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A five-year evaluation of the effectiveness of person-centred counselling in routine clinical practice in primary care
Abstract and Figures
Counselling is the recommended treatment for individuals with mild to moderate mental health problems of recent onset. In this evaluation of a primary care counselling service offering person-centred counselling, the Core Outcome Measure (CORE-OM) was administered at referral and at the beginning and end of therapy. A pre-post therapy effect size for 697 individuals over a 5 year period was 1.2. This compares with a waitlist (between referral and pre therapy) effect size of 0.24 for 382 individuals over a three year period. The results indicate that person-centred counselling is effective for clients with common mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate symptoms of recent onset, but extends to people with moderate to severe symptoms of longer duration.
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... Carl Rogers was among the founders of the humanistic approach to psychology. There are a variety of terms that are often used interchangeably in his therapeutic approach including Client-Centred Therapy (CCT), Person-Centred Therapy (PCT) or Non-Directive Supportive Therapy (NDST) (Gibbard & Hanley, 2008). ...
... Across the 28 papers identified in this review, ten papers (seven studies) specifically examined PCT rather than ST, SC or NDST (Alexopoulos et al., 2001;Areán et al., 2010;Feaster et al., 2010;Blanco & Ray, 2011;Blanco, Ray & Holliman, 2012;Bratton, et al., 2013;Eyssen, et al., 2013;Gibbard & Hanley, 2008;Koszyci, Bisserbe, Blier, Bradwejn & Markowitz, 2012;Stiles, Barkham, Mellor-Clark & Connell, 2009). Results across these studies are similar to what was found overall in this review; where PCT was the primary candidate (or equal candidate) effective and equivalent results were found for PCT (Blanco & Ray, 2011;Blanco, Ray & Holliman, 2012;Bratton et al., 2013;Gibbard & Hanley, 2008Stiles, Barkham, Mellor-Clark & Connell, 2009) with one exception (Eyssen et al., 2013) which found that PCT was no more effective than treatment as usual. ...
... Across the 28 papers identified in this review, ten papers (seven studies) specifically examined PCT rather than ST, SC or NDST (Alexopoulos et al., 2001;Areán et al., 2010;Feaster et al., 2010;Blanco & Ray, 2011;Blanco, Ray & Holliman, 2012;Bratton, et al., 2013;Eyssen, et al., 2013;Gibbard & Hanley, 2008;Koszyci, Bisserbe, Blier, Bradwejn & Markowitz, 2012;Stiles, Barkham, Mellor-Clark & Connell, 2009). Results across these studies are similar to what was found overall in this review; where PCT was the primary candidate (or equal candidate) effective and equivalent results were found for PCT (Blanco & Ray, 2011;Blanco, Ray & Holliman, 2012;Bratton et al., 2013;Gibbard & Hanley, 2008Stiles, Barkham, Mellor-Clark & Connell, 2009) with one exception (Eyssen et al., 2013) which found that PCT was no more effective than treatment as usual. When PCT was delivered as the control condition, the primary therapeutic candidate proved to 12/16 be more effective (Alexopoulos et al., 2001;Areán et al., 2010;Feaster et al., 2010;Koszyci, Bisserbe, Blier, Bradwejn & Markowitz, 2012) again reflecting the general methodological concerns in this area. ...
The purpose of this paper is to present a systematic literature review of the effectiveness of Supportive Counselling (SC) based on Rogerian principles. This review of recent international (last five years) and Australian (last ten years) papers was employed using the PsycINFO, Ovid Medline, APAIS (Informit), Web of Science and Social Services Abstracts data bases. Various terms were employed encompassing Supportive Counselling (SC) including; Person Centred Therapy (PCT), Non-Directive Supportive Therapy (NDST) and Supportive Therapy (ST). A total of 26 international papers and two Australian papers met the inclusion criteria. Papers were grouped into (i) meta-analyses and systematic reviews (n=4) as well as papers (ii) where SC was the primary therapeutic candidate (n=10), (iii) where SC was equally compared to other therapies (n=3) and (iv) where SC was the alternative, control therapy (n= 11). Various methodological issues were identified, primarily in the way SC was defined, implemented and compared to other therapies. Overall, while a number of methodological issues preclude definitive claims, there is evidence to suggest that the group of therapies often referred to as supportive are effective, and equally as effective as selected other therapies, in the treatment of adult depression.
