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BACP's 12th Annual Research conference was entitled 'The consumer and counselling research' and took place on 19-20 May 2006. It was held at Glasgow Marriott Hotel, Glasgow in association with The University of Strathclyde.

Friday opening address and keynote

John McLeod

Professional Role: Professor of Counselling
Institution: University of Abertay Dundee
Contact details: Institute of Health Studies University of Abertay Dundee
Email: j.mcleod@abertay.ac.uk

ABSTRACT: Friday opening address

Research into the outcomes of counselling and psychotherapy: refocusing the debate

Investigation of the outcomes or effects of counselling and psychotherapy has remained a key focus of research activity within the profession since the 1950s. The importance of this domain of research has been heightened by the adoption of evidence-based practice policies by health providers in the U.S.A, U.K. and elsewhere. In the main, the trend has been for research that has been carried out into therapy outcome to have consolidated around the use of randomised controlled trials (RCTs) as a preferred methodology, in which the effectiveness of different therapy models is compared using a comparison of pre- and post-therapy scores derived from standardised questionnaire measures. However, in recent years, the work of Bruce Wampold, Drew Westen and others, has suggested that the vast investment of time, money and effort into this kind of research has failed to provide a secure knowledge base that meets the needs of users and audiences of research. The key issues that have emerged within this debate will be briefly reviewed. A number of solutions to these issues have been put forward, including adoption of a practice-based evidence approach and accumulation of pragmatic case study evidence. The advantages and disadvantages of each of these research strategies will be outlined. It is argued that the counselling and psychotherapy community in the U.K. needs to decide where it stands in relation to the debate over outcome research. The important question of who are the consumers of outcome research needs to be addressed - up to now, this domain of research has been dominated by the perceived requirements of policy-makers, rather than other research audiences. Finally, it is suggested that it is essential for the profession to engage in deeper reflection, analysis and inquiry into the concept of outcome. Almost all of the research that has been carried out into the effects of counselling and psychotherapy has operationalised outcome as change in therapist/researcher-defined categories (such as depression or anxiety). It is likely that inquiry into user-defined outcomes has the potential to generate a new type of knowledge that would be of value to multiple audiences.   

Professor Paul Salkovskis

Professional Role: Professor of Clinical Psychology and Applied Science/Clinical Director
Institution: King's College, London Institute of Psychiatry/ Centre for Anxiety Disorders and Trauma, Maudsley Hospital
Contact details: Department of Psychology (PO Box 077), Institute of Psychiatry, Kings College, London, De Crespigny Park, Denmark Hill, London SE5 8AF
Email: P.Salkovskis@iop.kcl.ac.uk

ASBTRACT: Friday keynote

Giving people what they want; empirically grounded psychological therapy

The future development of talking therapies may be a simpler matter than it seems. Service users will play an increasing role in deciding how services are deployed, and which types of therapy continue to be offered. At present, there is a bewildering range of approaches, and those not only those wishing seek therapy but also those who wish to offer it may find it problematic to decide which to choose.

Evidence-based approaches have clarified although not entirely solve this issue. Although the drug metaphor embodied in pure evidence based approaches has been helpful when applied to psychotherapy, it has also been misleading particularly in terms of developing and refining brief psychotherapy. It is proposed that good psychotherapy is a skillful blend of clinical art and clinical science. The approach is particularly well characterised by the concept of "empirically grounded psychological therapies", implemented in ways which allow the patients to participate in the choice of treatment. It is proposed that giving people what they want needs to involve helping them engage with evidence-based patient choice as a type of shared decision making.

These principles are illustrated in the context of the highly successful application of cognitive approaches to the understanding and treatment of anxiety disorders. The importance of specificity in understanding treatment and training of therapists will be illustrated using research findings and clinical examples. Implications of the research described will be considered. These include the value of formulation-based (rather than diagnosis-based) approaches and the need for the development of dissemination and stepped care models. The difficult issue of inertia in those currently practicing psychological therapies will also be addressed. It is concluded that a profession which prides itself on helping people to change should be able to identify its own need for change and react accordingly.

