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In their own words: A narrative-based classification of clients' problems on an idiographic outcome measure for talking therapy in primary care

Abstract:

The perspective of users has become a crucial component of healthcare planning, delivery and evaluation but, within mental healthcare, clients' views of their problem, in their own words, rarely form the basis for measuring the outcome of talking therapy. A new outcome measure, 'PSYCHLOPS' (Psychological Outcome Profiles), invites the client to write down 'the problem that troubles you most', 'another problem' and to 'choose one thing that is hard to do because of your problem'. Responses to these three items enabled us to explore how clients conceptualise their most troubling problem and the consequences of this problem and to provide a typology of these responses. A narrative-based approach was used to analyse PSYCHLOPS data from 235 users of primary care mental health services recruited through four therapists working in southeast England. Seven thematic categories emerged from the analysis of clients' responses to the domain 'problem': interpersonal; past event; state of mind; somatic; self-evaluation; competence/performance; material issues. Responses to the domain, 'consequences of the problem', were categorised under one of six themes: competence/performance; interpersonal; frame of mind; resolution and progression; self-evaluation; somatic. Users of mental health services in primary care offer a rich diversity of narratives, and these represent clients' voices that frame problems within the personal and social contexts in which they are experienced. © 2006 Radcliffe Publishing.