... Research by Sa'ad et., Al. (2014) proved that the adoption of the person-centered approach showed a significant reduction (pre-test to post-test) in depression, increased self-concept and resilience of adolescents outside of marriage who were pregnant. Furthermore, Gibbard and Hanley (2008) presented the results of a five-year study which showed that person-centered counseling was effective for clients with general mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate onset of symptoms but extends to people with moderate to severe symptoms of longer duration. ...
The person-centered counseling approach has evolved in applications ranging from nondirective, client-centered, and student-centered to people-centered approaches. This paper describes the application of person-centered counseling in guidance and counseling services. The research method used a literature study. The results of the study and analysis were synthesized using a narrative method by grouping information or data according to the objectives of the study. The results showed that in order to truly achieve effective results from the implementation of person-centered counseling, the main attitudes the counselor needs to have are conformity, unconditional positive understanding, and understanding of empathy. The results of the study can also be discussed topics in group guidance services, individual counseling, and group counseling.
... Humanistic-experiential therapies were equally effective in alleviating such diagnostic symptoms when compared with other therapies aligned to the medical model, such as cognitive behavioural therapy (CBT) and psychodynamic therapy. Further to this, a number of studies and meta-analyses found person-centred therapy to be equally effective as CBT, psychodynamic therapy and pharmacotherapy in reducing symptoms of depression, anxiety, postnatal depression, psychosomatic problems and general psychiatric symptoms (Bedi et al., 2000;Bower et al., 2003;Friedli et al., 1997;Gibbard & Hanley, 2008;Gordon & Graham, 1996;Hemmings, 2000;King et al., 2000;Marriott & Kellett, 2009;Rowland et al., 2000;Stiles et al., 2008;Teusch et al., 2001;Ward et al., 2000). Meta-analyses of Rogers' (1957aRogers' ( , 1957b therapist core conditions found that empathy, congruence and unconditional positive regard are strongly and positively associated with therapeutic outcome (Elliott et al., 2018;Farber et al., 2018;Gelso et al., 2018). ...
Background
There have been substantial research efforts demonstrating the effectiveness of person‐centred therapy. However, little research has investigated whether person‐centred therapy is effective in facilitating psychological growth amongst clients experiencing suicidal ideation and serious mental health difficulties.
Aim
This study aimed to determine whether suicidal clients who received person‐centred therapy experienced increased levels of authenticity, well‐being and psychological distress. The predictive validity of authenticity and well‐being upon psychological distress was also tested.
Method
The study utilised quantitative, longitudinal methodology. Data were collected from a clinical sample of clients receiving person‐centred therapy at a counselling research clinic ( N = 56) over the course of 20 sessions.
Results
There were statistically significant improvements in levels of authenticity, well‐being and psychological distress over 20 sessions of therapy; a minimum of 15 sessions were required for significant change to be observed. Authenticity and well‐being were negatively associated with psychological distress, whilst authenticity and well‐being were positively associated with each other. Early authenticity and well‐being predict levels of distress later in therapy. These results provide initial evidence to support Rogers' theory of therapy, which is suitable for clients experiencing both mild and severe distress; the findings refute the view that person‐centred therapy is only suitable for the “worried well.”
Implications
There is now preliminary justification for person‐centred therapy being suitable for suicidal clients. Person‐centred therapists could consider offering suicidal clients at least 15 sessions to achieve meaningful change; ethical considerations pertaining to this are explored.
... CPR provides an important home for practice-based evidence. Gibbard and Hanley (2008) made use of five years of real-world routine evaluation data to demonstrate the value of person-centred therapy in primary care settings. Cooper (2009) also shared research which summarised the audit and evaluation data from school-based counselling services in the UK, developing arguments for increasing such provision going forward. ...
This virtual Research Methods edition of Counselling and Psychotherapy Research invites readers to consider and discuss the issue of therapist-researchers’ ‘epistemological home(s)’. What do we hold as ‘true’ and how do we generate knowledge about that?
... When we ran the analysis over the six-month period and controlled for baseline scores, combined services showed a significant association, namely with the change in the functional domain, with a medium effect size. Other studies have reported a medium to high effect size of similar interventions, such as different psychological therapies delivered in psychiatric routine care in Sweden [45], short-term counselling in Ireland [38], and person-centered care in primary care settings [47]. The comparison here, however, might not be similar given the effect sizes in the literature were reported in a pre-post research design rather than in a controlled observational model as in our study. ...
Background:
Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model.
Objective:
To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care.
Methods:
This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants' scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured.
Results:
A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively.
Conclusions:
The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.