Saturday opening address and keynote

Mick Cooper

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: Counselling Unit, University of Strathclyde
Email: mick.cooper@strath.ac.uk

ABSTRACT: Work in Progress (abstract for joint presentation - also see John McLeod)

Establishing a counselling research clinic in the UK based on a pluralistic model of therapeutic change

Abstract: Within the vast majority of counselling and psychotherapeutic paradigms - as well as research programmes - therapeutic change is accounted for by just a handful of processes: for instance, the correction of dysfunctional cognitions. However, the research and practice of the newly-established Tayside Counselling Clinic (a counselling centre in which clients have an opportunity to participate in a range of research protocols), starts from a very different basis, and one more in tune with a post-modern zeitgeist: that therapeutic change can happen via a plurality of diverse and non-exclusive pathways.

Having introduced this 'pluralistic' model of therapeutic change, the paper suggest that the process of counselling and psychotherapy can be broken down into a series of inter-related collaborative activities: (i) understanding the underlying problem in living that has lead the person to seek therapy; (ii) identifying what the person wants - their goals for therapy; (iii) agreeing on specific therapeutic tasks that would be necessary for the achievement of these goals; and (iv) selecting and implementing appropriate methods that will enable these tasks to be carried out. What happens at each of these stages has the potential to be linked to a multiplicity of elements at the other stages. For instance, a client's goal may be to 'like myself more', and this may be achieved by a range of tasks - for instance, identifying negative self-beliefs or behaving in ways which are known to bolster self-esteem - each of which may be achieved through a variety of methods.

Therapeutic implications of this model will be discussed, but the main focus of the presentation will be on the potential that this model has to provide a radical new grounding for counselling and psychotherapy research. This is because it provides an opportunity to move beyond 'macro-level' analyses of how certain methods relate to certain outcomes, and instead allows for the 'micro-level' analysis of which methods can be used to achieve which tasks, which tasks help to achieve which goals, and which goals help in the overcoming of which problems - an analysis which is best undertaken through in-depth qualitative research. This process will be illustrated through data from a recent study into young people's experiences of counselling in schools.

John McLeod

Professional Role: Professor of Counselling (JM)
Institution: University of Abertay Dundee
Contact details: Institute of Health Studies University of Abertay Dundee
Email: j.mcleod@abertay.ac.uk

ABSTRACT: Work in progress (abstract for joint presentation - also see Mick Cooper)

Establishing a counselling research clinic in the UK based on a pluralistic model of therapeutic change

One of the main reasons why counselling and psychotherapy research in the U.K. has lagged behind developments in the U.S. and Europe is because of the lack of dedicated research clinics. Not only do such clinics provide a unique opportunity to examine therapeutic processes and outcomes in an intensive and controlled way but they can serve as a hub of research activity, drawing together and strengthening a community of counselling and psychotherapy researchers. This paper will present the first-hand experiences of a group of academic-practitioners who have recently established a major new counselling research clinic in Dundee: The Tayside Centre for Counselling. The paper will discuss a range of practical issues involved in the setting up of such a clinic, including:

• obtaining funding
• arranging suitable accommodation
• manualisation of practice
• recruiting trainee counsellors
• liaising with GP surgeries
• managing the project
• ensuring that research is informed by a user perspective
• the relationship between the clinic and the wider professional community - for example, how to allow access to methods and data
• the relationship between research, and providing a counselling service
• research priorities - what are the most important questions to be pursued?
• the value of adopting a pluralistic counselling model, rather than carrying out studies that compare different approaches to therapy
• the ethics and morality of carrying out randomised trials
• advantages and disadvantages of team-based research
• the role of BACP in promoting research clinics.

The paper will also discuss key issues surrounding the development and implementation of research protocols, introducing the Clinic's first major research initiative: an in-depth qualitative study of therapeutic outcomes. This presentation will be of particular value to researchers and practitioners interested in the possibility of setting up a counselling and psychotherapy research clinic. 

