilities view their social identity, and the impact that this identity has on them. It is felt that research in this area gives valuable insights that are directly applicable to, and raise important questions about, clinical work with people with intellect...

Objectives Person-centred approaches do not easily lend themselves to standard methods of evaluation. This study develops a technique that will involve service users and their circle of support in making individual plans. Methodology Q-methodology is a phenomenological approach, which enables the researcher to co-construct the stories of many peopl...

Purpose To explore the experience of belonging to a self-advocacy group for people with intellectual disabilities, and how membership of such a group impacts on individual members. Methods Eight people with intellectual disabilities, who belonged to a self-advocacy group for at least 6 months, were interviewed about their experiences of membership....

This study reports on analyses carried out by the authors on five 'end of therapy' evaluations conducted with clients who had received a brief course of cognitive therapy for depression. The clients' evaluation was based on Elliott's (1996) Change Interview Schedule. The transcripts were then analysed using grounded theory methods, and arranged int...

The Cognitive Therapy Scale (CTS) has been widely used in cognitive therapy training Centers to assess therapist competence but competence has not previously been clearly shown to be associated with cognitive therapy outcome, possibly because an insufficient range of competence has been sampled. Competence was compared with alliance as process vari...

The authors attempted to replicate and extend D. M. Kivlighan and P. Shaughnessy's (2000) findings of (a) 3 distinctive patterns of alliance development across sessions and (b) a differential association of one of these, a U-shaped quadratic growth pattern, with positive treatment outcome. In data drawn from a clinical trial of brief psychotherapie...

ABSTRACT This study sets out to identify the characteristics of the roles and environments,of innovative persons at work. In particular, the relationship between (1) perceived work demands, (2) influence over decision making and (3) feelings of job security, with innovation was investigated. The sample was 1,229 health care workers. Measures were t...

For compelling reasons of equity and the advance of public health, brief psychotherapy has become the dominant format in both practice and research. One consequence of this is the apparent decline of a distinct stream of brief therapy research. However, much of the agenda formerly identified with that research stream is of increasing importance to...

The aims of this study were to use symptom intensity measures collected at each session (1) to describe the outcomes of clients who received cognitive therapy (CT) for depression in a clinically representative sample, and (2) to compare the outcomes of clients who completed the agreed number of sessions with those who did not. Clients (N = 58) cont...

The aims of this study were to examine the impact of psychological distress on absence from work; to compare psychological distress and job satisfaction as predictors of absence; and to compare the relative effects of 2 components of psychological distress, depression and anxiety, on absence. Organizational records of absence over a 3-year period w...

Sudden gains--large, enduring reductions in symptom intensity from one session to the next--were identified by T. Z. Tang and R. J. DeRubeis (1999b) on the basis of data from 2 manualized clinical trials of cognitive therapy for depression. The authors found similar sudden gains among clients with a variety of disorders treated with a variety of ap...

The convergent validity of the Agnew Relationship Measure (ARM) and the Working Alliance Inventory (WAI) was assessed in samples drawn from 2 comparative clinical trials of time-limited psychotherapies for depression. In 1 sample, clients (n = 18) and therapists (n = 4) completed self-report versions of both measures after every session (n = 198)....

This study examined the relationship between cognitive and interpersonal styles and outcome among 24 clients who received time-limited cognitive therapy for depression. The authors hypothesized that this relationship would be mediated by therapeutic alliance. They found that clients' interpersonal style, particularly an underinvolved style, was pre...

Comprehensive process analysis (CPA) was applied to a client-selected significant event from cognitive-behavioral therapy to show how the process of moving to the specific is effectively managed. A mirroring was shown between what the client articulated as the most helpful therapist advice and the defined steps of a cognitive-behavioral interventio...

Research on the process of psychological therapy aims to demonstrate how therapy works, partly to increase understanding, but primarily to increase effectiveness by pointing to the crucial ingredients which effect change. This paper aims to demonstrate some of the reasons why process research should be undertaken in the attempt to increase therapeu...

Both generic counselling (delivered by BACP level counsellors in primary care settings) and the interpersonal therapies place a central value on the role and function of relationships--both within and outside the practice setting - as a vehicle for understanding and treating people presenting with depression. Recent studies have compared generic co...

The object of this study was to examine the possibility of using clinically-orientated interviews to gain a similar attachment classification to the Adult Attachment Interview. Little agreement on classifications was shown between the two interviews, showing insufficient evidence to suggest that it is possible to assess adult attachment status usin...

Psychiatric interviews were carried out to validate the General Health Questionnaire-12 (GHQ-12; Goldberg, 1972) for use with staff of England's National Health Service (NHS), and to determine the appropriate threshold score to identify probable cases. In a sample of 551 NHS staff, the correlation between the GHQ-12 and the Clinical Interview Sched...

A total of 116 clients with a range of subsyndromal depression received 3 therapy sessions: 2 sessions 1 week apart followed by a 3rd session 3 months later (the 2 + 1 model). Clients were stratified for severity on the Beck Depression Inventory (BDI) as stressed, subclinical, or low-level clinically depressed. In a 2 x 2 design, they received eith...

General practitioners' responses to psychological problems presented in the surgery have a significant impact on the care that their patients will receive. Importantly, their referral behaviour has a knock-on effect on the shaping of psychological treatment services. The present paper summarizes the types of influences that impact on GPs' referral...

Analyzed the influences of client interpersonal styles on therapy processes using an attachment theory framework. Ten transcripts of client-identified significant therapy events were analyzed for evidence of client attachment styles (dismissing, preoccupied, or secure), attachment issues, and therapist responsiveness to attachment issues. The attac...