Counselling and Psychotherapy Research

Published by Taylor & Francis (Routledge)
Online ISSN: 1746-1405
Print ISSN: 1473-3145
Publications
Despite the general acknowledgement that it is important for counselling and psychotherapy practice to be informed by research, it is clear that in recent years a widening gap has emerged between research and practice. This paper briefly reviews some of the factors responsible for the current crisis in therapy research and offers a number of reasons why a healthy relationship between research and practice is necessary. It is suggested that, at present, there exists within psychology and social science a level of acceptance of pluralistic and innovative approaches to research, which may facilitate the emergence of a new genre of practitioner-oriented inquiry in the field of counselling and psychotherapy. Some of the ways in which Counselling and Psychotherapy Research intends to contribute to this movement are described, for example the promotion of new forms of writing, use of information technology, and the creation of knowledge communities. Readers are invited to participate in this endeavour. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
This article provides an overview of ethical guidelines for counseling and psychotherapy. In the author's view, the emphasis should be on evidence-based practice. An essential part of this strategy should be the promotion of high-quality research--research that is ethical. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
The authors of this volume offer a behind-closed-doors look at brief emotion-focused therapy (EFT) in the treatment of depression, capturing the state of the art of this important and widely used therapy. Six in-depth case studies--three that result in a good outcome and three in a poor outcome--exemplify the principles of EFT and show how treatment progresses. The clients vary widely in their backgrounds, personalities, and beliefs about the roots of their depression, vividly demonstrating the utility of EFT across a range of circumstances. Meticulous session-by-session descriptions of the therapy process include extensive dialogue and postsession evaluations using a variety of objective process measures. These measures illuminate clients' moment-to-moment cognitive-affective processing and their perspectives on self and others. The focus on therapists' strategic choices deepens readers' understanding of the interaction between client and therapist as therapy unfolds. Client characteristics that influence outcome are compared and discussed to help therapists identify who may or may not benefit from brief EFT. Finally, the authors provide suggestions that will help readers more quickly identify when clients may be having difficulty in brief EFT and present a set of therapeutic strategies for working with these clients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
In 2004, Counselling and Psychotherapy Research published the first article about a new psychometric outcome measure, PSYCHLOPS (Psychological Outcome Profiles; Ashworth et al., 2004). It was designed to capture what the client thinks the main psychological problem is and score this problem--rather than asking the client to score a list of indicators, some of which may lack personal significance. PSYCHLOPS seems to be feasible for everyday use in a primary care setting because it is short (one page) and can be self-administered. PSYCHLOPS is therapist-friendly, two validation studies have found that it is a more sensitive measure of change than existing outcome measures, and both internal and test-retest reliability were found to be satisfactory. It is concluded that PSYCHLOPS does seem to have a role as an outcome measure, but as a complement to existing measures--something that adds another dimension to outcome measurement, and not as an alternative to conventional standardised measures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
After more than 40 years of research, a substantial body of evidence has shown psychotherapy to be helpful in ameliorating psychological distress. This is seldom questioned in professional circles, yet intense debate persists over how, when, and why therapy works. Those claiming to know the answers fall into two main camps, one arguing that some empirically supported treatments work for specific problems, whereas others are less effective. The other camp posits that all approaches work equally well, as long as a strong therapist-client relationship and other common curative factors are present. Can both doctrines be correct? Second-Order Change in Psychotherapy: The Golden Thread That Unifies Effective Treatments asserts that they can, but a unifying framework of change that underlies both positions is needed. The authors identify that framework as second-order change in psychotherapy, or the "golden thread" that runs through the labyrinth of all effective therapies. To better elucidate this, first-order change refers to solutions that do not change the problem but that create stability, whereas second-order change transforms the first-order solutions, resulting in a resolution of the problem. In this fascinating and rich book written for therapists-in-training, researchers, practical theorists, and policymakers, the authors show how second-order change is at the core of all effective treatments. Moreover, they demonstrate the creative use of specific, targeted approaches in an interpersonal context of shared respect, empathy, and compassion. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
It is argued that different models of therapy result in broadly similar outcomes and that the therapeutic relationship is the most important factor in relation to outcome. This paper presents some of the main findings from over 30 years of psychotherapy research. We discuss these findings in relation to current provision of therapy within the UK National Health Service (NHS) and express our fears that despite a culture of evidence-based practice, this evidence is in danger of being ignored. We conclude by discussing some of the implications and challenges that this evidence presents to therapy researchers, policy makers, trainers and practitioners.
 
