A Qualitative Study of Patients' Perceptions of a ‘Minimal’ Psychological Therapy

Background : Access to psychological therapy is often difficult. Problems with access may be overcome through ‘minimal interventions’ (such as books and computer programs), which encourage self-help for mental health problems and are less dependent on the availability of specialist therapists. However, to be effective, such interventions must be acceptable to patients. Aims : To use qualitative methods to explore patient attitudes, by examining patient expectancies of psychological therapy and their experiences with a ‘minimal intervention’ (guided self-help). Methods : Qualitative interviews ( N = 24) were conducted with patients after they had received guided self-help for depression as part of a randomised controlled trial. Results : There were important gaps between patients' expectancies of psychological therapy and their experience of the guided self-help. These gaps related to the process of therapy (e.g. time, professional expertise) and outcomes. Particularly salient was a theme relating to explanatory models. Patients were often seeking insight into the ‘cause’ of their current difficulties, whereas the minimal intervention was largely focused on symptom resolution. Conclusions : The effective implementation of ‘minimal interventions’ requires an understanding of the expectancies of patients concerning psychological therapy, in order to provide a basis for effective communication and negotiation between professionals and patients.