Professor Liz Bondi

Professional Role: Professor of Social Geography and Co-Director of Counselling Studies
Institution: Institute of Geography (School of GeoSciences) and Counselling Studies (Sch of Health in Social Science)
Contact details: Geography, The University of Edinburgh, Drummond Street, Edinburgh EH8 9XP and Counselling Studies, School of Heath in Social Science, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG
Email: liz.bondi@ed.ac.uk

ABSTRACT: Saturday Keynote

Filling gaps or feeling gaps? Dilemmas for counselling researchers in an age of consumption

Research is often described and justified in terms of filling gaps in knowledge. The idea that counselling research responds to a variety of consumers is consistent with this point of view. Participating in this model of research brings benefits to counselling research but it is also fraught with dangers. This paper explores some of the ensuing dilemmas faced by counselling researchers. In so doing it argues for an approach to research that holds in mind the practice of counselling, including the insights it offers about the tension between filling and feeling existential gaps.  

Abstracts

Joe Armstrong

Professional Role: Lecturer in Counselling
Institution: Tayside Institute for Health Studies
Contact details: Tayside Institute for Health Studies, Dudhope Castle, Dundee, DD3 6HE
Email: joe.armstrong@abertay.ac.uk

ABSTRACT: Paper

Finding a voice: a qualitative study exploring the meaning and experience of becoming a volunteer counsellor

Background: Volunteer counsellors contribute significantly to the delivery of psychological therapy in Britain and other countries as well. This raises questions about, among other things, how volunteer counsellors develop competence and awareness, and the type and level of training and supervision required to achieve good client outcomes.

Aim: To explore a group of volunteer counsellors' experiences of training, entering practice and client work during their first year of practice.

Method: Eight minimally trained/experienced volunteer counsellors working within a voluntary sector mental health agency were interviewed for approximately one hour at the end of their first year of counselling practice. Interviews were semi-structured, tape-recorded and transcribed and analysed using a grounded theory approach.

Results: The meaning/experience of becoming a counsellor, entering practice and client work was constructed through five main categories: "resonating"; 'expressing and inner voice'; 'learning a language'; 'engaging in helping/therapeutic conversations'; and 'experiencing and resolving dissonance'. These main categories were contained within an overarching core category, 'finding a voice', a metaphor which denotes a process of discovery that references the person's initial encounter with counselling or helping 'in the broadest sense' and subsequent quest to achieve an identity as a counsellor.

Conclusions: "Finding a voice" can be regarded as a process that (volunteer) counsellors engage with in an effort to express 'self-as-counsellor'. The extent to which individuals 'find a voice' relates to them being able to establish a framework for practice within the context of the agency's expectations and culture, and which also accommodates their aspirations, motivations, needs, values and personal philosophy of life/helping. This process involves the experiencing of and successful resolution of dissonance or emotional conflicts in order to continue to engage in volunteer counselling and develop an identity as a counsellor 'the cycle of engagement'. These findings have implications for the selection, training and support of volunteer counsellors.

Liz Ballinger and Dr Jeannie Wright

Professional Role (LB): Senior Lecturer
Institution: Nottingham Trent University and Manchester University
Contact details: School of Education, University of Manchester, Oxford Rd, Manchester M13 9PL
Email: Liz.ballinger@ntu.ac.uk

ABSTRACT: Work in progress symposium

Does class count: what significance do counsellors attach to social class?

Research rationale: Both researchers identify themselves as coming from working class backgrounds and as holding a personal and practice-based interest in social class. Wider studies confirm the continuing significance of class in shaping life-style and life chances and, hence, its potential importance to the counselling process. This sits alongside our perception that class is accorded little interest in counselling texts and research, an impression confirmed by a review of British counselling literature.

Research design: The first stage of the research process involved an invitation to interested counsellors to join a Co-operative Inquiry Group to explore their perception of the significance of social class. This method was chosen as it reflected the researchers' priorities in terms of:

• Facilitating a collaborative, non-exploitative research process
• Enabling the development of an organic, evolutionary research process
• Creating a climate for an exploration of subjective experience and understanding.

Following two introductory meetings, a series of six meetings took place, three fitting into the 'project' and 'encounter' phases of the research cycle, the final three into the 'making sense' and 'encounter' phases. Nine counsellors participated. The three 'project' and 'encounter' meetings of the inquiry group were recorded on audio-tape. The research process has continued subsequently in collaboration with Nottingham Women's Counselling Project and counselling students at Nottingham Trent University.

