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Zainah Ahmad Zamani

Institution: Department of Psychology, Faculty of Social Science and Humanities, National University of Malaysia,
Contact details: 43600 Bangi, Selangro Darul Ehsan, Malaysia
Email: zainah@pkrise.cc.ukm.my

ABSTRACT: Paper

Strand: Counselling Settings

'Employees' Experience Of Counselling In Malaysia: An Exploratory Qualitative Study'

The aim of the study is to examine employees' experience of counselling through qualitative study

The method of qualitative was used where semi-structured interview was employed in gathering data on 25 counselling clients experience on the counselling intervention. The characteristics of this type of qualitative research seeks to identify the themes in "inductive analysis" which allows conclusion to arise from a process of immersion in the data, rather than imposing categories or theories in advance

The identification of main categories were obtained which reflect the meanings of the experience of clients based on the counselling intervention. A total of seven categories emerged: positive outcomes, safety of the process, images of counsellors, management issues, authoritarian, stigmatisation and reactions of interviews. One of the central themes running through this qualitative analysis of the experience of workplace counselling can be represented as the feelings of "ambivalence" among clients between acknowledging or legitimising the positive outcomes of counselling but careful consideration or scepticism toward the service.

From the analysis of the emerging themes, it can be summarised that positive outcomes of counselling were strongly felt by most clients, various images of counsellors were gathered, but scepticism of counselling provision still exists. Despite the sceptical attitude to counselling, efforts towards educating the public on the potential benefits of counselling should continue to be emphasised. The aura of suspicion and scepticism needs to be diminished and the accessibility of EAPs should be made fast, convenient and confidential manner. This should also include marketing EAPs and giving adequate information constantly to the public.

Lynda Ankrah

Professional Role: Lecturer in Counselling
Institution: M.A.N.C.A.T.
Contact details: 41, Dudley Road, Whalley Range, Manchester, M16 8FW

ABSTRACT: Paper

Strand: Counselling Relationships

'Dealing with Spiritual Emergency in Counselling Relationships'

Before becoming a counsellor I went through a period of intense personal crises involving 'non-ordinary' experiences. More recently many clients and students reported similar episodes and had received varying responses from professionals, including counsellors. I then came across the work of Stanislav Grof and others on the concept of 'spiritual emergency', which provides a non-pathological interpretation of this area. The study therefore asks: 'How far are people able to explore their experiences of spiritual emergency within a counselling relationship?'

Eighty questionnaires were distributed to a convenience sample of people known to have had counselling. Of the 20 respondents, 18 were female and 2 were male, aged between 25 and 49, of mixed cultural backgrounds. Three had follow-up interviews. The data was analysed using a qualitative approach based on Moustakas' heuristics.

I received several phone calls from people unwilling to complete the questionnaire for fear of exposure to a psychiatric system they had experienced as racist, and which might interpret spiritual experience as mental illness. This perceived taboo around spirituality is a possible reason for the low response rate.

All respondents reported at least one of the experiences classified by Grof as characteristics of 'spiritual emergency'. While five felt unable to explore this with their counsellors, ten respondents found them helpful and sympathetic. Respondents were greatly helped by the minority of counsellors able to provide sustained empathic support.

Three key messages for counsellors:

1. Provide an accepting space for people to explore spiritual experiences
2. Develop cross-cultural awareness, and be prepared to look at racism
3. Learn about spiritual emergency and other issues of spirituality

Further research is suggested into the link between spiritual transitions and personal growth, and how cultural factors affect the experience of spiritual emergency.

Kate Anthony

Professional Role: Counsellor/Consultant
Institution: Oxleas NHS Trust/Self Employed
Contact details: 82 Tormont Road, Plumstead, London, SE18 1QB
Email: KateAnthony@aol.com

ABSTRACT: Paper

Strand: Practical and Ethical Issues in Research

'Interviewing Clients and Counsellors via the Internet - Practicalities and Analysis of Data'

The Internet has opened up new possibilities and issues for conducting research. The aim of this presentation is to illustrate what it is like to conduct live research interviews using Internet Relay Chat (IRC) and e-mail. It includes the practicalities of setting up interviews that are not bound by geographical or world-time boundaries, and how to analyse the interviews when you cannot rely on interpretation of body language or tone of voice.

The presentation is based on experience of conducting an online MSc research project about Online Communication between client and Counsellor, the results of which were presented at the 2000 Research Conference. Eight respondents were interviewed via IRC and/or e-mail over a month in 2000 in order to examine the Online Therapeutic Relationship and the relationship between interviewer and interviewee, and the practicalities and issues this raised.

The presentation will encompass both synchronous and asynchronous communication regarding: setting up a research website, marketing a piece of research and potential access to Counsellors and clients, interviewee selection (and deselection), respondent biases within Internet research, organisation of the interview time, technical implications, the relationship between researcher and respondent in the absence of physical and auditory presence, and analysis of the research data.

The Internet raises as many implications for the future of Counselling and Psychotherapy Research as it does for Practice.

Kathy Baines and Frank Wills

Professional Role (FW): Deputy Head of Department of Health and Social Care
Institution: University of Wales College, Newport
Contact details: University of Wales College, Newport, Allt-yr-yn Campus, PO Box 180, Newport, South Wales, NP20 5XR
Email: frank.wills@newport.ac.uk

ABSTRACT: Paper

Strand: Outcome-studies using RCT's

'Challenging Beliefs in Obsessive Compulsive Disorder'

This is a multiple case study involving detailed analysis of the responses of 3 clients to cognitive-behavioural treatment of OCD. Data included case notes, pre and post therapy measures and responses to semi-structured interviews. Qualitative and quantitative analysis showed minimal changes in general negative beliefs but significant shifts in idiosyncratic obsessive beliefs. Responses to challenging were uniformly positive. Reactions to self-monitoring and behavioural experiments varied across cases. The implications for the treatment of OCD using cognitive-behavioural therapy are discussed.

Lindsay S Baines (paper 1)

Professional Role: Lecturer (Sociology and Psychology)
Institution: Dept of Surgery, Renal Transplant, University of Glasgow
Contact details: Renal Unit (7th Floor) Western Infirmary, Dunbarton Road, Glasgow, G11 6NT
Email: lyndsay.baines.wg@northglasgow.scot.nhs.uk

ABSTRACT: Paper No1

'Individual Versus Group Psychotherapy: Addressing Emotional Problems Amongst Kidney Transplant Patients'

Kidney transplant patients are liable to emotional problems (bodily boundary distortion, loss, fear of rejection) that might be more complex than traditionally suggested. Individual and group psychotherapy have been shown to be effective in treating this client group, although group psychotherapy is considered more cost effective. We have compared the clinical efficacy of group versus individual psychotherapy in recipients of kidney transplants.

Recipients of kidney transplants were randomised (using computer generated numbers to ensure even gender and age distribution) into two groups, to receive a 12 week course of group versus individual (comparison group) Systemic Integrative Psychotherapy. The control group was abandoned following a pilot whereby we were unable to maintain the constancy of the control group. It would seem that the availability of a psychotherapy service amongst this patient group generated expectations amongst patients and staff rendering the control unethical and invalid. The Beck depression Inventory (BDI) was utilised as a measure of change, pre-transplant and at 3 and 6 months follow up.

To date 54 clients have completed a 12 week course of psychotherapy, 34 individual and 20 in group psychotherapy. The mean age was 38 years, there were 31 males and 23 females. At termination clients in individual psychotherapy had significantly lower (improved) BDI scores compared to clients in group psychotherapy. Outcome was also determined by psychosocial variables (age at renal failure, pre-morbid personality traits, time on hemodialysis). Clients aim of treatment was a 'return to normal'. However, 'normal' as defined in the past (before the onset of renal failure). Many of the sessions were occupied with re-defining normality in the present.

Individual treatment was found to be more effective than group psychotherapy. These finding may provide clinical indicators to professionals who are increasingly being called upon to treat this patient group.

