The experience of existential experimentation from the service users’ perspective in primary care

Psychological therapies provided within primary care and of particular interest to this study, counselling psychology within primary care, are becoming increasingly homogensised. This is largely due to the need for therapies to demonstrate a robust evidence base, work alongside the medical model and meet the complex needs and restraints inherent in a primary care setting. Yet, the theoretical literature would suggest that existential-phenomenological therapy, a core modality of counselling psychology, could be aptly positioned to address the challenging requirements of primary care. The recognition of existential-phenomenological therapy as part of primary care’s service provisions could have a three-fold impact; it could facilitate primary care’s need to address clients’ diverse needs, ensuring that there is flexibility and a choice of therapies within the National Health Service (NHS), it could also enable counselling psychology to work within an NHS setting, whilst maintaining its core attributes and values. Finally, to be recognised as an effective psychological intervention in the NHS, is a measure of success for existential-phenomenological therapy.
Existential Experimentation (EE) is an individualised short-term, goal-oriented psychological intervention, that was designed for primary care. The EE intervention is existentially-informed and was developed by EASE Wellbeing to promote wellbeing and recovery for individuals with anxiety and/or depression. Studies suggest that the EE intervention is effective at reducing symptomatology, perceived psychological distress and attaining client-determined goals (Rayner & Vitali, 2015). Similarly, the initial qualitative data on client-determined goals attained in EE, allows for positive optimism (Rayner & Sayers, 2016). However, the qualitative data is limited and the service users’ experience of the EE intervention has not been explored. Therefore, qualitatively enquiring into the EE intervention from the service users’ perspective seems key to inform current and future provisions of EE in primary care. Consequently, this study aims to gain an understanding of the service users’ experiences of EE; to assess what were the more and less useful aspects and capture if, what and how change took place. The researcher held a placement with EASE Wellbeing and therefore acted as an ‘insider researcher’, with considerable experience implementing the EE protocol within primary care and a comprehensive understanding of the intervention.
Seven participants who had all completed EE in primary care were recruited. Two semi-structured interviews were conducted; the initial interview took place two weeks after the completion of therapy and the follow-up interview was three months post-completion of therapy. Interpretative Phenomenological Analysis (Smith, 1996) was used to analyse the data, in order to highlight convergences, divergences and nuances in the participants’ experiences of the therapy.
The participants described their experience of EE as a journey and thus the three superordinate themes that emerged from the research consisted of: the experience of beginning EE, the experience of the EE therapeutic work and the experience of leaving EE. The ten subordinate themes were comprised of: loss permeating existence, living behind the mask, in search of how to be, the value of a personalised approach, how the therapeutic relationship is key to change, stepping stones to awareness, key ingredients of client openness and active participation, reaching new awareness and personal meanings, towards acceptance and authentic living and short-changed by time. This research can inform the current and future service delivery of the EE intervention and existential psychotherapy and counselling psychology in primary care more generally. Moreover, it provides practice-based evidence that may aid a dialogue between existential-phenomenological therapies and the medical model.
This study will form part of the researcher’s Doctorate in Counselling Psychology at New School of Psychotherapy and Counselling and Middlesex University.