Sample: Purposive: Invitations to the Co-operative Inquiry Group were sent to interested counsellors in the East Midlands using informal networks.

Results/findings: Findings took the form of agreed descriptions of group experience distilled from the tapes and personal learning statements. These focussed on the continuing significance of class in intrapersonal and interpersonal relating, as well as its significance for counselling. Financial and cultural barriers to access were highlighted. Issues such as the use of language were also raised.

Conclusion: Class continues to be an under-acknowledged topic for discussion and research in counselling.

Jane Balmforth

Professional Role: Counsellor
Institution: University of Strathclyde (MSc student)
Contact details: c/o RSAMD, 100 Renfrew Street, Glasgow G2 3DB
Email: jane@nickwrightplanning.co.uk

ABSTRACT: Paper

Clients' experiences of how a perceived difference in social class between counsellor and client affects the therapeutic relationship

Background: There is already a body of research on how differences between counsellor and client such as race, gender and sexual orientation affect the counselling relationship; social class is a dynamic in the counselling relationship that has received less attention. I am a middle class person, very aware of my mixed middle/working class background, which was my motivation for choosing a class-related study. I am also aware that I bring my class background to the interviewees and to the research as a whole.

Aim: This is a qualitative research project to explore how clients felt a perceived difference in social background had affected their relationship with the counsellor. As a person-centred counsellor I wished to focus on the clients' lived experience of this difference, using a phenomenological study and definition of class. The research has received ethical approval from the University of Strathclyde.

Method: Counsellors and trainee counsellors were sought who had experience of being a client and felt they were a different social background to their therapist. Six participants identified themselves as working class and perceived their counsellor to be middle/upper middle class. Participants were interviewed either by phone or face-to-face using semi-structured interviews. The interviews were tape-recorded and the data transcribed. A thematic analysis was then carried out of the data.

Results: Themes that have emerged so far include clients feeling disempowered, having no connection with the counsellor and withholding parts of themselves in the counselling relationship because of feeling judged. Education, dress and accent were some of the factors that triggered feelings of shame connected to social class and meant the client did not feel able to be him/herself in the relationship with the counsellor.

Conclusions: In these clients' experiences the perceived difference in social background had a powerful effect on the counselling relationship. There were unresolved and unspoken issues of power, and a lack of awareness from the therapists of a working class frame of reference that prevented the clients from feeling accepted and able to develop in counselling. There may be wider aspects of how class is dealt with in therapy for counsellors to consider.

Emma Barnes

Other Author: Dr Kim Etherington

Professional Role: Research Assistant
Institution: University of Bristol
Contact details: University of Bristol, 8-10 Berkeley Square, Bristol BS8 1HH
Email: ejbarnes@aol.com

ABSTRACT: Paper

Problematic drug users' identity construction through relationships and group affiliation during use and recovery

Background: Identity reconstruction within addicts' narratives is seen as being an integral part of the recovery process (Baker, 2000). This paper looks at the development of an 'addict' identity and what clients who have been prescribed methadone tell us about the influence on their changing sense of self and identity of relationships with the people in a community drugs project (other service users, the counsellors they work with individually and in a group setting, and other members of staff). The therapeutic importance of relationships between client and counsellor is well known: this study extends that thinking to include other service users and other drug workers.

Research design: One to one semi-structured interviews and a group interview were carried out in a community drugs project to gain an understanding of the lived experiences of drug use and attempts at recovery. Interviews were tape-recorded, transcribed and then thematically analysed individually by three researchers, who then jointly negotiated the final themes. 22 current and previous clients of a community drugs project in Bristol were approached either by their counsellor, by letter from the project, by 'word of mouth' from other clients or by the researcher at drop-in sessions at the project. Participants were at various stages of recovery and whilst all had a history of poly-drug use over several years, it was their use of heroin that was the focus of their methadone treatment.