Lindsay S Baines (paper 2)

Professional Role: Lecturer (Sociology and Psychology)
Institution: Dept of Surgery, Renal Transplant, University of Glasgow
Contact details: Renal Unit (7th Floor) Western Infirmary, Dunbarton Road, Glasgow, G11 6NT
Email: lyndsay.baines.wg@northglasgow.scot.nhs.uk

ABSTRACT: Paper No2

Strand: Medical and Health Issues

'Women With Dysthymia: A Study Of Social Network Activity During Short-Term Psychotherapy'

The aim of this work was to study the higher incidence of dysthymia amongst women and to explore gender inequality from the point of the sufferer's difference to other women. This is in contrast to the majority of health studies which have considered women as homogenous group with little regard for individual characteristic differences. The thesis considered, 'What are the mental health implications of women socialised to be different to men, but the same as other women, in a male dominated society?'

Four women (21-49 years) with dysthymia receiving psychodynamic short-term psychotherapy were subjected to four semi-structured interviews, that ran concurrent to, but without collaboration with, their psychotherapeutic treatment. Social network graphs were compiled to systematically determine how women differentiated themselves from each other and whether these individual differences could be developed as independent variables with regards the recovery from dysthymia. Data was compiled into a series of in-depth exploratory single case studies. The emerging patterns of social interactions between social network members were then matched to feminist theory.

Respondents' were socialised by their mothers to be stereotypical men within the context of highly dense, isolated and achievement orientated social networks, which served to equate both mother and respondent with male power and differentiated them from other women. The subsequent social isolation and their ability to live up to their mother's ambitions for them generated loss and anxiety associated with dysthymia. Recovery from dysthemia was directly related to the formulation of secondary and previously unidentified independent 'weblet' constellations, that simultaneously reinforced respondents' similarities to other women while accommodating their individual characteristic differences.

The study alerts psychotherapists to the role of relationships in clients lives as a means to emphasising intra, as well as inter-gender differences, as a causative factor in women's mental health.

Patsy Bamford and David Acres

Professional Role (DA): Counsellor, Supervisor and Counsellor Trainer in Private Practice
Institution: Cornwall Macmillan Service
Contact details: Old School House, 12 Ford Road, Wembury, Plymouth, Devon, PL9 OJB
Email: davidacres1@compuserve.com

ABSTRACT: Paper

Strand: Counselling Models

'Travellers' Tales. Clients' and a Counsellor's Reflections on the Bereavement Journey. An Evaluative study Examined'

Patsy Bamford initially undertook this research study in 1995, re-contacting some of her clients five years later in her role as a bereavement counsellor with the Cornwall Macmillan Service. In this workshop Patsy and David Acres, Consultant Clinical Supervisor to the Cornwall Macmillan Service, present the bereavement journey of 'Jane', one of the 26 people involved in the original study, and one of those re-contacted in 2000. At the beginning of this workshop we will tell Jane's story in order to demonstrate and illustrate the 12-part qualitative research method in which Patsy and her clients collaborated.

David was excited by the study when he first saw it because the clients' experience was vividly revealed to him by this comprehensive methodology. It makes use of pie charts, graphs and journal entries, completed by the clients, to chart their bereavement experience over time. Clients assess the degree of impact of the counselling relationship, comparing it with other variables, in the recovery process. The counsellor also records her own responses throughout.

Patsy and David will begin the workshop with the short presentation taken from the 'Travellers' Tales' report compiled for the Council of the Cornwall Macmillan Service and presented to them in March 2001. Participants will then be invited to reflect both individually and in small groups upon the relevance, if any, of the methodology to their own practice and research. In the final part of the workshop, the presenters will welcome responses and suggestions for the development of this person-centred model, using the experiences and creative thoughts of those present.

Christina Birtwistle

Professional Role: Counsellor/Psychotherapist
Institution: Liverpool John Moores University
Contact details: 50 Greasby Road, Greasby, Wirral, CH49 3NE
Email: christina300ab@aol.com

ABSTRACT: Poster

'Clients' Perceptions of the Effectiveness of the Counselling Service within their General Practice Setting in a sub-urban area of West Wirral, Merseyside'

In this small, local study, the counsellor researched all clients she counselled, in the nine months prior to this report, at the GPs setting where she works, two afternoons per week.

Because of the particular demands of General Practice, she uses a multi-modal approach, drawing mainly on humanistic techniques, such as non--directive Rogerian: Transactional-analysis; Gestalt; and giving Roger's core conditions of empathy, non-judgemental attitude, and congruence. Where appropriate, she uses personal-development; self-awareness; stress--management; assertiveness, or relaxation exercises. All clients have 1 ½ hour sessions, and the range of treatment varies both in intensity and extent, and is suited to individual needs. No attempt is made to get clients to discontinue medication.

Fifty-six questionnaires were sent out; 52 (92.8%) were returned. It would appear that there was an appreciation of the Counselling Service, in this setting, at this time. All, but two clients, found the Service beneficial, and all bar one, would choose to use it again. It seems that counselling intervention has resulted in, reduction in clients' problems; medication use; and demand on GPs time. Of clients who used exercises, all but one, found them helpful, to some extent. All but two, found new coping strategies, enabling them to live with their problems in more manageable ways.

There seems to have been some sense in using clients directly as the chief judges of outcomes. They defined their problems, and chose where to go for help. Only they could really say whether they were, or were not, able to cope with their problems. Whether counselling helps with future problems is, perhaps, a further question for research.

The author believes that, obtaining a view from those who have been on the receiving end of the service, was perhaps the most effective way of checking the outcome of both her work and work-place.

Tim Bond

Professional Role: Reader in Counselling and Professional Ethics
Institution: University of Bristol
Contact Details: University of Bristol, Graduate School of Education, 8-10 Berkeley Square, Bristol, BS8 1HH
Email: tim.bond@bris.ac.uk

ABSTRACT: Paper

Strand: Counselling Relationships

'Putting The Quality Of Relationship First In Professional Ethics'

In 1999 I was approached by BAC to prepare a review of the possibility of radically restructuring the presentation of the ethical guidance for its members. The intended outcome is the publication of new ethical guidance in a single document that encompasses all the practitioner, educator and researcher roles associated with counselling and psychotherapy. I approached the task as systematically as any of the empirical research that I have undertaken. In this paper I will examine the conceptual rethinking involved in such a project and close with the challenges this thinking poses for researchers in counselling and psychotherapy.

The conceptual analysis and evaluation of the project is presented within the context of an autobiographical narrative. The mode of presentation is in itself experimental. It is intended to mark a shift from ethics founded solely on rational analysis or assumptions about the bounded autonomous individual to an approach to ethics that emphasises the relational basis of ethics and the challenge posed by differences in personal values and culture. The documents, which for the purposes of this paper constitute the findings and outcome of process will be launched by BACP in September 2001.

Liz Bondi and Arnar Árnason

Professional Role: Liz Bondi - Reader
Institution: The University of Edinburgh
Contact details: Dept of Geography, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP
Email: Liz.Bondi@ed.ac.uk Tel: 0131 650 2529 Fax: 0131 650 2524

Professional Role: Arnar Árnason - Research Fellow
Institution: The University of Edinburgh
Contact details: Dept of Community Education, Moray House Institute of Education, University of Edinburgh, Holyrood House, Edinburgh, EH8 8QA
Email: Arnar.arnason@ed.ac.uk Tel: 0131 651 6205 Fax: 0131 651 6111

ABSTRACT: Paper

Strand: Evidence and Practice

'It's A Wee Kind Of Niggling Thing, You Know: On Evidence and Practice In Counselling Research'

'Evidence' is crucial to the ways in which counselling is practiced. In recent years, the notion of 'evidence-based' practice has attracted a great deal of attention among those conducting research about counselling. In this paper we offer a critical discussion of the kinds of evidence with which counselling research can engage. Our account draws on interview transcripts collected for a research project concerned with the social and cultural significance of voluntary sector counselling in Scotland. We use this material to show how both research interviews and the counselling process are constitutive of 'persons in relationships', which we use to reflect on the nature of evidence.

