Service user and/or carer informed common therapeutic factors of therapist competence in mental health service delivery

This project will develop and implement a new measure of service user and/or carer (SU/C, often termed Experts by Experiences; EbEs) informed common factors and therapeutic competence. This will be tested alongside attitudes to service user involvement and co-production in mental health services, and use it to determine the core outcomes of co-production in mental health services to service users and carers.

Therapist competence may be defined as the degree of knowledge and skill required to deliver treatment to the required standard to achieve its intended outcomes, as well as the therapy quality, that is, the degree that an intervention is delivered ‘well enough’ to achieve outcomes. When considering therapist competence, common factors in psychotherapy are considered as vital for successful treatment outcomes. Common factors relate to therapist practice elements that are assumed to be universally effective for any psychotherapy, are evidenced as aspects of therapy that predict outcome, and seem to differentiate between effectiveness of therapist. As specific treatment practices have treatment specific factors for training, they are also increasingly adapted for a trans-diagnostic approach, and indeed, person-centred care is now considered a central facet of successful treatment outcomes.

Involving SU/Cs bridges the theory-practice gap, can aid challenging assumptions, stereotyping and stigma, and encourages reflections on practice. Five key attributes of involvement include: a person‐centred approach, informed decision making, advocacy, obtaining service user views and feedback, and working in partnership. Whilst some of these facets map onto those considered common therapeutic factors within the literature, factors relating to advocacy and reflections of power are considered essential in building effective therapeutic rapport and alliance. SU/Cs cite common factors as key facets of successful therapeutic change. Implementing and evaluating SU/C involvement in the development of common factors skills is one measurable outcome to ensure that involvement is integral to training and continued professional practice. Although tools to assess common factors are available, barriers remain in their application in terms of requiring experts for scoring. In addition, such tools, often involve a narrow focus on content, can be lengthy in administration, have some copyright restrictions, are not associated with outcomes across cultures, and may overly represent values and treatment philosophies that are not universal.

This project will address the limitation in the research in developing a SU/C informed common factors measure that may be applied across therapeutic settings and services. We will also test this measure and apply within a wider context of exploring attitudes and organisational structures to SU/C involvement and co-production within mental health services. The proposed research will guide and inform theories of co-production and implementation with mental health services by providing a new framework within which a person-centred approach may be evidenced, within organisational structures, and its impact on service user and carer outcomes.

There is current momentum from partner organisations to further advance the empirical evidence of SU/C involvement and co-production within mental health services, and the successful candidate will therefore join a dynamic group of co-production research, and will have opportunities for cross-collaboration, support, mentorship, and networking. All aspects and stages of the project will be co-produced, to include dissemination of findings. The dissemination and project development will be dynamic and evolving, to include a dedicated website and blog access for input from a wide network of SU/Cs, national and local conferences, and peer-reviewed publication for the stages of the project itself.