... Second, HCCT emphasizes the importance of unconditional self-acceptance as REBT does; however, it accomplishes this by the therapist's actions alone and not by direct teaching or Socratic Questioning as in REBT. Third, HCCT is more nondirective (Gibbard & Hanley, 2008) compared to REBT's active directive approach. ...
Objective: This study evaluated the effectiveness of Rational Emotive Behavior Therapy (REBT) for outpatients with GAD and mild depression and tested the effectiveness of REBT to an active, alternative treatment, Humanistic, Client-Centered Therapy (HCCT) in a clinical setting. The study aimed to understand whether REBT is a more effective treatment than HCCT through testing both pre-treatment and including three-month follow-up results.
Design: Thirty-one participants were assessed for overall psychopathological variables such as anxiety, depression, levels of unhealthy negative emotions and regret, activation, hope and nothingness as ontological well-being (OWB) variables before and after a 12-week intervention as well as during a three-month follow-up. We randomly assigned participants to either REBT or HCCT. The psychotherapists followed strict guidelines to incorporate the distinctive features of REBT. This included educating clients about irrational and rational beliefs, introducing the binary model of emotional distress, using a range of disputing techniques (logical, philosophic, and functional), and discussing alternative rational beliefs such as unconditional acceptance of self, others, and life. The HCCT group was treated with Rogerian techniques such as unconditional positive regard, accepting negative emotions, and reflection. The clients completed the Beck Depression Inventory, Beck Anxiety Inventory, Shortened Attitude and Beliefs Scale, the Ontological Well-being Scale, and the healthy and unhealthy negative emotions scale. The outcomes were analyzed using split plot ANOVA with post hoc, Reliable Change Index, and Clinical Significance Change Index.
Results: Although split-plot ANOVA results showed that there was not significant difference in main effect of treatment between REBT and HCCT groups, further detailed analysis such as main effect of time, time by interaction values, Reliable Change Indices, clinically significant change analysis, and post hoc indicated that REBT treatment was more beneficial than HCCT treatment at any of the three time points in most variables. Another experimental study with larger sample is needed to confirm the result in future studies.
This study aims to determine the effectiveness of "Sequencing Stories" as a medium of language games in improving the reading ability of MA AnnuqayahSumenep students. This type of research is quantitative, using a pre-experimental design with one group pre-test and post-test. The sample of this study amounted to thirty first-grade students. Data analysis was performed using paired sample T-Test. The results of this study indicate: (1) The procedure for applying the language game media "Sequencing Stories" consists of opening, core, and closing activities. Learning is carried out three times: delivery of vocabulary, reading, and practice. (2) The T-Test results show that the T-Count value is higher than the T-Table value. This shows that the alternative hypothesis (H1) is accepted, and the game is quite effective. This study's findings indicate that using the Sequencing Stories language game effectively improves students' reading skills. Keywords: Language Learning Media, Story Sequence Games, Reading Skills ملخص تهدف هذه الدراسة إلى تحديد فاعلية استخدام "تركيب القصة" كوسيلة للعبة اللغوية لترقية مهارة القراءة لدى طلبة مدرسة النقاية الثانوية الإسلامية سومنب. هذا النوع من البحث الكمي باستخدام تصميم ما قبل التجربة مع مجموعة واحدة قبل الاختبار وبعد الاختبار. بلغت عينة هذه الدراسة ثلاثين طالبا في الصف الأول. وتم إجراء تحليل البيانات باستخدام اختبار "ت" للعينة المزدوجة. تشير نتائج هذه الدراسة إلى أن: (1) إجراء تطبيق لعبة اللغة "تركيب القصة" يتكون من الأنشطة الافتتاحية والأساسية والختامية. ويتم عملية التعليم بثلاثة لقاءات وهي: توصيل المفردات، والقراءة، والتدريبات. (2) نتائج اختبار "ت" من النتيجة الحسابية أكبر من النتيجة الجدولية، هذا يدل على أن الفرضية البديلة (H1) مقبولة، وأن اللعبة فعالة للغاية. والحاصل إن نتائج هذه الدراسة تقول بأن استخدام لعبة "تركيب القصة" يحفز الطلبة على تعزيز تفاعلهم ومشاركتهم في عملية التعليم والتعلم. بالإضافة إلى ذلك، فقد أظهرت الدراسة فعالية هذه اللعبة في تعزيز كفاءة الطلبة في مهارة القراءة بشكل ملحوظ الكلمات المفتاحية: الوسائل التعليمية اللغوية، لعبة تركيب القصة، مهارة القراءة
Content & Focus
This paper introduces the concept of Health Technology Assessment (HTA) as an available research tool to examine the cost-effectiveness and impact of therapeutic interventions on clients’ quality of life. It encourages practitioners to think about how they can use HTA concepts to analyse and present their own clinical outcomes as a means to justify continuing to provide services within the Primary Care Sector as it morphs into its new funding format. This paper aims to describe HTA methodology and how it is used internationally in evidence-based health care practice. The paper aims to give a staged explanation of the phases of the assessment process and their rationale. It aims to consider the strengths and weaknesses of utilising HTAs in general, alongside considerations of future developments in HTA in the field of psychological therapy.