We argue that counselling research has been dominated by a particular notion of 'evidence', which is embedded in a highly influential, but limited and limiting, view of 'science'. Drawing on our research material we show how this understanding of evidence is unable to 'capture' aspects of the counselling process to which great weight is attached by counsellors, including many aspects of interpersonal relationships. We go on to illustrate how meanings are negotiated between people in particular contexts, a process with which counsellors are very familiar, and we argue that these processes can and should be recognised as crucial forms of 'evidence' in counselling research.

Christina Bracegirdle

Other Author: Helen Payne

Professional Role: Counsellor and Co-ordinator of Counselling/Researcher
Institution/Affiliation/Workplace: Herts and Beds Counselling Foundation/WPF and PhD Candidate University of Hertfordshire
Contact details: 3 Havelock Road, Biggleswade, Bedfordshire, SG18 0DB
Email: tinabracegirdle2@netscapeonline.co.uk

ABSTRACT: Poster

'Containment - Freedom In The Therapeutic Relationship; A Necessary Polarity'

Containment and Freedom are familiar concepts in counselling theory. Freud (1905) originated the container concept with the body and its physical borders and openings to symbolise the boundaries and thoroughfares of the mind's functioning. Winnicott (1971) stresses the need for 'holding' the client satisfactorily, while Bion (1962) used an active model to think about containment as a holding process.

Freedom on the other hand has a strong philosophical background (Hare, 1963) with roots in the existential counselling model (Yalom, 1980). Fromm (1942) recognised man's primitive desire for freedom, and his fear of it, while Tillich (1952) called freedom 'man's primitive power of life' demonstrating the active quality of freedom. It is the active and opposite processes of these two concepts which are the focus of interest in this study.

A polarity is understood as a tendency to develop differently in opposite directions. Trees, for example grow roots down, into the ground, while also growing branches out, into the space above. The Containment-Freedom polarity (C-Fp) implies that the client 'roots' into the ground of internal containment, yet also 'branches' out towards internal freedom.

The data for this collaborative study was in the form of personal journals written by co-researchers who were in personal therapy. Six co-researchers kept a weekly journal over a period of fifteen weeks reflecting on feeling from their counselling sessions. They were informed that the study was researching into aspects of the counselling relationship, but the concept of containment and freedom was not described to see if it emerged spontaneously without prior direction. The first study seeks to demonstrate not only that this polarity exists, but also that it is integral to the client in the counselling relationship.

Alex Cheyne

Professional Role: MPhil Student
Institution: Counselling Unit, Strathclyde University
Contact details: 3/1 24 Elie Street, Dowanhill, Glasgow, G11 5JD
Email: acpraxis@cs.com

ABSTRACT: Paper

Strand: Outcome-studies using RCT's

'A Counsellors Perspective: A Pilot Study For A Randomised Controlled Trial Of The Use Of The Schedule For The Evaluation Of Individual Quality Of Life (SEIQoL) In An Alcohol Counselling Setting'

A randomised controlled trial was undertaken to test the methodology for using SEIQoL within an alcohol counselling setting and to compare outcomes of standard structured counselling (control) and standard structured counselling with SEIQoL (intervention).

Setting: This study was carried out at the Greater Easterhouse Alcohol Awareness Project (GEAAP) based in the Greater Easterhouse area of Glasgow.

Subjects: The sample comprised of 42 consecutive new referrals made to the GEAAP over a 6 month period (January - June 1999). Of these 20 (intervention group) received counselling using SEIQoL and 22 (control group) received counselling alone.

Study entry and randomisation: As service users were assigned to a counsellor prior to first attendance a randomised consent design described by Zelen (1)(2) was used.

Study design: Consent was obtained from all service users at the beginning of their first appointment.

Control group: Standard counselling, using a cognitive - behavioural approach was used over an 8-12 week period.

Intervention group: SEIQoL was administered at the start of the first counselling session. The standard counselling process was then followed for subsequent sessions and SEIQoL administered at the end of the final counselling session. At final sessions, the SEIQoL tool was used twice. Once for the original cues and once for new cues.

Data collection: All records and outcomes documents was anonymised, by GEAPP staff not otherwise involved in the study.

Analysis: All data analysis was carried out on an intention to treat basis. Descriptive statistics were calculated for the variables listed and Chi-squared tests were used for the categorical data.

Findings
Those receiving SEIQoL had slightly more favourable outcomes than controls. SEIQoL scores increased during the intervention. Clients understood and found the tool easy to use; Counsellors that SEIQoL helped focus on the most important issues early in the counselling process. The main strengths identified by Counsellors and clients of SEIQoL are first, that it provides users with a dynamic means to identify important areas that contribute to quality of life, and secondly, it appears to enhance the reflective process early on in counselling.

Kamaldeep Dhillon

Professional Role: ESRC Doctoral Researcher and Counsellor
Institution: Counselling Department, University of Manchester
Contact details: Counselling Department, University of Manchester, Oxford Road, Manchester
Email: kdhillon@lineone.net

ABSTRACT: Paper

Strand: Cultural Issues

'Counselling Marginal British South Asians: A Study Investigating Acculturation And Ethnic Identity'

Aims:
Acculturation describes a bi-directional process where immigrants interact between their ethnic and host cultures and ethnic identity as an ego developmental process. The strength of ethnic identity is overlapped by the style of acculturation a person adopts, these being: acculturation, assimilation, disassociation and marginalisation. Both Hutnik (1991) and Ghunam (1999) inferred that around 12% of the 1.9 million South Asians living in Britain (Office of National Statistics, 1997) existed in the latter style category, struggling in developing an integrated and stable ethnic identity. It is being argued that this group responds to cultural and other stressors by harmful behaviours, for example, by misusing alcohol and drugs and being significantly more suicidal, and may need specialist therapeutic help (Bhugra et al, 1999, Cochran & Bal, 1990; Kingsbury, 1994; McKeigue & Karmi, 1993; Orford & Copello, 1999). This research aims to give a voice to their stories taking a psychotherapeutic perspective. Applied counselling research in this area is limited and what psychological work is available tends to have been conducted in school settings and has rarely explored adult lives, making this adult South Asian and marginal group an appropriate and viable one for investigation.

Methodology:
Both a qualitative and quantitative approach, adopting a pluralistic epistemology, was taken in this study. Ghunam's (1999) Aberystwyth Bi-culturalism Scale was adapted and used to screen participants to highlight marginality, followed by semi-structured interview which was analysed using Interpretative-Phenomenological-Analysis (Smith, 1996). The purpose sample consisted (so far - as this is work in progress) second-generation Punjabi Sikh men living in the West-Midlands.

Summary of Preliminary Findings:
Participants stories supported the definition of marginality and sabyachaar-chinta/ culture-anxiety, translated from Punjabi) emerged as the super-ordinate theme. Examples of sub-ordinate themes included: 'religiosity-chinta', 'felt-ethnicity-chinta', 'generational-expectation', and 'majabi(class)-chinta' (*).

Conclusions, Implications and Audience Participation:
As this is a work-in-progress paper it is difficult to offer precise conculsions, however, the findings could be inferred by practitioners in their work. The writer hopes that a discussion of the findings so far may offer the audience an opportunity to consider their therapeutic practice with clients and supervisees, review the cultural accessibility and sensitivity of their helping service and raise awareness and knowledge of British /South Asian culture.

Susan Ellis

Professional Role: RGN, Lecturer in Palliative Care, Clinical Supervisor, Education Co-ordinator
Institution: Saint Francis Hospice, Romford, Essex
Contact details: 50 Greville Road, Cambridge, CB1 3QL
Email: susan_ellis@ntlworld.com and susan@slmsupervision.com

ABSTRACT: Paper

Strand: Supervision Symposium

'Disabling Defenses: the Self-Learning Model of Supervision (SLMS)'

Aim:
The aim of this study was to examine the influence a newly devised Self-Learning Model of Supervision (SLMS) had upon health professional's social defense strategies.

The study was executed from three points of reference. These were:

• Individuals' motivation to care
• Identification of the presence of defense strategies
• The influence the SLMS had upon awareness, actions and strategies

Method:
This grounded hermeneutic study involved three participants working within community based, in-patient and day care palliative care provision. Open interviews were undertaken at the beginning of the supervisory contract and again at the end of a nine-month period.