Results/findings: Drug subculture group identification initially fostered a sense of belonging for marginalised individuals, but increasingly problematic use had negative effects on relationships, with both non drug-users and other users, and having few supportive relationships led to feelings of isolation. This, coupled with a perceived social stigma, reinforced an 'addict' identity. Counselling sessions, group work and user involvement at the project fostered feelings of connection with others, with clients seeing themselves as actively contributing members rather than just service users. Positive relationships with staff members and the formation of mutually helping relationships with other clients aided self-esteem and led to the adoption of an identity based on a shared norm of staying drug free rather than drug use.

Conclusions: The findings highlight the importance of the social and personal changes that occur through positive relationships formed within a drugs project and the value of user involvement in enhancing engagement and a feeling of agency over treatment.

Reference

Baker, P. L. (2000). I didn't know: Discoveries and identity transformation of women addicts in treatment. Journal of Drug Issues. 30, 4, 863-881.

Commissioned by the Southmead Drugs Project and funded by the European Social Fund.

Ginny Bates

Professional Role: Counsellor
Institution: Inner Care Primary Care Mental Health Team
Contact details: C/o Inner Care Montpelier Health Centre, Bath Buildings, Montpelier, Bristol BS6 5PT
Email: ginny@riseup.net

ABSTRACT: Paper

What's in a name? A narrative inquiry into the relationship between addiction and identity: implications for counselling 'addicts'

Research Question: This study explores the interplay between dominant discourses of addiction and personal narratives of identity in making sense of the experience of addiction.

Research Rationale: 'Every era has a particular configuration of self, illness, healer and technology; they are a cultural package.' (Cushman, 1995: 7) The 'cultural package' that constructs addiction as a behaviour that is 'out-of-control' and 'a disease', is considered through the lens of social constructionism. This study aims to provide a socially, culturally, historically and politically situated account of drug addiction and 'thick description' (Geertz, 1979) of the experience of being 'addicted'.

Research Design: The above issues are co-researched with a former heroin addict, using an individual case study/life story interview to produce a situated account of addiction. Subsequent interviews explored themes relating to addiction and identity arising from the life-story. The researcher is situated within the research by the inclusion of her own personal and professional stories relating to addiction. The researcher invited members of a self-help group for former problematic drug-users at a local drugs agency, to participate in the study. The participant who responded is a white European male, aged 40. A poly-drug user since his teenage years, he became addicted to heroin in his thirties. He was abstinent from heroin for two years.

Results/Findings: Eight hours of interview time generated 30,000 words, which were transcribed and re-presented as co-produced stories in stanza form. It is argued that the participant's personal and local narratives mediated the influence of dominant discourses of addiction on the meaning he ascribed to both the experience of addiction and its claims on his identity.

Conclusions: Addiction is discussed as a socially mediated process. It is suggested that dominant discourses of addiction can give rise to expectations of helplessness in relation to drugs. (Davies, 1997) Alternative metaphors are discussed from narrative therapy. Counsellors are encouraged to pay close attention to issues of identity and to privilege local and personal knowledge over expert knowledge in relation to drugs and addiction.

References:

Cushman, P (1995) Constructing the self, constructing America: a cultural history of psychotherapy Reading, Mass; Addison-Wesley

Davies, J. (1997). Drugspeak: the analysis of drug discourse. Amsterdam: Harwood Academic.

Geertz, C. (1973). The interpretation of cultures: selected essays. New York. Basic Books

Dr Loretta Bradley and Dr Bret Hendricks

Professional Role: Professor and Chairperson
Institution: Texas Tech University
Contact details: Texas Tech University, College of Education, P.O. Box 41071, Lubbock, Texas, 79413-41071
Email: loretta.bradley@ttu.edu

ABSTRACT: Paper

Music therapy techniques in treatment of adolescent depression: A cognitive behavioural study

Research Question: Music listening techniques paired with CBT will be more effective than CBT techniques alone when treating adolescent depression. Additionally, since school attendance and academic achievement are correlated with depression, these areas would be improved through reduction of depressive symptoms.

Research Rationale: One in ten adolescents is depressed and research does not indicate positive outcomes of treatment. Counsellors need strategies which motivate adolescents to actively participate in psychotherapy. Because music is an ever-present part of adolescents' lives, it was hypothesized that music listening could be integrated into a group for treatment of adolescent depression. Further, it was hypothesized that all participants would be positively motivated to complete treatment if they took part in the development of a parent education program about adolescent depression.