Conclusion
HTA is undertaken via systematic staged methodology of 10 phases. HTA’s key strength is the high level of external and internal validity of its findings. The weaknesses of HTA include that report findings can have a variable impact on commissioners, policy makers, practitioners and clients; due in part to the choice of dissemination method and also that HTAs can quickly become out of date. Finally, examples are given as to how HTA processes could be used to specifically research and report on Primary Care Psychological Therapy provision in the NHS. It could assist both commissioners and practitioners with making sense of new systems such as Any Qualified Provider and Payment By Results.
Millions of people participate in online peer-to-peer support sessions, yet there has been little prior research on systematic psychology-based evaluations of fine-grained peer-counselor behavior in relation to client satisfaction. This paper seeks to bridge this gap by mapping peer-counselor chat-messages to motivational interviewing (MI) techniques. We annotate 14,797 utterances from 734 chat conversations using 17 MI techniques and introduce four new interviewing codes such as ''chit-chat'' and ''inappropriate'' to account for the unique conversational patterns observed on online platforms. We automate the process of labeling peer-counselor responses to MI techniques by fine-tuning large domain-specific language models and then use these automated measures to investigate the behavior of the peer counselors via correlational studies. Specifically, we study the impact of MI techniques on the conversation ratings to investigate the techniques that predict clients' satisfaction with their counseling sessions. When counselors use techniques such as reflection and affirmation, clients are more satisfied. Examining volunteer counselors' change in usage of techniques suggest that counselors learn to use more introduction and open questions as they gain experience. This work provides a deeper understanding of the use of motivational interviewing techniques on peer-to-peer counselor platforms and sheds light on how to build better training programs for volunteer counselors on online platforms.
The study sought to investigate on the effectiveness of approaches used in addressing depression among young adults at teachers’ colleges in Zimbabwe. The study adopted the post-positivism paradigm where a mixed approach was used through questionnaire and interview schedule as means of data collection. The sample consisted of 206 participants drawn from 180 students, two vice principal, two deans of students, 13 heads of departments, one chaplain and eight counsellors. While quantitative data was coded and analysed by the use of tables with frequencies and percentages, qualitative data was analysed through the thematic approach. The study concludes that cognitive behavioral therapy, behavioral therapy and person centered therapy are used to address depression cases in Zimbabwean teachers’ colleges. The specific techniques which were commonly used include guided discovery, role play, cognitive restructuring, relaxation and visualization, exposure and person centered. The study therefore recommends that the Ministry of Higher and Tertiary Education, Innovation, Science and Technology Development and other stakeholders should come up with a policy which spells out expected counselling approaches and techniques to be used at the colleges to address the depression of students. The study further recommends the provision of more trained counselling personnel for the identified approaches to be effective in addressing depression.
This article reviews the development of the CORE‐OM and CORE System from 1995 to 2005 in the context of the need to measure, monitor, and manage the delivery of counselling and the psychological therapies in service of providing best quality care for clients. The origins and philosophy of these tools are summarised and practical aspects of how to use them in routine service settings are set out, including an easy to use look‐up table of differing ways of presenting CORE‐OM scores and their associated meaning. The wider family of CORE outcome measures is briefly outlined to show the relationship between the various versions and how each is designed for a specific purpose. These outcome tools are set within the broader context of the CORE System. In turn, the CORE‐OM and CORE System are placed within the paradigm of practice‐based evidence and examples are provided of how these tools have been applied in routine as well as more traditional evaluative settings.
The aim of the present article is two‐fold. The first aim is to provide a background to the origins and development of the CORE‐OM and its role as part of the broader‐based CORE System during the period 1995 to 2005. The second aim is to consider the applications of both the CORE‐OM and CORE System within the context of the developing paradigm of practice‐based evidence up to 2005.