On completion of data collection, material was scrutinised using axial coding and constant comparative method as the analytic process through which data was conceptualised.

Validity in limited due to the small number of participants and the qualitative approach although credibility is achieved through 'transparency', 'consistency - coherence' and 'communicability' (Rubin and Rubin 1995)

Findings:
Data revealed that 'compulsive care giving' was present and correlated to an overriding need for perfectionism leading to self-deprecation and ultimately depressive and persecutory anxiety states that further manifested through introjective and projective identification.

The participants' experiences of the SLMS resulted in varying degrees of increased Reflexive Awareness and adaptation of their self-perception, recognition of 'fear' factors each reached a point of Transition to self-empowerment and ownership of anxiety states.

Conclusions:
Important issues of retention and wastage of staff, professional burnout and ultimately the influence upon the care of patients and relatives are highly pertinent.

To fully understand the impact the SLMS has upon individuals and their defense mechanisms a longitudinal study is necessary. Further validity may be achieved through scrutiny and epistemological examination of the process involved in each individual supervision session.

Jenifer Elton Wilson

Contact details: Bakehouse, Thickwood, Colerne, Nr. Chippenham, Wilts. SN14 8BN.
Email: jenifere@metanoia.ac.uk

ABSTRACT: Paper

Strand: Training and Development Issues

'Dancing with the Dragons of Academia'

This paper delineates the development, implementation and reflective evaluation of a doctoral programme in Psychotherapy by Professional Studies (DPsych), which is intended to provide a structure within which senior psychotherapists and counsellors can contribute to the validation of their own profession, carry out major projects within their own work environment and achieve academic recognition. The programme combines the professional expertise of psychotherapy with the progressive knowledge and techniques of work based learning in the form of an innovative professional doctorate. The programme is a specialisation pathway of a university based doctoral programme, which is delivered within the organisational setting of a psychotherapy training institution.

The history of the design and development of the programme up to the end of its first academic year is contained in an introductory outline. This is followed by an account of how the experience of all the participants in this programme, both candidates and members of the programme team, was subjected to a process of initial exploratory evaluation through a series of collaborative and appreciative inquiry focus groups and individual interviews. The audio-transcripts of these groups and interviews were subjected to qualitative analysis in order to extract specific provocative propositions regarding the programme from all participants. These propositions were carried forward for further inquiry in the form of a questionnaire distributed to all participants in the programme. The responses to the questionnaire were summarised, reflected upon and then concretised in the form of fifteen proposed changes to the programme as delivered. The presentation includes a series of personal commentaries by the author and concludes with a reflection upon the learning outcomes and implications of this project for the personal development of all senior practitioners, the profession of psychotherapy and counselling, the world of education and the wider social context.

Kim Etherington

Professional Role: Lecturer/Practitioner
Institution: University of Bristol
Contact details: 11 Old Sneed Park, Bristol, BS9 1RG
Email: kim@effingpot.com

ABSTRACT: Paper

Strand: Counselling Relationships

'Writing Qualitative Research - A Process of Integration'

Aim:
To explore the counselling relationship and process of recovery with two-ex clients

Method:
Two ex-clients who are brothers, and myself, met together and collaborated on a creation of a book about working with adult male survivors of childhood sexual abuse. We used narrative methodology, using counsellor reflexivity and heuristic process. The study took approximately one year.

Findings: N/A - the process was the outcome

This presentation is a reflection and discussion on the integration that may occur when we use ourselves in heuristic research. It focuses on a study which I undertook with two of my ex-clients who are brothers, and their journey towards healing, particularly focusing on their experience of counselling as part of that journey. As their counsellor, and the main researcher, my story inevitably intermingles and overlaps with theirs. My 'selves' as woman, survivor, client, counsellor, researcher (and numerous other selves) and their selves a survivor, man, client and researcher, are impacted by the collaborative, experiential nature of this work. Issues of power, control, safety, boundaries and informed consent echo many of the client issues we all struggled with in all aspects of our 'selves'. I intend this presentation to be informal and collaborative - it is a continuous process of reflection to which I invite you. Your questions, reflections, experiences will undoubtedly enrich the process

Stephen Goss

Professional Role: Research Development Manager and Counsellor
Institution: BACP and Strathclyde University
Contact details: BACP, 1 Regent Place, Rugby, Warwickshire, CV22 6LD
Email: stephen_goss@bacresearch.co.uk

ABSTRACT: Paper

'Strategic research needs in counselling and psychotherapy: What now? What next?'

Aim:
The purpose of this brief paper is to stimulate discussion regarding the research related needs of the counselling profession as a whole in the current climate of evidence based care. In particular, it will raise questions regarding the development of a strategic 'research agenda' for our profession. Such questions might include,

• What areas would benefit most from a pooling of current research findings?
• What topics could be most usefully submitted to systematic reviewing?
• What areas have the greatest need for primary research?
• What are the strategic research needs of practitioners in different settings such as primary or secondary health care, education, private practice etc?
• How can these needs best be addressed?
• Other topics / questions may also be addressed during discussion.
• Summary of method(s) used (if possible include number of participants, time period, setting) and other related issues (e.g. weakness/strengths/improvements)

Theoretical investigation and review - no single empirical study reported.

Findings:
We have come a long way from the care and treatment of those with mental illnesses and life problems were treated in the past. However, recent years have seen a number of developments in the research 'map'. These have already had a profound impact on the research needs of all the psychological therapies and will continue to do so. In order to keep up with developments in the evidence based care world, it is vital that the counselling/psychotherapy profession considers in detail where the main research activities should lie.

Jill Hayes

Professional Role: Senior Lecturer
Institution: University of Chichester
Contact details: 57 Downview Road, Barnham, West Sussex, PO22 0EF
Email: wilson.hayes@talk21.com

ABSTRACT: Paper

Strand: Counselling Models

'Processes in dance movement therapy: dance student's perceptions of an experiential dance movement therapy group'

Aim:
Doctoral research (heading for completion this year) into the effects of participation in an experiential dance movement therapy group for students of dance. The research aims to discover perceptions of effects on personal and artistic growth.

Methods:
Qualitative methods of data collection were used for this case study, principally interviewing participants (individually and as a group) and process recording of sessions. Three consecutive year groups of students took part in an experiential dance movement therapy group, which formed part of a module providing an introduction to dance movement therapy. The first two groups were given eight ninety minute sessions, whilst the third group were given ten ninety minute sessions (due to the change from terms to semesters). The number of participants was fifteen, seventeen and nineteen respectively. Most students were in their final year of a BA Dance or Dance and Related Arts.

Findings:
Movement metaphors illustrating relational processes evolved spontaneously. Students explored personal and interpersonal processes through movement and conversation. Therapeutic effects were discovered, principally related to playing and relaxation. Creative use of emotional, imaginal and mental inspiration from the dance movement therapy process was examined.

Conclusions:
Principle benefit of this model was to bring people into intimate relationship with one another via the creation of an accepting playing space. This nurtured both personal and artistic growth via emotional freedom within a safe environment. Whilst many students were aware of how the dance movement therapy process effected their creative work, the researcher identified a need for 1) Focused body work to provide movement material and 2) Guidance on how to use spontaneous inspiration as choreographic material so that the link between these two aspects of the creative process could be demonstrated.

Kathy Hunt

Other Presenters: Geof Alred, Peter Cook, and Maggie Robson

Professional Role: Lecturer in Counselling
Institution: Centre for Studies in Counselling (CESCO)
Contact details: CESCO, University of Durham, School of Education, Leazes Road, Durham, DH1 1TA
Email: K.F.Hunt@durham.ac.uk

ABSTRACT: Paper

'Counting The Beans Or Watching The Pot? How Should We Be Evaluating Counselling?'