Voluntary sector low and no cost counselling services very often find themselves overwhelmed by clients. This paper describes how one agency decided to deal with this problem by introducing a system of assessment for differential contracts. A piece of action research enabled the development and introduction of a model of assessment that reflected the values of the agency. The guiding principle of the assessment was that the client's way of managing in the world was the best guide to clinical need. The different lengths of contract are described, together with the criteria for deciding which might be appropriate for a client. The model was introduced on the understanding that it could and would be continuously monitored. The reactions of counsellors and clients that were gathered in a review of the working of the model a year later are described.
 
OQ-Analyst screen shot illustrating feedback graph and report of patient progress. 
We argue in this paper that it is time for therapists and supervisors to incorporate outcome monitoring and brief client assessments into ongoing counseling supervision. Tracking client treatment response, comparing it to expected treatment response, and alerting counselors and supervisors when a client shows poor progress is described. It is suggested that such methods can maximize recovery in those individuals who are not responding to treatment as expected. The degree to which such methods facilitate the recovery of helpful client outcomes is summarized. Incorporating an outcome management system into routine counseling and supervision is encouraged to help actualize the goals of supervision.
 
This paper seeks to summarise recent discussions within the British Association for Counselling and Psychotherapy (BACP) about the strategic direction and priorities for the organisation, the profession as a whole and, ultimately, the service users. The standing research policy commitment to a pluralist approach to research is affirmed and a number of competing approaches are briefly considered. The direction of general policy and specific aims are noted. The paper does not seek to define a BACP position, as such, and is intended to stimulate further debate and discussion which will feed directly into the development of the BACP research policies and activities during this crucial development period.
 
Waiting times for primary care psychological therapy and counselling are an increasingly important area by which the effectiveness of service delivery is measured. Authorities and advisory bodies advocate a reduction in waiting times and improvements in waiting list management (Department of Health, 1999, 2001, 2004; Healthcare Commission, 2005a; Health and Social Care Advisory Service, 2002). Research and practice both report large variations and inconsistencies in service waiting times. This paper uses the CORE National Research Database for Primary Care Psychological Therapies and Counselling (valid?=?31882 clients) to develop benchmarks that services can use to measure their performance at a national level. Three time frames are analysed: Referral to first assessment, last assessment to first therapy, and referral to first therapy. The average waiting times were 8 weeks, 2 weeks, and 10 weeks respectively. The practical use of, and implications for these benchmarks within and between services and practitioners are explored by managers of primary care psychological therapy and counselling services. The discussion explores the significance of the benchmarks in relation to both political agendas and overall service performance. Initiatives to reduce waiting times and factors that may effect them are also discussed.
 
Context: The context of the article is a supervisory relationship between an academic supervisor and a student-researcher and an ethic of risk within the research and supervision. Focus: The challenges for supervisor and student, and thus the supervisory relationship, and the strategies to move beyond the ethical dilemmas encountered in the research project, within an ethic of risk, form the focus of the article. Discussion: This article highlights the moments when a student counsellor/ researcher came to an impasse in transcribing and analysing data generated in an auto-ethnography, and the author, the academic supervisor's responses to these difficulties. The use of specific knowledge, skills and strategies in the supervisory relationship opened space for agency and movement within these moments of impasse. Text work and researcher identity work was facilitated through the use of particular listening skills and narrative therapy informed questions.
 
While supportive-expressive group therapy (SEGT) has been found to be effective in significantly reducing distress associated with life-threatening illness, the challenge in Australia is to develop a means of providing supportive interventions to rural women who may be isolated both by the experience of illness and by geographical location. In this study an adaptation of SEGT was provided to women with metastatic breast cancer (n =21), who attended face-to-face or by telephone conference call. Participants showed significant gains on standardised measures of well-being, including a reduction in negative affect and an increase in positive affect, over a 12-month period. A reduction in intrusive and avoidant stress symptoms was also observed over 12 months; however, this difference was not significant. These outcomes suggest that SEGT, delivered in an innovative way within a community setting, may be an effective means of moderating the adverse effects of a diagnosis of metastatic breast cancer while improving access to supportive care for rural women. These results are considered exploratory, as the study did not include a matched control group.
 
Aims: This article reviews a research methodology that uses an Internet mediated qualitative, narrative approach to provide in-depth analysis of vignettes. The research sought to investigate the ways in which dramatherapists, based in different countries, understood the nature of therapeutic change in their work with children. Method: The article describes a qualitative approach to the generation of data by a combination of therapist-authored vignettes, live, synchronous Internet mediated communication (aMSN Messenger) and email. Participants kept a diary of their response to the research and the article draws on this data within its analysis of the methodology. Findings: Samples of the data are used to analyse how such innovative, online methodology can develop effective access and relationships with geographically dispersed participants and as an effective way of investigating therapist practitioners' understanding of their practice.
 