Research Design: The independent variables for the study were age, grade level and gender. The dependent variables were measured depression, school attendance and academic achievement. Treatment and control groups used journaling, mood identification, discussion of irrational beliefs and anger management strategies in a group counselling format. The treatment group additionally listened to self-selected music identified by group members as helpful in positively altering moods and discussed ways each member used music in his/her daily life as a coping strategy. The treatment group was assigned music listening as daily homework and each member was asked to keep a journal of the music that he/she listened to. 106 participants were referred by school counsellors in the Southwest US. Treatment took place over 11 weeks (weekly groups of 2 hours); 52 in the treatment group / 54 in the control group with random assignment. 103 participants were Anglo-American. 49% were female. Treatment and control groups were divided respectively into four therapy groups.

Results: 100 participants completed the study and participated in the parent education class after 11 weeks of treatment. All participants (control & treatment) showed significant reductions in depression, with the treatment group indicating dramatically lower levels of post-test depression, improved school attendance and academic performance.

Conclusions: The use of music therapy techniques provided a valuable addition to the CBT treatment. Participants in the treatment group showed stronger results in all areas. Music listening techniques are simple and cost effective for any counsellor to use. Additionally, the completion rate for all participants seemed to be positively enhanced by the participant development of a parenting programme dealing with teen depression.

Dr Jill Brennan

Professional Role: Counsellor
Institution: Manchester Mental Health and Social Care Trust
Contact details: Department of Clinical Psychology, North Manchester General Hospital, Central Drive, Crumpsall, Manchester M8 5RB
Email: jill.brennan@nhs.net

ABSTRACT: Workshop

Exploring psychological therapies contexts through stakeholder mapping: A pragmatic approach

This workshop is intended primarily for practitioner case study researchers, although it may be of interest to anyone who wishes to reflect systematically upon a therapy context. It aims to share with participants an imaginal process of exploration and notation of the social context of examples of psychological therapy, through stakeholder mapping processes developed as a means to conceptualise context in two unpublished pragmatic case studies. Participants are encouraged to bring and work through an example of a therapy context familiar to them.

The mapping exercise will be illustrated from the above-mentioned study settings in the NHS and voluntary sector. It is hoped that this exercise will stimulate discussion, e.g. of the influence of stakeholder communities on research and practice, and of the use of stakeholder matrices as an (as yet crude) preliminary conceptual tool. Discussion may be recorded and summarised in the workshop report to be submitted for publication.

The workshop will include:

• A brief introduction to stakeholder theory
• An analysis of who the stakeholders are in an act of psychological therapy?
• Identifying and mapping immediate stakeholders, along with 'stakeholders in stakeholders', interest communities, rhetoric, values and goals
• Locating research in relation to stakeholder interests
• And translating the above into research.

References:

Fishman, D. (1999). The case for pragmatic psychology. New York/London: New York University Press

Stoney, C. and Winstanley, D. (2001). Stakeholding: confusion or utopia? Mapping the conceptual terrain. Journal of Management Studies 38:5, 603-626

Chris Brown

Professional Role: Counsellor/Psychotherapist, Supervisor & Counsellor Trainer
Institution: Lewisham College, London
Contact details: Room B215 Lewisham College, Lewisham Way, London SE4 1UT
Email: christine.brown@lewisham.ac.uk

ABSTRACT: Paper

The therapeutic relationship: what relevance and impact does 'the other characteristic' have to and on the therapeutic process?

Background: It has become apparent through recent published works (e.g. Norcross, 2002) that it is the quality of the therapeutic relationship, not the therapeutic model which is most pivotal to a successful therapeutic outcome for the client. Toward the end of his life Carl Rogers wrote about a phenomenon he experienced during his client work which he named 'the other characteristic' - a phenomenon which arose from a profound relational connection to his clients (Rogers, 1980). The above raises questions about the nature of the therapeutic relationship, and requires an explanation of its essence to clients and potential clients.