Aim: Much of counselling research today reflects a value base of economic demand, and a 'market place' society in which 'scientific' paradigms of research geared to concrete outcomes are seen to offer value for money. As a result, much counselling research contains little of interest to practitioners as it has moved away from the everyday experience of practice. The epistemology of the practitioner is at odds with 'scientific' methods of evaluation. Traditionally, what has emerged is that good practitioners have developed a method based on an understanding of process that is at odds with a hypothetico deductive model of evaluation associated with theory building.

The authors believe that counsellors evaluate counselling process as an inescapable part of that process. The aim of the paper is to make explicit this dynamic, ongoing process, to make visible what is largely invisible but familiar to counsellors. In this way, a formal system for evaluating the process can be devised, acknowledging and building upon the already existing 'unspoken' one.

This research is in process and will be complete in time for presentation. Data has been collected but not yet analysed so an evaluation of methodology and summary of findings are not yet available.

Method

• qualitative research; focus group
• 10 participants

Summary of findings
To follow

Conclusions and Implications
To follow

Stephen M Hunt

Professional Role: Full time research student and Counsellor
Institution: University of Hertfordshire and Central Surgery Bell Street, Sawbridgeworth, Hertfordshire
Contact details: Centre for Community Research, University of Hertfordshire, College Lane, Hatfield, Herts, AL10 ONZ
Email: s.m.hunt@herts.ac.uk

ABSTRACT: Paper

'Learning from the Most Potent of Psychotherapies'

Aim:
The aim of the paper is to throw light on the practice of both psychotherapy and psychotherapy research. This paper has been written in connection with my ongoing research at the University of Hertfordshire into the efficacy of experiential counselling as a treatment for Panic Attack Disorder.

Method:
The paper is a discussion.

Findings:
"The placebo effect" is not a paradox but an incoherent term. Nonetheless, the phenomenon of significant response to placebo use requires explanation in non-paradoxical terms. The explanation put forward in this paper is that the confused notion of "the placebo effect" masks a powerful psychotherapy which can be conceptualized with the coherent term of SMCH. Further, significant response to SMCH is conceptualized as non-paradoxical RMH. As the psychotherapy behind "the placebo effect", SMCH is unsurpassed in its ability to generate self-healing. This is evidenced by decades of consistent, powerful results in both clinical trials and primary health care. It follows that behind the mask of "the placebo effect" is psychotherapy in its most potent form.

Conclusions
An implication of this revision is that the concept of "placebo-controlled psychotherapy research" is revealed as incoherent. This is because the process of placebo use is SMCH, SMCH is a treatment and a research control must be neutral, so cannot be a treatment.

A further implication is for medical research. This is because if "placebo-controlled research" is an incoherent concept, then it serves no useful purpose for any discipline.

Further, SMCH provides the major approaches in psychotherapy with a unique opportunity to enhance their understanding of, and so positively develop the efficacy of, their own practices This is primarily because the potency of SMCH to generate self-healing is a consequence of what the client/patient brings to the treatment rather than theoretical idiosyncrasies of the treatment.

The well-established connection between client/patient expectations and what I call RMH, fails to provide a full/satisfactory account of why SMCH produces RMH. In which case, research is required to establish just what it is that clients/patients bring to SMCH.

Monika Jephcott and Jeff Thomas

Professional Role: Chief Executive and Clinical Director, Communications and Systems Director
Institution: APAC Limited
Contact details: Fern Hill Centre, Fern Hill, Fairwarp, Uckfield, TN22 3BU
Email: Apacorg@aol.com

ABSTRACT: Paper

Abstract: Evidence and Practice

'APAC's Integrated Service Model (AISM) - Gathering Practice Based Evidence - Putting the Evidence into Practice in a Primary Care Setting'

Aim: To validate the efficiency, clinical effectiveness, quality and user satisfaction arising from the use of the AISM. The AISM has been designed as a result of a survey of the needs of 12 PCGs in South East England. This earlier research was carried out in 1999/2000. The objectives of the AISM are to meet the needs of PCG/Ts within the current policies of the NHS, namely:

• Optimise the use of Counselling resources and budgets without prejudicing the quality of patient care
• Provide equity of provision
• Implement Clinical Governance

Methods: Over 250 patients have been counselled in a PCG (20 surgeries-79 GPs) using the AISM over a 6 month period October 2000 - March 2001.

The main features of the hypothesised service that have been tested in practice are:

• The service has been provided using a pool of Counsellors operating across a number of surgeries as opposed to a Counsellor being based at a practice
• Initial assessment, post referral, separated from the main Counselling process
• The recognition of a spectrum of patient needs and the importance of prioritising patients' objectives
• The use of specially developed procedures and software to control Counselling plans, communications between Assessors, Counsellors, GPs and patients

Outcomes have been measured using the CORE Outcome Measure, patient objective attainment, patient satisfaction and GP satisfaction.

Findings: Overall results: 60% increase in the efficiency of using Counselling resources, initially 70 % of the patients counselled have shown significant and clinically reliable improvement. Equity of provision has been improved from 5 to 19 surgeries without increasing costs.

Other findings: There have been many practical problems to be overcome. These will be explained together with some of the solutions.

Conclusions and implications: Our experience shows that a managed and systematised service, such as the AISM, is essential to achieve the requirements of the majority of PCG/Ts.

The authors also recognise that a perfect or ideal solution to providing counselling services within the NHS is not feasible at the present time. However the AISM meets the majority of requirements more effectively than most other service models.

Measuring outcomes using a number of methods including the CORE OM is a fundamental requirement. The most difficult problems to be overcome are concerned with managing change with the practitioners. This implies a willingness of Counsellors and others to change their working practices, the need for integrated communications with GPs and a management that is prepared to try new methods.

The next stage in developing the AISM, which has been designed on a modular basis, is to confirm its scalability with a larger group of patients and practices.

Clare Lennie

Professional Role: Psychology Tutor/Student Counsellor/Ph.D. Student
Institution: Oldham Sixth Form College/Manchester University
Email: clarelennie@supanet.com

ABSTRACT: Paper

Strand: Training and Development Issues

'The Role of Personal Development Groups In Counsellor Training'

Aim:
To investigate the relationship between training time (time spent in Personal Development Groups) and trainee self-awareness. The study also looked at the extent to which trainees were able to transfer learnings from the P.D. group setting to outside of the group environment. The research was carried out in part fulfillment of an M.A. in Counselling Studies at Manchester University.

Method:
A questionnaire was devised based on Connor's objectives for intra and inter personal development (Connor 1884). Eighty-three trainers of counselling were questioned over a year at various points in their training, ranging from the start of the Certificate course through to the end of the Advanced Diploma course.

Findings:
It was found that the relationship between training time and self-awareness was not simple or linear and, contrary to expectations, Certificate trainees seemed to find it easier to transfer their skills to outside group setting when compared to Advanced Diploma trainees. However, these conclusions can be questioned in the light of methodological limitations.

Grounded theory analysis suggested that trainees felt more positively about the P.D. group at the start of the course, then became more negative and finally positive again. This trend was reversed for Advanced Diploma trainees. Unhelpful experiences in the P.D. group centred around themes of emotions, the facilitator, performance, and group composition. Application to practice became more concrete as training progressed.

Implications:
The research has implications for the selection and training of counsellors and, in particular, the development of self-awareness.

The research has provided the basis for further study for a PhD at Manchester University looking at the relationship between personal beliefs and self-awareness.

Isie MacIntyre

Professional Role: Primary Mental Health Care Researcher / counsellor
Institution: University of East Anglia / Local Health Partnerships Suffolk.
Email: isie.macintyre@lhp.nhs.uk

ABSTRACT: Paper

Strand: Supervision Symposium

'Surviving Supervision: What Happens When Supervision Goes Wrong? A Phenomenological Exploration Of The Supervisory Relationship'

Supervision is a fundamental part of counselling and psychotherapy training. It is also a crucial element of ethical practice during training and post-qualification (BAC 2000). The process, functions and activities within supervision have been explored providing heuristic models to aid development of theory and provision of training (Clarkson 1998, Shipton 2000). Also qualitative research of the supervisors experience (Clarkson 1998). However, research into supervision from the perspective of the trainee counsellor is somewhat limited. There are many different models of supervision (Clarkson 1998, Hawkins & Shohet 1989, Inskipp & Proctor 1993, Stoltenberg & Delworth 1987). The rhetoric of counselling supervision suggests that if supervision is happening as it is described through these models then the supervision should be a positive and productive experience. However, supervision depends on relationships and the quality of the supervision relationship can vary enormously. Despite good training for supervisors and desires by both parties for the supervision to be 'professional', providing an educative, developmental, and supportive function to facilitate ethical practice (Harris 1989, Page & Woskett 1994), the actual 'lived' experience for either party may be somewhat different.