The concept of congruence represents a core theoretical construct in the development of client-centred therapy, and remains fundamental to the practice of experiential approaches to psychotherapy. This study explores the ways in which congruence is experienced during significant moments of therapy. Client and counsellor accounts of moments of congruence/incongruence were collected from six cases of person-centred counselling, and were analysed using a method of narrative analysis. It was found that participants experienced congruence in a variety of ways, suggesting that the construct does not describe a unitary phenomenon. Congruence was experienced as simultaneously intrapsychic and relational. The effective negotiation of episodes of incongruence comprised a necessary element of effective therapy. Further research into the nature of congruence may be valuable in contributing to new understandings of how therapeutic alliances are made, broken and repaired.
 
Aim: This article gives an overview of the setting up of the Art Therapy Practice Research Network (ATPRN) in 2000, amidst a culture resistant to research. The authors discuss their experiences in changing this culture and encouraging art therapists to become practitioner/researchers. They identify learning points that may be helpful for other professionals who want to form new practice research networks (PRNs). Context: The research and practice context contemporary to the ATPRN foundation is outlined and identified as a significant influence on its inception and development. Key events in the 14 years of the PRN's life and articles on art therapy and psychotherapy research published at the time of the ATPRN foundation are used to illuminate the historical context. ATPRN newsletters and symposium reports were consulted to identify themes and issues across 14 years of development and growth. Learning points: Several learning points are identified and listed as useful factors to address when setting up and maintaining a PRN and include: shape the culture from the start; review and revise; get practical together; encourage members' presentations; build synergy with professional body; embed the ATPRN around all aspects of research publication. Conclusions: Successful PRNs depend on making practitioners feel included from the start by acknowledging fear and anxiety about research. Providing practical projects helped practitioners to feel less isolated by being part of a meaningful and productive network. Maintaining and developing PRNs is an iterative process that demands constant reviewing and revising.
 
The present study investigates beliefs, attitudes and practices of 101 monolingual and multilingual therapists in their interactions with multilingual patients. We adopted a mixed-method approach, using an on-line questionnaire with 27 closed questions which were analysed quantitatively and informed questions in interviews with one monolingual and two multilingual therapists. A principal component analysis yielded a four-factor solution accounting for 41% of the variance. The first dimension, which explained 17% of variance, reflects therapists’ attunement towards their bilingual patients (i.e., attunement versus collusion). Further analysis showed that the 18 monolingual therapists differed significantly from their 83 bi- or multilingual peers on this dimension. The follow up interviews confirmed this result. Recommendations based on these findings are made for psychotherapy training and supervision to attend to a range of issues including: the psychological and therapeutic functions of multi/bilingualism; practice in making formulations in different languages; the creative therapeutic potential of the language gap.
 
Aims: School-based humanistic counselling (SBHC) is a common psychological intervention for young people, particularly in the UK. However, studies have tended to suffer from high attrition rates, such that effects may have been over-estimated. This paper describes a low budget ‘star topology’ practice research network (PRN) outcome evaluation of SBHC in a sample where attrition rates were minimised. Design: A practice-based longitudinal study in a small PRN compared levels of psychological distress at first and last session from session-by-session data. Multilevel regression modelling was used to identify predictors of outcomes. Methods: Eight counsellors working across 11 schools agreed to use session-by-session self-rating on the Young Person's CORE (YP-CORE) yielding data from 256 young people aged 11 to 17. Predictors of outcomes were analysed using multilevel regression analysis. Results: Mean levels of distress on the YP-CORE reduced from 18.29 (SD = 7.32) at baseline to 9.10 (SD = 6.19) at endpoint, giving a baseline to endpoint effect size of 1.26 (95% CI = 1.06–1.46). Lower levels of psychological distress at endpoint were associated with male clients, younger age groups, greater rates of attendance at counselling, and bereavement as a presenting problem. Conclusions: This ‘star topology’ PRN focused on a single study and demonstrated that such a system can provide relatively low cost, high quality data. The data showed that SBHC is associated with large reductions in psychological distress, and that this cannot be attributed to the high attrition rates of previous datasets.
 
