Brewster, Kay and Greasley, Pete and Tighe, Martin (2015) Client experiences of cognitive behaviour therapy (CBT) : factors influencing engagement. PhD thesis, Lancaster University.
2015BrewsterDClinPsy.pdf - Accepted Version
Available under License Creative Commons Attribution.
Download (14MB)
Abstract
This thesis constitutes a qualitative exploration of individuals’ experiences of cognitive behaviour therapy (CBT) in both physical and mental healthcare settings. The literature review comprises a meta-synthesis of nine papers exploring experiences of CBT, which resulted in the identification of six themes: shared experience allowing reconnection; CBT skills enabling changing relationship with illness; therapist factors central to engagement; therapy as challenging; the importance of being able to talk to someone outside of the family; and therapy as life-changing. The main implication of these findings is the need for greater consideration of the complex nature of social support in the context of chronic illness and the specific challenges and benefits of engagement in CBT in this population. The empirical paper provides a qualitative exploration of the experiences of adults who have dropped out of CBT in a community mental healthcare setting. Thematic analysis resulted in the identification of five themes: the role of therapist factors; limitations of the CBT model; CBT as pathologising; the socio-political context of CBT; and responsibility for engagement and change. This is the first qualitative exploration of CBT drop-out across diagnostic groups and, as such, this study contributes an important insight into the challenges associated with engagement in CBT and the influence of socio-political context. Finally, the strengths, limitations and challenges of the research process are discussed in the critical appraisal, with particular reference to the broader theme of occupying the position of both clinician and researcher.