This paper explores the experience of trainee counsellors where this supervisory relationship appears to be more complex, and distressing, than was expected. The data consist of taped, verbatim interviews over a three year period where the trainees talk of their experiences of supervision. Additional use is made of course literature and field notes of conversations and ethnographic participatory researcher experience. Initially, the analysis will use the integrative psychodynamic / person-centred model of the course to analyse and explore the data. Subsequently, a deconstructive approach will be used for analysis and discussion (Derrida 1997, Parker 1999). Through these analyses a reflexive approach to the articulated phenomenology of the experience will be mapped providing a range of explanations to inform theory-building around the act of supervision within counselling (Hicks & Wheeler 1994, Wheeler & McLeod 1994).

Peter Martin

Professional Role: Therapist in Private Practice
Institution: ACW
Contact details: 52 Ethelburt Avenue, Bassett Green, Southampton, SO16 3DD
Email: Peter.Martin.Training@cwcom.net

ABSTRACT: Workshop

Strand: Training and Developing Issues

'The Therapist As A Person: How Do Life-Events And Life Crises Affect Our Work With Clients?'

This workshop is designed to be a theatre for the kind of self-reflexivity associated with Gidden's notions of learning. It takes as its motif the idea that the therapist changes all the time, sometimes even during the course of one client's therapy. Such events a divorce, bereavement, loss or gain of faith, disciplinary procedures etc. make a huge impact on the work of the practitioner, and thus on the client. Some early work has been done on this topic in a collection of papers by Gerson (1996). My research uses a specifically heuristic design and invites reflection from co-researchers. My own story features in this design so the outcome is likely to be tentative, suggestive and may function more as an invitation to discourse as opposed to a claim to discovery. The workshop for BACP is also planned as an invitation to discourse.

Outline of content

1. The meagre literature on the therapist as a person.
a) The Wounded Healer.
b) The stages of professional life (
c) The pre-training/selection profile of the practitioner.
d) Gerson's paper (1996).

2. An outline of my research.
a) Inspiration - brief biography.
b) Events that impinge and change.
c) Feedback from one client.
d) A brief note on heuristic methodology in the context of hermeneutic epistemology. (Moustakis 1990).

3. Discussion and counter views about what so far prevented (e.g. the argument for the prophylactic effects of training and supervision; schools, interpretations such as countertransference or positions such as humanistic, or transpersonal and other existential explanations of the phenomenon.

4. Paired work on the perceived effects of own life-trajectory on particular clients. Some appropriate feedback.

Conclusion - therapy as a moving feast. The place of ethics, regulation self-monitoring, but also the possible benefits of concurrent lives.

Barry McInnes

Other Authors: Rachel Murray

Professional Role (BI): Head of Royal College of Nursing Counselling Service/Counsellor, RCN Counselling Service
Institution: Royal College of Nursing
Contact details: RCN, 8 - 10 Crown Hill, Croydon, CR0 1RF
Email: barry.mcinnes@rcn.org.uk

ABSTRACT: Workshop

Strand: Using CORE in Evaluation

'Using CORE To Evaluate Workplace Counselling: Process, Pitfalls, Challenges and Opportunities?'

Workshop aim:
This workshop will present the latest findings of a two year ongoing process of audit and evaluation of the Royal College of Nursing's Counselling Service using the CORE system and discuss the implications for workplace counselling services of routine evaluation of this kind.

Under the themes of process, pitfalls, challenges and opportunities, we will use this time to share with participants some of the learning gained from our experience of implementing the CORE system within a workplace context.

We will present some of our key findings to date, focusing on aspects of client outcomes and client and service profiling and benchmarking. Together with workshop participants, we will discuss the implications of routine audit and evaluation for services, and address a range of possible questions such as:

Is routine audit and evaluation of service effectiveness and efficiency feasible?
How acceptable is the CORE system to clients and practitioners?
Does outcome measurement help or hinder the therapeutic process?
How can routine audit be used to enhance service quality?
What works, what doesn't and what would we do differently?

This is not a definitive "how to" workshop - we will instead suggest a pragmatic approach to data collection and utilisation using CORE, based on the characteristics and needs of individual services. We aim to draw on the perceptions, experiences - and perhaps anxieties - of participants, and hope that it will be of interest to service managers, practitioners, researchers and others. While the focus of our study has been the workplace application of CORE, many of the issues raised by its implementation may be of direct relevance to other counselling and therapy domains.

John Mellor-Clark (workshop)

Professional Role: Visiting Senior Research Fellow
Institution: Psychological Therapies Research Centre, University of Leeds
Contact details: 47 Windsor Street, Rugby, Warwickshire, CV21 3NZ
Email: j.mellor-clark@freeuk.com

ABSTRACT: Workshop

Strand: Using CORE in Evaluation

'Can CORE-PC Help to Monitor and Develop Counselling Service Quality?'

Aim: The overall aim of the workshop is to profile a new support product for practitioners using (or thinking of using) CORE System measures. CORE-PC is a user-friendly, dedicated database that requires no experience of data entry or database structures. It has been designed in consultation with current CORE System users, and aims to maximise the yield from audit, evaluation and outcome measurement activity for enhancing service quality and informing personal development. The workshop structure aims to offer participants first-hand experience of data-entry, data summation, and national service quality benchmarks.

Summary of method(s) used: The workshop will be divided into three self-contained sections. In the first section, the structure and functions of CORE-PC will be demonstrated using a pre-loaded data set of counselling practice that offers service quality benchmarks. In the second section, volunteer participants will have the opportunity to enter and analyse sample data for themselves. The final section will be an interactive session to involve all participants in a discussion in the benefits of CORE-PC for routinely monitoring the quality of service provision to assist supervision and inform continuing professional development (CPD).

Primary learning objective: Traditional approaches to counselling service monitoring have often used substantial resources to amass non-standardised data over a considerable period of time. Unfortunately, the resultant data often have limited capacity for informing reflective practice, and developing counselling service delivery. It is intended that this workshop will provide participants with the opportunity to assess the benefits of an alternative approach. The primary workshop learning objective is to offer participants opportunity to assess CORE-PC as a standardised resource to assist routine service monitoring that provides instant access to summary data that can be compared to national service quality benchmarks. It is hoped that all participants will continue to appraise CORE-PC for themselves by taking the opportunity of applying for a free-trial inspection copy.

John Mellor-Clark (paper)

Professional Role: Visiting Senior Research Fellow
Institution: Psychological Therapies Research Centre, University of Leeds
Contact details: 47 Windsor Street, Rugby, Warwickshire,
CV21 3NZ
Email: j.mellor-clark@freeuk.com

ABSTRACT: Paper

Strand: Evidence and Practice

'Monitoring and Developing Service Quality in Primary Health Care'

Aim: The study had two overall aims. Firstly, to assess the feasibility of collecting large standardised data sets across a range of sites. Secondly, to explore the utility of resultant data for developing service quality and practitioners' continuing professional development.

Method: The study collected CORE System data from a sample of approximately 150 counsellors working in over 200 different primary care settings over a 12 month period. The resultant data set profiled 2800 referred patients.

Summary: The presentation intends to present a profile of: (1) the types of problems presenting for primary care counselling; (2) the types of interventions used: and, (3) the levels of counselling effectiveness. Considerable differences were found between the range of participants, and these will be addressed to reinforce the yield from the use of standardised data sets used across a wide range of counselling service provision.