Example of PCEPS Item Wording and Anchored Rating Scale PC1. CLIENT FRAME OF REFERENCE/TRACK: 
Aims: This study aimed to assess the reliability of the Person-Centred and Experiential Psychotherapy Scale (PCEPS), a new adherence/competence measure of person-centred and experiential psychotherapies. The PCEPS consists of 15 items with two subscales: Person-Centred Process and Experiential Process. Method: One-hundred twenty audio-recorded segments of therapy sessions were rated independently by two teams of three raters using the PCEPS. Half of the segments were 10 minutes long and the other half were 15 minutes long. Six therapists were experienced therapists and four were counsellors in training. Seven of the therapists identified their work as ‘person-centred’, and three identified their work as ‘process-experiential’. Three raters were qualified and experienced person-centred therapists and three raters were person-centred counselling trainees in their first year of training. Results: Interrater reliabilities were good (alpha: .68–.86), especially when ratings were averaged across items (alpha: .87); interitem reliabilities were quite high (alpha: .98). Exploratory factor analyses revealed a 12-item facilitative relationship factor that cuts across Person-Centred and Experiential subscales (alpha: .98), and a nonfacilitative directiveness factor (3 items, alpha: .89). Conclusions/Implications: The PCEPS has potential for use in RCT research as well as in counselling training and supervision, but will require further testing and validation.
 
This paper reflects the experiences of young people in child guidance and family coun¬selling. For this purpose, first the institutional background of these counselling services in Germany is outlined. The fact that the adolescents concerned feel partly ex¬cluded and insufficiently integrated into the counselling process is illustrated through qualitative analysis of the experiences 17 young people had during their counselling process. These empirical findings are critically discussed in terms of the institutional conditions and methodical approaches which counteract the in¬volve¬ment of the actual addressees of the counselling service. The closing thoughts include methodical options for a stronger orientation of professional be¬ha¬viour to¬wards fa¬cilitating participation.
 
Kids Help Line is a national service providing free telephone counselling and online counselling to young people in Australia. This study used a naturalistic design and standardized measures to compare outcomes, session impact and therapeutic alliance for samples of 100 young people receiving a single session of telephone counselling and 86 young people receiving a single session of online counselling, provided by Kids Help Line. Results suggested that telephone counselling is associated with better counselling outcomes, higher session impact and stronger counselling alliance when compared with online counselling. The limitations imposed by a naturalistic design require caution in interpretation of the results. However, the pattern of results suggests that there are differences in effectiveness between telephone and online counselling. The most likely explanation is the greater communication efficiency of telephone counselling, which enables more counselling work to be undertaken in the time available. Implications for further development of online counselling are discussed.
 
Aims: There is currently a lack of clarity surrounding how men experience anxiety. This is caused by epistemological limitations with the perspectives employed to explore male anxiety, but equally by a lack of empirical research and uncertainty of how to define masculinity. In order to explain male anxiety more effectively this study needed to overcome these limitations by both incorporating the notion that there are multiple masculinities, through which men experience specific anxieties, and allowing men to talk directly about their experiences. This study focused on one kind of masculine identity: that of male psychotherapists. Research design: A hermeneutic phenomenological method was employed. Eight male psychotherapists of various modalities were interviewed who work in a number of therapeutic contexts. Results: Anxiety patterns are complex and comprise of feelings that are very difficult to deal with. Yet, anxiety is also an impetus for learning and improvement. Conclusions: The few existing ideas of male anxiety fail to capture the complexity of how men experience anxiety. Concepts of male anxiety need to be defined with more accuracy.
 
Background: Belief in the effectiveness of professional counselling and psychotherapy training is widespread and generally unquestioned. Few studies have attempted to understand the changes experienced by trainees, or identified which aspects of professional training programmes assist them in the process of becoming therapists. Aims: to investigate how a trainee counsellor changes at the start of training, and to identify which aspects of a professional counsellor training programme were helpful in instigating and supporting change. Method: the experience of one trainee counsellor, Margaret, was captured through three semi-structured interviews conducted at the beginning, middle and end of her first term. The data were subjected to systematic qualitative analysis. Findings: Margaret experienced significant change during her first term. Each interview revealed a different phase of her development. The core categories were: becoming something new (week 3); growth in therapeutic confidence (week 6); surviving 'stressful involvement' through supervision (week 11). Experiential learning, in particular group supervision, was helpful throughout. The presence of real clients was identified as the main driver for change. Conclusion: The findings were found to be consistent with a number of other studies, which suggest that training is potentially painful because of the emotional demands it places on trainees, particularly at the start of practice. Consequently trainees require opportunities for experiential learning, peer support and supportive supervision to assist them in their development, but most importantly, given that supportive supervision can only minimise the harm of stressful involvement (Orlinsky & Ronnestad, 2005), they need early positive experiences with clients.
 