Aims: To explore and describe the components and nature of 'the other characteristic', and to discover how and when it arises during the therapeutic relationship, to what effect and to shed more light on the therapeutic relationship in general.

Method: Six person-centred therapists were chosen to be interviewed based on their length of experience. These therapists were both male and female and were local service providers with a wide range of clients. The interviews were semi-structured and audio taped, then transcribed and phenomenologically analysed using the Duquesne Method (Moustakas, 1994). The research was approved by the University of East London's Ethics Committee.

Results: The main conclusion indicates that 'the other characteristic' is often experienced by the participating therapists during the therapeutic alliance. The findings also illuminate both the individually experienced and commonly experienced elements by which 'the other characteristic' may be recognised. In addition the research shed light on when 'the other characteristic' arises and its impact on the therapeutic work and relationship in general.

Conclusion: The research findings allowed the researcher to postulate a definitive description of 'the other characteristic' as: 'unplanned moments of profound, defenceless connection between client and therapist which stand out, experientially and perceptually, among other moments of connectedness. Moments in which the deep visceral and sensory understanding of the therapist for the client's perceptual world will bring about a felt sense of organic union within the therapeutic alliance - which in turn will earnestly assist the client in his/her movement toward actualized-self'.

References:

Norcross, J. C. (2002). Psychotherapeutic relationships that work. Oxford University Press.

Rogers, C. (1980). A way of being. Boston/New York: Houghton Mifflin Company.

Moustakas, C. (1994). Phenomenological research methods. London: Sage.

Professor Julia Buckroyd

Professional Role: Director, Obesity & Eating Disorders Research Unit/Editor CPR
Institution: University of Hertfordshire
Contact details: Health Sciences Research Unit, University of Hertfordshire, College Lane, Hatfield AL10 9AB
Email: julia.buckroyd@bacp.co.uk

ABSTRACT: Workshop

A Writers' Workshop: Getting your work published in Counselling and Psychotherapy Research (CPR) Journal

Do you have a research article you have started writing (and stopped and started and possibly stopped and started yet again) with the aim of submitting for publication in an academic journal? If so, and you would like some sound advice on how to go about writing your article and giving it the best possible chance of publication, then why not join our 'writer's workshop' at the research conference?

The writers' workshop is for those new to writing for academic journals and advice will also be available for the more experienced author. Those new to writing for academic journals are often unsure about the expectations, practices of peer-review and what counts as a good academic paper. This often results in many authors being disappointed when their paper gets rejected. If you want to get your research published in an academic journal, in particular in CPR, then this workshop is for you. Professor Julia Buckroyd, Editor of CPR, will take delegates through all the stages of writing and submitting a paper for CPR, providing information on how to best write a paper that is more likely to be accepted for publication. Julia will cover topics such as:

• The vision for CPR
• What counts as research for CPR
• How to structure a paper
• Necessary ingredients of a paper
• Presentation of the paper
• What happens to your paper after you submit it
• Topics of particular interest

The workshop will include a formal presentation on the above issues, followed by discussion and debate, whereby those attending will have the opportunity to ask questions about their own work and get some useful hints on how to best write for academic journals in general. Bring along any draft papers you have started as Julia will also provide a Q&A session offering immediate feedback on your work.

Dr Khatidja Chantler

Professional Role: Lecturer in Social Work
Institution: University of Manchester
Contact details: University of Manchester, School of Nursing, Midwifery and SocialWork, Coupland 3, Oxford Road, Manchester M13 9PL
Email: Khatidja.Chantler@manchester.ac.uk

ABSTRACT: Paper

Attempted suicide and self-harm (South Asian women): policy and practice

Research Question: The research explores to what extent mental health policy and provision, with a specific focus on attempted suicide and self-harm, addresses the needs of South Asian women experiencing such distress.

Research Rationale: There is an overall national policy context of reducing suicide and undetermined injury by 2010 (Our Healthier Nation) and the National Service Framework for Mental Health makes the prevention of suicide one of its key priorities. Raleigh's research (1996) indicates that suicide is high in young Asian women (15-24 years) compared to other ethnic groups in the UK. Evidence illustrates unequal treatment of black people within the mental health system (e.g. Fernando, 1991). Much of this literature overlooks the specific experiences of minoritised women, as does much of the literature on mental health and women (Aitken, 1996).