Conclusions and implications: The conclusions to the study suggest that counselling in primary care has the potential to be a highly effective intervention for a wide range of common presenting difficulties in primary care. Demonstrations of individual service differences will be highlighted to help assess the implications of increased use of standardised tools for monitoring counselling effectiveness and service quality.

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. 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 to this activity, National Health Service (NHS) policy documentation has introduced a series of initiatives to enhance service quality throughout healthcare. This has placed a premium on routine audit, evaluation and outcomes monitoring for the development and dissemination of practice-based evidence. In this presentation, an initiative will be outlined that tested the feasibility and utility of using a standardised 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. The conclusions will be discussed in the context of the NHS's commitment to monitoring National Service Framework Standards for Mental Health Service delivery.

Tim Pittock

Professional Role: Counsellor, Student Counselling Service
Institution: University of Bristol
Email: TimPittock@msn.com

ABSTRACT: Paper

Strand: Counselling Relationships

'Beyond the words ...'

This study set out to examine the impact upon the counsellor of the therapeutic relationship. An inquiry into the experience of counsellors working in further and higher education was undertaken using a heuristic approach. The aim was to explore and compare the personal rewards, costs and legacy for counsellors working in this field.

Conversational interviews were conducted and recorded on audio tape. Each participant was invited to amend their interview transcripts and to comment upon the process. A research journal was maintained. Heuristic principles and narrative analysis techniques were used to distil portraits of each participant and to form a creative synthesis as a statement of their combined counselling experience.

The investigation affirmed the significance and value of the therapeutic relationship. A major theme of congruence or genuineness was revealed. A sense of authenticity, both in the reported experiences from counselling practice and the immediacy of the engagement between researcher and researched, is evident. The process of the inquiry has therefore proved to be a parallel process to what was being investigated. Congruence is revealed as a process which includes the spoken words and also that which transcends them. The unspoken in the presence of an authentic other imbues both meaning and health.

Recommendations for the counsellor focus in the area of personal development and self-knowledge. Awareness of the need for personal exploration and growth in a setting and context of safety is commended. There are implications here for a) counsellor training programs, and b) the level of support for counsellors in their practice setting. There is further opportunity, to celebrate the role and work of the counsellor in the existential rhythm of the life within and the culture, time and place of our being.

Paula Pope

Professional Role: Senior Lecturer in Youth and Community Work
Institution: Liverpool John Moores University
Contact details: School of Law and Applied Social Studies, 1 Myrtle Street, Liverpool L7 4DN
Email: p.m.pope@livjm.ac.uk

ABSTRACT: Paper

Strand: Counselling Young People

'Empowering Practice in Counselling Young People and Adults'

Aim:
The purpose of this qualitative study was to gather first hand descriptions of the characteristics of helpful listening that contributed to feelings of empowerment for the thirty young and adult participants. Analysing the themes across the age groups could lead to identifying some shared and contrasting age-specific 'stages of empowering counselling'.

Methods:
The questionnaire was administered to each participant through semi-structured interviews during spring 2000. After sharing their perceptions of counselling and experiences of empowerment, participants looked at the counselling relationship from the perspectives of both counsellor and client. Their commentary on the stages of the listening process that would lead to the client becoming more empowered was written down verbatim and later analysed and coded for themes.

The interview process and procedures, though time consuming, enabled a relationship to be established. Any areas of uncertainty could be clarified directly as the same person interviewed all the participants. The low numbers in the survey (9 young people and 21 adults) means that these are tentative findings.

Findings:
The main findings on the 'stages of empowering practice' reveal the significance of:

• creating a warm welcome for the client
• a sensitive response to client's anxieties
• affirmation and encouragement
• discussing confidentiality and agreeing a contract
• understanding the testing out in new situations
• valuing the contribution of the client
• active listening skills
• facilitating the listening process
• enabling experimentation with support
• acknowledging the work undertaken, and
• being open to future work

Implications:
Some factors were markedly more important for young people than for adults. The implications of these initial findings, as indicators of stages of empowering counselling, will be discussed.

Jane Power

Professional Role: Counsellor/Supervisor in Independent Practice; Counsellor in Primary Care
Institution: Burnley Health Care NHS Trust
Contact details: Hebden Bridge Centre for Natural Medicine, 33 West End, Hebden Bridge, West Yorkshire, HX7
Email: janepower@beeb.net

ABSTRACT: Paper

Strand: Supervision Symposium

'The Other Side Of The Coin: Experienced Counsellors Reflect On 'Being A Supervisee''

The research was part of a Masters in Counselling Studies at Manchester University, whose aim was to broaden understanding of the supervision process by exploring what supervision means from the perspective of a small group of experienced practitioners. A phenomenological approach was taken in this qualitative study of 21 BACP members. Participants replied to a postal questionnaire in two parts: A) to the question: "What does being a supervisee mean?" and B) to 40 questions about themselves, their supervision and their supervisors. The main method of data analysis was categorising participants' statements in Part A by frequency. The high volume of data generated meant that only one interview was used, for triangulation.

Theories of supervision include three common elements: managing, teaching, and supporting. Supervisees' statements gave the largest emphasis to Emotional Support (17.7%), with much less to Good Management (7.8%) and Learning (3.7%), sixth and ninth of fourteen categories. The second largest category related to negative feelings caused by Bad Management (14.3%), the third to Contextual and Organisational aspects (9.5%), and the fourth to supervisees' Professional Development or Style (9%). Client Work was fifth (8.1%), the Person to Person relationship was seventh, (7.4%), and Supervisor Style/Orientation was eighth (6.6%).

The reasons for these findings were discussed. Checklists were presented to promote supervisee-centred evaluation of supervision. A seeming lack of cultural awareness in supervision was noted, and a conceptual framework for culturally aware supervision presented. Given the emphasis found on support needs, research was suggested focusing on the emotional work counsellors do; and given the prevalence of negative feelings about supervision shown, it was suggested BACP evaluate by research the quality and effectiveness of 'life-long' supervision undertaken under its auspices, to help understand factors affecting supervisee experience and supervisor performance.

Andrew Reeves

Other Authors: Sue Wheeler, Ric Bowl

Professional Role: University Counsellor
Institution: University of Liverpool
Contact details: University of Liverpool Counselling Service, 14 Oxford Street, Liverpool, L69 7WX
Email: areeves@liverpool.ac.uk

ABSTRACT: Paper

Strand: Training and Development Issues

'The Training of Counsellors in Risk Assessment and Risk Management: A Questionnaire Study'

Through the development of policy and practice counselling continues to be an important component in health delivery. Primary Care and Health Trusts, Psychiatry and Higher Education all respond to people with psychological disturbance amongst their client/patient populations and thus also respond to varying degrees of risk. The identification and management of risk is an important issue for counsellors to consider in terms of their ethical accountability to clients and their duty of care.

The aim of this questionnaire survey was to ascertain attitude and teaching amongst BACP accredited counsellor training programmes in terms of risk identification, assessment and management. Risk was defined as risk of suicide, life-threatening self-injury and of violence to others. Questionnaires were sent to those courses accredited by BACP at the time of the study. There were 24 respondents from a total of 49 possible (48.9%)

The questionnaire was based on a Likert summated scale and aimed to gain insight into the conceptualisation and perceived relevance of risk management in the teaching of trainee counsellors. Attitudes were explored in three distinct areas: "issues of training for counsellors in risk and mental health", "knowledge and skills of risk for counsellors", and "counselling as a profession in relation to issues of risk".

The results suggest that concepts of risk are seen as important components of counsellor training, although there appeared to be less emphasis placed on the development of skills within course teaching. Risk awareness was identified by several respondents to be located in the supervisory relationship, rather than in the formal taught programme. Additionally, the issues pertinent to the risk of harm to self seemed more focused than the risk of violence to others.

This research highlights further areas for exploration, including risk and contracting, and the role of supervision in the teaching of risk ideology and methodology.