No Gerard Egan's problem management and opportunity development model is currently in use training prospective counsellors, social workers, nurses, managers, etc. the skills of helping. This essay attempts, experimentally, to depict in three different ways Egan's work and its relationship to operations of power: (1) from a relatively uncritical stance, (2) from a personal experience stance, and (3) from a social constructionist perspective. The whole piece, taken together, attempts to tackle the issue of theory as practice — to ground/unmask/make present the ways in which we are socialised into a profession and the problems inherent in that process. Two themes run through the work: the double bind created for a student on a counselling course which makes some claim to train around Rogers' core conditions, and which is also assessed/accredited; the connections between theory, training and practices.
 
Background: The link between sight loss and depression is well documented. The UK Vision Strategy seeks to bring the emotional impact of sight loss into public awareness and improve access to emotional support for visually impaired people. However, dedicated counselling services for visually impaired people remain scarce, and research into the effectiveness of psychological interventions is predominantly anecdotal rather than evidence based. Aim: To explore the emotional impact of sight loss in four core areas (mood, self concept, social connectedness and loss), and to explore the counselling experiences and needs of blind and partially sighted adults. Method: Data were collected using the mental health and social functioning sub-scales of the National Eye Institute Visual Functioning Questionnaire-25 and semi-structured interviews transcribed and analysed using grounded theory. Results: Participants with a serious eye condition shared a common transition from sight to blindness, starting with diagnosis, coping with deterioration of sight, experiencing loss in different areas of life, experiencing changed perceptions of self in relation to society, experiencing others in a changed way and experiencing rehabilitation. A theoretical model describing the transition from sight to blindness is proposed. Participants reported negative perceptions of counselling and a lack of counselling opportunities in relation to their sight loss. Implications: The implications for policy and practice are discussed, particularly the need for counselling after diagnosis of visual impairment and the specific challenges facing those who deliver counselling to blind and partially sighted clients.
 
Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In-depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem-solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes - aligned to a range of different orientations - can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.
 
Research into the effectiveness of counselling and psychotherapy has great practical significance, as a means of collecting evidence that may potentially enhance the quality of services delivered to users. In recent years, the evidence base for counselling and psychotherapy has increasingly relied on data derived from self-report questionnaires completed by clients, with relatively little attention being paid to therapists' evaluations of outcomes. To make full use of therapist estimates of outcome, it is important to develop an understanding of the processes and criteria that therapists employ when making such judgements. However, little is known about the evaluation strategies used by therapists in their everyday practice. The aim of the present study was to explore the implicit and informal construction of outcome evaluation by experienced practitioners. Person-centred therapists were interviewed about their approach to evaluation. The interview data were analysed using a grounded theory approach. These practitioners reported that they engaged in a process of evaluation based on a range of different sources of evidence, which was then “weighed up”. Evaluation was a continuous activity that was embedded in the counselling process itself rather than arising from discrete measurements carried out at particular times. The findings of this study suggest that practitioners may possess a sensitivity to the complexity of outcome that is missing in much current research. Implications for training, research and practice are discussed.
 
This study used a Consensual Qualitative Research methodology to explore the motivations and experiences of young people who utilize the Internet for counselling over other counselling media. Semi-structured online group interviews (focus groups) were conducted with 39 participants from the Kids Help Line, a 24-hour national telephone and counselling service located in Australia. Analysis revealed five domains relevant to the adolescents' motives and experiences and the frequency of categories within and across cases were analyzed to generate and understand themes and patterns. Specific motivators and barriers are identified and discussed, as are implications for practice and continued research.
 
Aim: Cognitive errors (CE) and coping strategies (CS) can bear weight on how individuals relate to others and perceive interpersonal relationships. However, there is little research into how clients' erroneous beliefs and maladaptive coping strategies can interfere with the therapeutic process. This study utilised a sample of healthy clients to explore the relationship between their CEs and CSs and their evaluation of therapy. Method: Therapy sessions of undergraduate student clients (N =26) were rated using the Cognitive Error Rating Scale (CERS – 3rd edition), the Coping Patterns Rating Scale (CPRS;), the Session Evaluation Questionnaire (SEQ) and the Session Impact Scale (SIS). Results: Clients who engaged in dichotomous thinking endorsed problem solving less and were more likely to feel unsupported and misunderstood by the therapist. Clients who discounted the positive tended to feel more pressured and judged by therapists. Conversely, those who engaged in problem solving were more likely to find sessions deeper and more valuable as compared to those who reacted to stressful events by submission, escape, or opposition. Implications: Better understanding how and when a client's cognitive errors and coping mechanisms are at play during therapy can help clinicians to address them and intervene appropriately.
 
