Dr. Gemma Kothari [BA (Hons); DClinPsy; PGDip]

Research Fellow / Project Manager: AdEPT (Understanding & Preventing Adverse Outcomes in Psychological Therapies)

Mental Health Group, Health Services Research
School of Health and Related Research (ScHARR)
University of Sheffield
Regent Court, 30 Regent Street
Sheffield S1 4DA

UK Tel: +44 (0) 114 222 0753
Fax: +44 (0) 114 273 0547
email: g.kothari@sheffield.ac.uk

Biography

Following undergraduate studies in Psychology, I briefly worked in the prison service before taking up a research post at the Institute of Psychiatry. This involved managing a follow-up study looking at the outcomes of drug arrest referral schemes in London. I also worked at the Royal College of Surgeons as a systematic reviewer for NICE guidelines for the diagnosis and treatment of lung cancer. I then undertook a senior research post at the National Centre for Social Research before deciding to re-train as a clinical psychologist. I now work as a principal clinical psychologist within the NHS, as well as a research fellow at ScHARR.

Research Interests

• Understanding ‘what works’ within psychological therapies (i.e. common and effective factors across psychological therapies; therapist perspectives on delivering treatment with different client groups; what comprises, and contributes to, the therapeutic alliance; understanding possible adverse effects of psychological therapy).
• Substance misuse, particularly what may constitute effective treatments or interventions for ‘complex’ clients with comorbid legal, social, and personal problems.
• Forensic issues (i.e. how to work effectively at an individual, organisational, and policy level to reduce the prevalence of people with mental health problems within the criminal justice system).

Current projects

Understanding and Preventing Adverse Effects of Psychological Therapies (AdEPT) - NIHR Research for Patient Benefit – 2011 -2014

Many people with mental health problems are helped by psychological therapies (‘talking treatments’), but some people who have therapy (between 5-8%) feel worse afterwards. We do not know how often this is because of the treatment: people could have become more distressed anyway, for example after stressful life events. However, there are good reasons to think that for some people, it’s the psychological therapy itself that causes harm. There is a range of testimony from people who report damaging experiences, for example leading to suicide attempts.

An American study found that when people were given at random either an active psychological treatment or an inactive ‘placebo’, although more people benefitted from the active treatment, those who deteriorated were in the active treatment group. Professionals, managers and researchers are not yet properly aware of these problems. Therefore, we shall publish a major review to challenge professional complacency and, without putting people off receiving help, show realistically how to balance the benefits of therapy with the risks. (Work package 1)

Second, to understand adverse effects of treatments better, we shall analyse existing datasets to find out which kinds of people, in which kinds of therapy, with which kinds of therapist are most at risk, and whether the findings of the American study hold up across more studies of a range of mental health problems. (Work packages 2 & 3)

Then, through analysis of in-depth interviews with service users and their therapists where therapy has gone wrong, we shall explore the process of failing or harmful therapy and generate understanding of what would have prevented the problems. (work package 4)
All of this work will lead to the main part of the project (work package 5): developing and testing practical ways to reduce adverse effects, and in particular to prevent harm. Three possible ideas for how to do this are: a method for therapists to know when a therapy is failing and what to do about it, a tool to help psychological therapy users spot the early signs of harmful therapy and decide whether to end therapy, and a standard form for the NHS to monitor adverse events and poor outcome therapies. We will also use the results from the first part of the project to decide what other practical steps are needed.

Key publications

Kothari, G., Hardy, G. & Rowse, G. (2010). The therapeutic relationship between therapists and substance-using clients: a qualitative exploration. Journal of Substance Use, 15(4), 257-271.
Boreham, R., Blenkinsop, S., Hewton, J., Kothari, G., McGee, A., Moody, A., Simmonds, N. & Wardle, H. (2004). Drug use, smoking, and drinking among young people in England 2003. London: TSO
Contributor to the following publication: National Institute for Health and Clinical Excellence (2004). The Diagnosis and Treatment of Lung Cancer. London: Department of Health.
Oerton, J., Hunter, G., Hickman, M., Morgan, D., Turnbull, P., Kothari, G. & Marsden, J. (2003). Arrest referral in London police stations: characteristics of the first year. A key point of intervention for drug users? Drugs: Education, Prevention & Policy, 10(1), 73-85.