David Rennie

Professional Role: Professor
Institution: York University, Canada
Contact details: Department of Psychology, York University, Toronto, Ontario, Canada M3B
Email: drennie@yorku.ca

ABSTRACT: Paper

'The Client as a Self-Aware Agent in Counselling'

This paper will be derived from the reports of 14 clients on their moment-to-moment experiences of an hour of counselling. Clients' recollections of their experiences were stimulated by replay of a tape of their counselling session. The reports were analyzed in terms of the grounded theory form of qualitative research. The core category emerging from the analysis is clients' reflexivity, which I have defined as self-awareness and agency within that self-awareness. I came to understand that from moment-to-moment clients reflexively refer to themselves in response to where they at within themselves and to how the counsellor is responding to them. Moreover, this assessment is made within an awareness of the relationship with the counsellor. Within this complex awareness, in a given instant they form an intention and engage in activity in fulfillment of it. The activity may be either the discourse with the counsellor or thinking that is engaged in either between moments of discourse and during pauses in the discourse, or both. This activity is unreflective - what John Searle refers to as an intention-in-action. It comes to a close either because it fulfills the intention or is disturbed in some way. The disturbance may be a negative feeling arising from where the activity has taken clients to as they search for meaning. Alternatively, it may be something that the counsellor says or does. In any case, the client once again becomes reflexive, and the cycle repeats. This paper will present an aspect of clients' experience that I have as yet not addressed, namely their experience of counsellors' techniques. I will show that this experience is influenced by what clients desire, by whether or not they reflexively desire what they desire, and by their relationship with the counsellor. The paper will thus have implications for the working alliance between clients and their counsellors. Moreover, because a surprising amount of clients' activity is covert, the paper will draw attention to the importance of meta-communication so that the client and counsellor can have better access to each other's intentions, in the interest of facilitating this alliance.

Barbara Richards

Professional Role: Director of Counselling Courses
Institution: The University of Reading
Contact details: The University of Reading, Health and Social Care, 77 Bulmershe Court, Woodlands Avenue, Earley, Reading, Berkshire, RG6 1HY
Email: b.m.richards@reading.ac.uk

ABSTRACT: Paper

Strand: Training and Development Issues

'A Study of the Application of Counselling Training within the Workplace: Ripples in the Pond'

Aim:

• To explore ways in which people make use of a counselling training after qualification
• To examine the value of counsellor training when incorporated into a person's established professional role
• To investigate how a person's counselling training contributes to the development of their professional role

Methods:
Questionnaires were sent to people who had graduated from an MA/Diploma in Counselling in the past 10 years, to identify those who had continued in their core profession following training. Respondents were asked if they would be willing to take part in a focus group and/or an in depth exploratory interview.

Twelve respondents were identified as fulfilling the criteria for the second stage. These worked in a variety of settings where the prime role was other than counselling, including social work, health care, teaching, management, consultancy, priesthood, and probationary service.

Six respondents were invited to a Focus group meeting at the University of Reading. Semi structured interviews were conducted with six further respondents.

Findings:
Some common themes emerged:

• Insight which has facilitated and, for some, transformed work with their 'client' group
• Understanding and working with the organisations of which they are a part
• Working with colleagues
• Facilitating change
• Counsellor training as part of a developmental process
• Counsellor training as a challenging personal growth experience
• Frustrations

Conclusions
For the 12 people involved in this study it appears that counselling training has impacted on all aspects of their work role. The results indicate that there can be a benefit of such training in the workplace and that trained people have much to offer. This has implications for employers and for the trainers of counsellors. A larger scale study, amongst graduates from a number of courses and also amongst employers is indicated.

Suzanna Rose

Professional Role: Project Leader
Institution: West Berkshire NHS Traumatic Stress Services
Contact details: West Berkshire NHS Traumatic Stress Services, Erleigh Road Clinic, 25 Erleigh Road, Reading, Berks. RG1 5LR
Email: suzannar@wbpcs-tr.anglox.nhs.uk

ABSTRACT: Paper

Abstract: Evidence and Practice

'An Update Of The Cochrane Collaboration Review On 'Debriefing' Following Trauma - Presentation Of The Data And Implications For Good Practice'

A systematic review was undertaken of brief early psychological interventions following trauma (Rose and Bisson 1998) and that work formed the basis of a new Cochrane Collaboration protocol and subsequent review (Wessely, Rose and Bisson 1997). Recently, a substantive amendment has been made to this Cochrane Review. Four further randomized controlled trials have been included in the updated review. These new studies are again of individual psychological debriefing in various settings and include a 3 year follow up of an earlier trial. Overall the outcome was again considered neutral and methodological quality varied widely. Again no trials of group debriefing were discovered. The data and the process of updating a Cochrane Review will be presented. Additionally, the implications for good practice in this area, given the continued lack of evidence to support the current practice of debriefing, will be discussed.

Linda Sakr

Professional Role: Intercultural Therapist
Institution: NAFSIYAT
Contact details: 12 Phillimore Court, Campden Hill Road, London W8 7DS
Email: Lindu35@yahoo.com

ABSTRACT: Paper

Strand: Cultural Issues

'Multicultural Counselling: Some Considerations Of Working With Arab Immigrant Clients'

Aim: The study attempts to examine the extent of self-disclosure in counselling/therapy of Arab immigrant clients in London. As Western societies become increasingly multicultural, there has been a growing recognition that the practice of Western-style therapies may not necessarily be effective nor appropriate for the treatment of people from different cultures (Toukmanian & Brouwers, 1998).

The writing of this project is a reflection of my own experience of living in the Arab world as well as living in the West. Growing up in the Arab world, I had accepted many facets of self-disclosure as the conventional way of life. For example, avoiding disclosure of familial conflict to anyone. After coming to live in the West however, as a University student, my ability to examine these values form an 'etic' (outsiders) perspective, allowed me to question the benefit of counselling/therapy for Arabs.

Summary: Nine interviews were conducted with nine counsellors/therapists, from various backgrounds. Six of the participants were female and three were male. Four interviews took place at the therapists' houses, three took place at a therapy centre, one took place at a hospital and one took place at a University. Each interview lasted around an hour and a half.

Grounded theory was the mode of qualitative analysis for this study. This approach was the most suitable in facilitating categorisation of the data, as well as the identification of relationships between categories.

Summary of Findings:

(1) A theme that consistently emerged is 'shame' and 'guilt' associated with self-disclosure. Disclosing familial conflict is considered a form of betrayal of the family.

(2) The concept of 'somatisation' as opposed to 'psychologisation' of problems was particularly emphasised.

(3) Arab clients tendency to view things as 'genetic', 'fixed', 'in the hands of Allah' (God). Therefore help is more likely to be through a hakeem or exorcist.

(4) The importance of collectivism and self-disclosure can be viewed as being very supportive as well as very painful.

Conclusions: This research concentrated on Arabs as a general rule. The term Arab, however, covers a large group of people all of subtly different cultures. One of the influences that may have affected the interpretation of the data is my own background as an Arab. Future research should focus on the existing conflict between the counselling culture and the Arab culture. This can be achieved by examining different counselling approached that seem to incorporate Arab cultural values.

The results of this study, indicated that Arab self-disclosure is usually linked to 'guilt' or 'shame' and the importance of 'collectivism'. However, the preliminary and open-ended nature of this analysis, must be acknowledged since the present study was a short-scale research attempting an initial exploration of Arab immigrant clients' self-disclosure tendencies.

Vicky Seddon

Professional Role: Senior Counsellor
Institution: Sheffield Hallam University
Contact details: Counselling Service, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB
Email: v.seddon@shu.ac.uk

ABSTRACT: Workshop

Strand: Cultural Issues

'Reflecting On Our Practice: Why Have The Number Of Ethnic Minority Clients Increased?'

In the Counselling Service here, where we currently see more than 500 students a year, we noticed, during 1998/99, a dramatic increase in the number of ethnic minority students using the Counselling Service, in particular, the number of male students. This is interesting in itself, but beyond the numbers, we currently have no further information about patterns of usage by these clients. As a counselling practitioner, I have undertaken to review the usage of all self-identified ethnic minority home-based clients who used the service in 1999/2000.

We keep a basic record of counselling provided which includes the number of clients using the service over specific time periods, which informs this presentation. I will be exploring issues in methods of collecting and verifying data in a busy service which has limited