In 2005 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence related to the impact of supervision on counsellors and psychotherapists, their practice and their clients. This paper reports on some of the findings of this review, specifically from articles published in this area since 1980. Detailed inclusion and exclusion criteria were agreed. EPPI-Reviewer software was used to organise and analyse the articles that met the inclusion criteria. This article reviews 18 individual published studies. The quality of evidence is variable, but supervision is consistently demonstrated to have some positive impacts on the supervisee.
 
This study explores the role of community meetings within BACP (British Association for Counselling and Psychotherapy) accredited counsellor training courses. A postal survey was carried out with trainers on 56 BACP accredited training courses in January 2000. A questionnaire was used to elicit information about trainers, courses and the organisation of community time, along with perceptions relating to the meaning and purpose of community meetings. Possible links between course attributes (course length, cohort size and core theoretical model) and the implementation of community time are explored, as are links between core theoretical model and explanations of community group process. Findings indicate a diversity of definitions and assumptions concerning the role of community groups within counsellor training courses in Britain. It is suggested that there is a need to establish a much clearer definition of the nature of community groups on counselling courses. A tentative, trans-theoretical description of community group process is offered, and further research on this topic is recommended.
 
An essential feature of psychodynamic counselling is a secure frame for the work that holds boundaries as sacrosanct, both to ensure ethical practice and to provide a vehicle through which unconscious processes can be recognized and understood. Conscious or unconscious attacks on the frame are inevitable in any therapeutic relationship, and provide an opportunity for exploration and insight. However such incidents also have an impact on the therapist who must decide how to respond. In order to understand more about the therapist process when there is an attack on the frame, an investigation was carried out into ways in which psychodynamic counsellors manage the difficulties and dilemmas that arise as they try to hold a secure therapeutic frame. Ten counsellors were interviewed using a semi- structured interview format during which they were asked about an instance when the frame was challenged and the process by which it was resolved. The resulting dilemmas were categorized using grounded theory. Three categories of dilemmas emerged a) prior to making a decision about how to deal with it, b) after making a decision, and c), as a result of the outcome of the action taken. The nature of the dilemmas and the process of resolving them are reported and discussed.
 
Background: Psychotherapy is effective, but knowledge about how it produces change is insufficient. Researching how skilled therapists obtain change in naturalistic settings is recommended as a fruitful research strategy to advance this knowledge. Aims: We studied how skilled therapists from various affiliations experience their own contribution in specific therapies, and how they integrate therapeutic techniques. Method: We performed semi-structured in-depth interviews with 12 experienced therapists from various affiliations, and analysed transcripts with an explorative and reflexive systematic qualitative approach. Results: We report the overarching theme of maintaining double awareness to provide a relational space for growth, achieved through three concrete themes: (1) tailoring the therapeutic frame to relational struggles, (2) using embodied empathy, and (3) creating meaning from the perspective of a theoretical model. Themes are common across therapeutic modalities. Conclusions: We discuss how the themes offer a relational contextualisation that allows for a constructive understanding of the place of theory and technique in therapy.
 
Background: Existing research findings indicate that minimally trained/experienced paraprofessional counsellors can be as effective as professionally trained and experienced counsellors. More research into the effectiveness of paraprofessionals with specific client populations is required to determine the conditions under which they can be most effective. Aims: To evaluate the effectiveness of a group of 12 minimally trained/experienced volunteer mental health counsellors. Method: Data were collected over a one year period on 118 clients referred to a voluntary sector counselling agency. The CORE-OM was used to measure clients' levels of distress on a session-by-session basis. Clients and counsellors also completed a range of additional self-report measures. A benchmarking strategy was used to evaluate the outcomes achieved by participants in this study against three benchmark studies selected from published literature. Results: Paraprofessionals in this study were less effective than their professional counterparts. Results showed that participants in this study achieved an effect size of .70 compared to effect sizes of 1.36, 1.39 and 1.42 in the selected benchmark studies. Implications: Findings suggest that minimally trained/experienced paraprofessional counsellors working in mental health settings may benefit from longer and more targeted training programmes before engaging in practice. Conclusions: The benchmarking strategy provided a valuable and practical means of evaluating the comparative effectiveness of paraprofessional and professional counsellors. Findings should be interpreted cautiously as the selected benchmarks are not precise measurements and may not reflect the organisational factors operating within voluntary sector counselling agencies.
 