To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services (
n = 2,710) and within an intensively evaluated single service (
n = 1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Measuring the outcomes of counselling and the psychological therapies has become an increasingly important component in managing individual services within routine primary care settings. Outcome data collected from multiple settings can be combined to establish benchmarks against which services and practitioners can make comparisons. To achieve this, we used a large data set comprising >11,000 clients from 32 primary care NHS services who completed the CORE-OM at both intake and end of counselling or therapy. We used four categories relating to components of reliable and clinically significant change (recovery, improvement, no reliable change, and reliable deterioration) to establish service benchmarks. However, we focussed primarily on those relating to recovery and improvement. Importantly, in addition to service benchmarks, we calculated benchmarks for individual practitioners taking into account a simple adjustment for case mix. The resulting benchmarks and their meaning are discussed.
Formally evaluating and reporting on the progress of clients is now seen as a central component of clinical practice. Generally, research suggests that the percentage of practitioners who use outcome measures as part of their clinical practice is relatively low. However, no national benchmarks have yet been presented which allow both practitioners and services to assess their relative performance in terms of data collection. The present study uses the CORE National Research database (n=31882) and reports pre- and post-therapy assessment completion rates, thereby enabling services to track their performance relative to other services. On average, pre-therapy CORE-OMs were reliably completed by 83% of clients while post-therapy forms were completed by 39%. However, there were large variations between services. The practical use and implications of the results presented are discussed by managers of NHS primary care counselling services.
The availability of counselling in primary health care has increased substantially in recent years. As a result, the findings of a range of research studies have been collated to inform a series of published reviews assessing the evidence to support continued expansion. Until recently no supportive research evidence could be found. However, the most recent reviews have refined the focus and specificity for assessing the efficacy of counselling in primary care and evidence is now slowly beginning to emerge to support counselling as an evidence-based practice. Concurrent with this review activity, National Health Service (NHS) policy documentation has introduced a series of initiatives to enhance service quality throughout health care. This has placed a premium on routine audit, evaluation and outcomes monitoring for the development and dissemination of practice-based evidence. In this paper we briefly summarize this background to introduce an initiative that tested the feasibility and utility of using a standardized approach to profile patients and outcomes in primary care counselling practice. The results suggest that it is feasible to routinely monitor and profile service provision and that counselling interventions have considerable potential to alleviate client distress for a wide range of psychosocial difficulties that commonly present in primary care. These findings are discussed in the context of the NHS's commitment to monitoring National Service Framework Standards for Mental Health Services.
Outcome research in counselling and psychotherapy has come to rely heavily on the use of self-report questionnaire measures of anxiety, depression and general symptomatology. The validity of these measures in the context of psychotherapy research has, in general, been taken for granted. This paper proposes that, despite the success of self-report questionnaires in personality research and personnel selection, there are significant problems involved in the use of these methods in research into therapeutic change. Specifically, three areas of difficulty are reviewed. First, questionnaires are completed in a social setting that itself changes as a result of therapy. Second, the experience of psychotherapy changes the way that clients make sense of questionnaire items (the ‘response shift’ phenomenon). Third, the conceptualisation of the person implicit in questionnaire design is not compatible with the conceptualisation of persons espoused by most contemporary therapeutic approaches. It is argued that the continuing popularity of self-report questionnaires can be understood in terms of Kurt Danziger's model of the social construction of psychological knowledge.
Reviews the book, What works for whom? A critical review of psychotherapy research by Anthony Roth and Peter Fonagy (see record 1996-98691-000). This book presents a comprehensive review of the status of psychotherapy research. The authors look at the evidence dealing with both efficacy and effectiveness of psychotherapy for the more common DSM-IV disorders. All of the chapters are geared toward the goal of providing the practitioner with a list of treatments for which there is empirical support. The reviewer notes that the amount of information covered in this text is extensive and provides sufficient evidence for the efficacy of psychotherapy for many of the diagnostic categories. Despite an overemphasis on cognitive/behavioral treatments, the authors do present the best of the research in psychodynamic therapy. The reviewer recommends this volume to both to researchers and practitioners. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Four key areas of research work are identified: efficacy, effectiveness, practice, and service system. These research areas are placed within the paradigms of evidence-based practice and practice-based evidence. This article provides an introduction to these two paradigms and these four research areas together with examples of current work. From this basis, we argue for a knowledge base for the psychological therapies in which each area has a place within an overall research model and in which the interdependence of each area on the others is acknowledged. A cyclical model exemplifying the complementary relationship between evidence-based practice and practice-based evidence is presented as a means for furthering the delivery of a rigorous but relevant knowledge base for the psychological therapies. Copyright © 2003 John Wiley & Sons, Ltd.