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Journal article review: The Tree Theme Method

Dr Katrina Bannigan

Gunnarsson AB, Eklund M (2009) The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes, reviewed by Dr Katrina Bannigan, Director of RCOMH

I thought this paper was going to be about a novel intervention because I had never heard of The Tree Theme Method. However the intervention was not unfamiliar; it was just the name that was new to me. When I worked in clinical practice I had used the intervention (clients paint trees representing certain periods of their life as a starting point for telling their life stories; it initiates a process of reflection and interaction as a means of enabling changes to be made in their daily lives). It was a technique I had learnt ‘on the job’; a creative exercise with no specific name. So, for me, this paper demonstrates a really useful point, i.e. the importance of an intervention being documented and having clear protocol. Without this there is no consensus about what the intervention involves which makes it difficult to evaluate.

Having established that this was an intervention that I am interested in I was eager to see whether it was effective or not. As the authors make clear that was not the point of this paper; it is not a randomised controlled trial. There was no control group so it was not possible to establish whether the correlations identified in the study were as a result of The Tree Theme Method. However, this does not mean the paper is without value. As was stated in the paper:

The study of the implementation of The Tree Theme Method follows a logical continuum of research, starting with exploratory studies such as qualitative case study (Gunnarssonet al 2006) followed by studies like the present study based on quantitative research methodologies” (Gunnarsson and Eklund 2009: 174)

The aim of this study was to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health related factors, with clients experiencing The Tree Theme Method intervention.

The results of this paper are promising and suggest further research would be useful. However, there are a some methodological points that would need to be considered in designing future studies, e.g. identifying a representative sample (in this study they identify that there was a gender imbalance but it is not clear whether the proportion of diagnostic groups was typical), the selection of outcome measures (the authors reported reliability and validity studies but did not indicate whether these were well conducted), and whether is the use of client satisfaction is an appropriate outcome measure? (satisfaction has been discredited as an outcome measure in recent years).

Gunnarsson AB, Eklund M (2009) The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes. Australian Occupational Therapy Journal, 56 (3) 167–176. [doi: 10.1111/j.1440-1630.2008.00738.x]