Aim: The current study aimed to explore the psychometric properties of the CORE-OM (Clinical Outcomes in Routine Evaluation – Outcome Measure) when used in an eating disorder sample. Method: The CORE-OM was administered at assessment to 360 individuals referred to an eating disorders service. Principal component analysis was conducted to look at the psychometric structure of the CORE-OM, and psychometric properties were investigated using analyses of reliability and validity. Results: Analyses of the psychometric structure suggested a three-component solution reflecting negatively worded, positively worded and risk items. The CORE-OM showed good acceptability, acceptable internal and test-retest reliabilities, as well as good convergent and known groups validity. Conclusions: The results of the current study support the CORE-OM as a reliable and valid measure for assessing psychological distress in eating disorders.
 
Kids Help Line (KHL) is a national Australian youth counselling service that provides free online and telephone counselling. This qualitative study examines the experience of 26 online KHL counsellors. Using a focus group methodology, counsellor responses were organised into categories: privacy and an emotionally safe environment; communication through text; and time. Counsellors reported the main benefit of the online environment to be emotional safety, due to reduced client emotional proximity to the counsellor, and the main disadvantage to be that reduced emotional proximity and the absence of non-verbal cues could result in communication problems and difficulty in accurately assessing young people's concerns. Time proved a significant issue for counsellors, as the slow speed of text exchange could limit their ability to complete interventions. Methods that enhance both the process and effectiveness of online counselling are needed. Potential solutions to the challenges faced by online counsellors are discussed.
 
The culture of supervision is produced both in wider professional contexts and in particular local supervision conversations. This paper is shaped by the post structuralist ideas of governmentality and disciplinary power. It uses these ideas to trace the detail of a supervision conversation, noticing the shaping effects of ideas familiar within the professional culture. Excerpts from the supervision conversation demonstrate a supervision process that pays attention to the politics of its own production, and thus to the culture of supervision that it produces.
 
Aims : The aim of this study was to conduct an exploratory investigation into the in-session processes and behaviours that occur between therapists and young people in online counseling. Method: The Consensual Qualitative Research method was employed to identify in-session behaviours and a coding instrument was developed to determine their frequency of use and assess whether nuances carried in the meaning of text messages have an influential effect during sessions. Eighty-five single-session transcripts were examined in total by two independent coders. Results: Sample statistics revealed that, on average, rapport-building processes were used more consistently across cases with both types of processes having a moderately strong positive effect on young people. However, closer examination of these processes revealed weaker positive effects for in-session behaviours that rely more heavily on verbal and non-verbal cues to be accurately interpreted. Implications for Practice and Future Research: These findings imply that therapists may focus more on building rapport than accomplishing tasks with young people during online counselling sessions due to the absence of verbal and non-verbal information when communicating via text messages.
 
Full-text of this article is not available in this e-prints service. This article was originally published [following peer-review] in Counselling and Psychotherapy Research, published by and copyright Routledge. This paper considers our experience within a group researching domestic violence in minoritised groups and the implications for counselling practice. Issues of race, gender and power were significant within the research team. These issues are intrinsic to minoritised women's experiences of service responses and are also a powerful, yet often unexplored, dynamic in counselling practice. We reflect on issues of 'outsiders' and 'insiders' in terms of the research process and findings, and the impact and influence of these power roles on counselling practice. We acknowledge that it is only by retrospectively engaging with each other and our differences that we have been able to explore our parallel processes and consider their implications for counselling practice.
 
Objective: To explore the ways in which graduates of a university counsellor-education programme reflected on their career development, retained the programme's distinctive theoretical counselling model in their counselling practice and engaged in continuing professional development. The main aim was to discover whether or not teaching a solution-focused model of counselling was worthwhile. Method: A questionnaire, using primarily solution-focused type questions, was distributed to all graduates. Interest was focused on specific events, both inside and outside the training programme and beyond, that contributed to graduates' sense of development as counsellors. Results: Thirty four graduates (response rate 62%) provided responses indicating their recognition that their sense of competence and identification as professional counsellors develops over time, and is assisted by relevant feedback and supervision from lecturers and practical counselling experience. Graduates also indicated that their favoured working model was solution-focused and that, as a framework, it provided them with opportunities to integrate other counselling models and add complementary professional development education. Conclusion: The graduates' continued use of a solution-focused model supports the view that teaching the solution-focused model is working. The findings are considered alongside four models of counsellor development and implications for counsellor-education programmes are explored.
 
Overview of literature search and retrieval.
Therapeutic approaches and study quality.
In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand-searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak.
 
