The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
Usability - Rating: 3
3 - Somewhat Usable
The intervention has operationalised principles and values and core components that are measurable and observable but does not have a fidelity resource; modifiable components are not identified
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.
Supports - Rating: 3
3 - Somewhat Supported
Some resources are available to support competency development or organisational development but not both
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.
Evidence - Rating: 4
4 - Evidence
The intervention has demonstrated effectiveness with one rigorous, external research study with the focus population and a control group.
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).
Need
Comparable Population
PCECfD has been shown to be effective in the treatment of depression in adults without significant comorbidities or additional learning needs.
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.
1 - Does Not Meet Need
The intervention has not demonstrated meeting need for the identified population
2 - Minimally Meets Need
The intervention has demonstrated meeting need for the identified population through practice experience; data has not been analysed for specific subpopulations
3 - Somewhat Meets Need
The intervention has demonstrated meeting need for the identified population through less rigorous research design with a comparable population; data has not been analysed for specific subpopulations
4 - Meets Need
The intervention has demonstrated meeting need for the identified population through rigorous research with a comparable population; data has not been analysed for specific subpopulations
5 - Strongly Meets Need
The intervention has demonstrated meeting the need for the identified population through rigorous research with a comparable population; data demonstrates the intervention meets the need of specific subpopulations
Fit
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.
PECfD specifically targets depression in adults and is typically delivered on a individual basis. It can be delivered face to face or using videoconferencing.
Existing Initiatives
1 - Does Not Fit
The intervention does not fit with the priorities of the implementing site or local community values
2 - Minimal Fit
The intervention fits with some of the priorities of the implementing site, but it is unclear whether it aligns with local community values and other existing initiatives
3 - Somewhat Fit
The intervention fits with the priorities of the implementing site, but it is unclear whether it aligns with local community values and other existing initiatives
4 - Fit
The intervention fits with the priorities of the implementing site and local community values; however, the values of culturally and linguistically specific population have not been assessed for fit
5 - Strong Fit
The intervention fits with the priorities of the implementing site; local community values, including the values of culturally and linguistically specific populations; and other existing initiatives
Capacity
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.
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.
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.
Financial Support
Training is available through organisations at a cost.
1 - No Capacity
The implementing site adopting this intervention does not have the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
2 - Minimal Capacity
The implementing site adopting this intervention has minimal capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
3 - Some Capacity
The implementing site adopting this intervention has some of the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
4 - Adequate Capacity
The implementing site adopting this intervention has most of the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
5 - Strong Capacity
Implementing site adopting this intervention has a qualified workforce and all of the financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
