Person-Centred Experiential Counselling for depression (PCECfD)

Core Components

Person-Centred Experiential Counselling for depression (PCECfD) is a form of person-centred/experiential therapy specifically designed to address depression in adults. PCECfD aims to help people with depression access underlying feelings, make sense of them, and draw on the new meanings with emerge to make positive changes in their lives. It focuses on areas where the person feels there is a discrepancy between how they are and how they feel they should be.

Core components of PCECfD are outlined in ‘The competences required to deliver effective humanistic psychological therapies’ (1) and the Person-Centred Experiential Counselling for Depression manual (2). The therapist should communicate empathy, unconditional acceptance and authenticity. Specific competences include the application of focal interventions to help clients process emotions, find solutions and develop their own coping strategies.

For mild depressive symptoms PCECfD is typically delivered over 6-10 sessions delivered over 8 to 12 weeks. Twelve to sixteen regular sessions are recommended for more severe presentations.

Although counselling is available in many forms for depression, PCECfD describes a specific form of counselling that has been developed for adults presenting with depression that aligns with the evidence base underpinning the recommendation in the NICE (2022) guidelines for the management of depression.  It is delivered by trained practitioners and is delivered in face to face sessions or through videoconferencing.

Fidelity

NICE (2022) recommends that PCECfD should be delivered by competent practitioners with ongoing supervision.  PCECfD should be delivered using an empirically validated protocol developed specifically for depression and adhered to in order to ensure consistency in the delivery of the intervention. Fidelity is enhanced by ensuring adherence to treatment manual and providing on-going supervision to therapists. Recorded therapy sessions can be rated to assess treatment adherence. The Person-Centred and Experiential Psychotherapy Scale can be used to measure fidelity (3).

Modifiable Components

PCECfD is delivered by trained practitioners and is delivered in face-to-face sessions or through videoconferencing.

Implementation Support

Implementation support is provided mainly by trained supervisors who support the practitioner’s delivery of PCECfD. Support for implementing CfD is available from organisations such as the British Association for Counselling and Psychotherapy (www.bacp.co.uk) and through NHS England Talking Therapies resources, including a training curriculum and competency framework.

Start-up Costs

Costs apply when training is provided by private organisations. 

Building Staff Competency

Qualifications Required

Staff will have completed a diploma in humanistic or person-centred counselling or psychotherapy and should have BACP Counsellor/Psychotherapist accreditation or equivalent.

Training Requirements

Training is available in NHS England Talking Therapies and through private training organisations. Training assumes prior competence in counselling and courses typically expect two-years’ experience of providing brief counselling to clients prior to accessing PCECfD training. PCECfD training is typically provided over five days. It should follow the Curriculum for Counselling for Depression: Continuing Professional Development for Qualified Therapists Delivering High Intensity Interventions (4).

Supervision Requirements

It is recommended practice in Scotland that this psychological intervention is conducted under regular supervision with a practitioner who has expertise in a) the intervention b) the clinical area and c) has completed training in supervision. This should involve a qualification to provide clinical supervision to counsellors and psychotherapists such as a relevant certificate or diploma in supervision.  

Theory of Change

PCECfD is based on theories that support change through developing understanding of the emotional meaning associated with experiences and exploring alternative ways of understanding these experiences to inform a new self-concept and reduce symptoms.

Research Design & Number of Studies - Adult

The evidence for PCECfD includes an analysis of routine clinical data and one pragmatic non-inferiority trial.

A study analysing routine clinical data of people receiving CBT or counselling for depression in services in England (Improving Access to Psychological Therapies services) included data collected from 33,243 patients (5).

A pragmatic non-inferiority trial by Barkham et al. (6) compared PCECfD with CBT in the Talking Therapies service in England.  It included 510 people experiencing moderate or severe depression.

Outcomes Achieved - Adult

Adult Outcomes

• Similar reductions in depressive symptoms for PCECfD and CBT at end of treatment (Pybis et al, 2017)
• Similar reductions in depressive symptoms at 6mths when compared to CBT but inferior to CBT at 12mths (Barkham et al. 2021).

Values

Person-Centred Experiential Counselling for depression (PCECfD) is a form of person-centred/experiential therapy specifically designed to address depression in adults. PCECfD aims to help people with depression access underlying feelings, make sense of them, and draw on the new meanings with emerge to make positive changes in their lives. It may be useful for people with psychosocial, relationship or employment problems contributing to their depression.

• Do the underpinning theory and the underlying mental health condition addressed by the intervention align with the requirements of your organisation?

PECfD specifically targets depression in adults and is typically delivered on a individual basis. It can be delivered face to face or using videoconferencing.

• In what format will PCECfD be delivered?
• Is your service delivering this intervention to people at a particular life stage?
• Are there likely to be co-occurring mental health conditions as well as depression (e.g. anxiety disorders including OCD, GAD, PTSD)?

Existing Initiatives

• Does your service currently deliver interventions to treat depression?
• How does it compare with existing initiatives in terms of practicalities and effectiveness?
• Do existing initiatives fit current and anticipated requirements?

Workforce

PCECfD can be delivered by trained counsellors who have undergone further training to support its’ delivery.  PCECfD can be delivered over 8 or more regular sessions.

• Does your service have qualified practitioners who are available and interested in learning and delivering PCECfD?
• Can your service support the time commitment required for practitioner training, supervision, and intervention delivery?
• Will your practitioners deliver PCECfD face-to-face or remotely?
• If delivered face-to-face, is there capacity to support its delivery?

Technology Support

PCECfD can be delivered without access to technology but access to video platforms for remote delivery can be useful, as is access to methods of recording sessions for supervision.

• Will PCECfD be delivered in-person or remotely?
• Does your service have the technology to support PCECfD remote delivery?
• Can your practitioners access technology to record sessions for supervision?

Administrative Support

PCECfD is typically delivered weekly or fortnightly, typically over x sessions, with each session lasting about 30-60 minutes. Face-to-face therapy sessions can be held in settings such as primary care, mental health services and third sector services. Administrative support is needed to manage appointments, collate and input outcome measures and process written reports.

• In what setting will PCECfD be delivered?
• Does your service have a venue to deliver PCECfD sessions?
• Can administrative supports needed to deliver this intervention be provided?

Financial Support

Training is available through organisations at a cost.

• Can your service financially support practitioner training costs?

Comparable Population

PCECfD has been shown to be effective in the treatment of depression in adults without significant comorbidities or additional learning needs.

• Is this comparable to the population your service would like to serve?

Desired Outcome

PCECfD has been shown to effectively reduce depressive symptoms, as well as depression diagnosis, at post-treatment and follow-up.  It has also been shown to reduce remission.

• Is delivering PCECfD for the treatment of depression a priority for your organisation?
• Does your organisation have other initiatives in place that effectively and efficiency achieve the above outcomes?