Introduction: In this research, proposed criteria for what has been termed ‘Prolonged Grief Disorder’ (PGD) (more recently termed, ‘Persistent Complex Bereavement-Related Disorder’ (PCB-RD) in the proposed DSM-V), were presented to psychologists and counsellors. Method: Participants were asked about their views on the ‘disorder’ and whether they considered its inclusion in diagnostic manuals was justified. A total of 185 participants, (147 psychologists, specialist and general, and 38 counsellors) responded to an online survey (part of a larger research project), concerning their attitudes, choices and activities regarding bereavement therapy. In this part of the research, therapists’ perspectives about pathological grief, the recognition of PGD and its inclusion in diagnostic manuals were explored. Fifty-nine participants took the option of adding written remarks to the survey to expand on their opinions regarding PGD. Results/Conclusions: Tentative support for the inclusion of PGD in diagnostic manuals was given; however many therapists indicated considerable reservations about potential negative repercussions of using such a diagnosis. One-way between-groups analysis of variance was undertaken to determine whether participants' opinions varied according to main occupation or specialism; however, no significant difference was found. This research was conducted prior to the latest update to the proposed revision and diagnostic category concerning bereavement in the DSM-5 of April 2012, but many observations and recommendations concerning PGD made by the therapists participating in this research can be seen to be applicable to PCB-RD. Implications: The implications of this research for assessing and diagnosing grief, and ways of working with bereaved clients, are discussed.
 
This paper describes a questionnaire survey of therapists in the UK who have been subject to requests for disclosure of client records as part of a legal process. Therapist responses are outlined in terms of the perceived effect of such disclosure on the client, therapist and the therapeutic relationship. Negative effects included the experience of exposure of sensitive client material in an adversarial legal system, of powerful emotional responses by therapists, and a sense of feeling professionally de-skilled in an unfamiliar and often challenging legal environment. Positive effects for the client included the achievement of valued outcomes such as compensation, and, for the therapist, the facilitation of support for the client in this process. These findings are discussed in terms of a contrast between therapist perceptions of consensual and contested disclosure. In the former, therapist and client are in agreement about the restorative value and outcome of disclosure. In contested disclosure, the process is experienced as disrupting therapeutic privacy, undermining professional self-confidence and introducing an unwelcome element of critical re-evaluation of client motives for undertaking therapy.
 
Aim: The therapist's feelings play a remarkable role in contemporary models of psychotherapy. However, these models are biased towards negative feelings. The present study explores therapists' personal experience with positive emotion in-session. Method: A grounded theory analysis was conducted of interviews with 26 Brazilian psychotherapists. Results: Clinicians derive positive affect from the client's input in treatment, from their own input, and from the personal relationship with the client. Therapist positive emotion adds to the material that can be worked on in-session by providing interpersonal events in the relationship with the client. It can improve therapist input in treatment by increasing in-session awareness, resourcefulness and daring and by cuing efforts for professional development. It enhances involvement in the relationship with the client by prompting compassion and closeness in the dyad. Its effects may spill over and contribute to the therapist's personal thriving. Discussion: These results are discussed in light of what positive psychology can add to current work on therapist effects in the treatment process.
 
Context: The challenge of producing ethical representational practices is of critical interest to both practitioner-researchers and research theorists. For practitioners becoming researchers a central ethical question may be how to manage a relational presence in writing their research, in ways that acknowledge participants, the research relationship, and a researcher's own subjectivity. Focus: The article offers examples from practitioner research to illustrate and theorise how researcher subjectivity is managed through the use of witnessing practices as a representational strategy. Witnessing practices – translated into counselling research from narrative therapy – offer researchers a strategy to take up a reflexive, relational presence in research reports. Discussion: Researcher witnessing honours the contributions of research participants as well as making visible the shaping effects of the research on a researcher's life. Through witnessing self and other, and thus declaring presence, privilege and partiality, re-presentational ethics are made transparent.
 
Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post-session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person-centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process-experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.
 
Intention: This study focused on questions of whether and how clients benefit from supervision. As practitioner research, the study was intended to shape the researchers' own supervision practice. Method: The qualitative approach was based on interviews with a small number of experienced practitioners about their supervision experiences. The findings are presented in the form of reflexive stories, told by each researcher. Findings: In these stories the researchers tell how engagement with experienced practitioners' accounts of their past supervision shaped the hopes and intentions the researchers hold for their future supervision. Implications for practice: The stories suggest there are therapeutic benefits in an ethic of transparency that provides for practices that overtly carry stories in both directions between counselling and supervision.
 
Top-cited authors
Janice Connell
  • The University of Sheffield
Victoria Clarke
  • University of the West of England, Bristol
Virginia Braun
  • University of Auckland
John Mellor-Clark
  • Birmingham City University
Michael Barkham
  • The University of Sheffield