Research design: A qualitative study based on feminist/anti-racist principles, using semi-structured interviews with different stakeholders in Manchester. 64 people participated: 18 interviews with mental health workers (eg GPs, counsellors, social workers); 8 interviews with senior managers of mental health services; seven interviews with South Asian women survivors of attempted suicide/self-harm; and 31 South Asian women in four focus groups. Interviews were analysed using a thematic approach. Key issues are located within recent government mental health policy: 'Women into the Mainstream' & 'Inside Outside'. These are explored for their ability, or otherwise, to respond to the needs of South Asian women experiencing this form of distress.

Findings: Poor understanding of the issues experienced by South Asian women, primarily the ways in which state practices (e.g. mental health policy and immigration practices) impact on mental distress, and the privileging of culture over gender.

Conclusions: Action is required at multiple levels to impact positively on South Asian women's mental health. Interventions are needed in national mental health policy, immigration law, increased visibility of South Asian women's needs in service planning and delivery and staff development.

References

Aitken, G. (1996). The present absence/pathologized presence of black women in mental health services.

In E. Burman et.al (Eds.), Psychology discourse practice: From regulation to resistance (pp. 75-95). London: Taylor & Francis.

Fernando, S. (1991). Mental health, race & culture. Macmillan in association with MIND Publications.

Raleigh, S. V. (1996). Suicide patterns & Trends in People of Indian Subcontinent & Caribbean Origin in England & Wales. Ethnicity and Health, 1 (1): 55-63.

Dr Samantha Chromy

Professional Role: Lecturer
Institution: University of Bristol
Contact details: University of Bristol, Graduate School of Education, 8-10 Berkeley Square, Bristol BS8 1HH
Email: sam.chromy@bris.ac.uk

ABSTRACT: Paper

Sexual behaviour problems in sexually abused children: psychological, behavioural and victimization characteristics

Research Question: Is there a difference between sexually abused children who exhibit sexual behaviour problems and sexually abused children who do not exhibit sexual behaviour problems, in their psychological, behavioural and victimization characteristics?

Research Rationale: Childhood sexual abuse is perpetrated not only by adults, but also by children. Many adult and adolescent offenders began perpetrating or displayed sexual behaviour problems at young ages, including pervasive, age or developmentally inappropriate and abusive behaviours. Sexual behaviour problems appear to be one of the most common after effects of sexual abuse. Counsellors and those in the helping professions are in a position to help facilitate early treatment and prevention. This research aims to provide information that may help such professionals identify those at higher risk of sexual behaviour problems.

Research Design: This quantitative design was based on a retrospective chart review of the clinical records of a sample of sexually abused children. The sample was divided into two groups - those with sexual behaviour problems and those without. The groups were compared on a number of variables regarding their psychological, behavioural and victimization characteristics, using statistical analysis procedures.

Sample: The sample for this study was 125 children aged 4-12 years old who had received services at a counselling centre specializing in the treatment of sexually abused children in Florida.

Results / Findings: The study identified a number of characteristics that differed significantly between the groups - sexually abused children with and without sexual behaviour problems. The characteristics identified included the presence of assaultive behaviours, encopresis, the frequency of abuse and age of onset of abuse. The children with sexual behaviour problems presenting increased frequencies of these behaviour, and were abused with more frequency with a younger age of onset than the children without.

Conclusions: The study identified a number of characteristics that differed significantly between sexually abused children with and without sexual behaviour problems. It hopes to add to a body of developing research that will help to identify children at particularly high risk of the negative sequelae of abuse, including sexual behaviour problems.

Angela Clark

Professional Role: Counsellor/Supervisor
Institution: Winchester Bereavement Support
Contact details: Cornerstones, Fairfield Road, Shawford, Winchester SO21 2DA
Email: midgeresearch@yahoo.co.uk

ABSTRACT: Paper

'Who's there for Lucy?': Counselling for children of single parents with drug and alcohol problems

Rationale: This research attempts to investigate the availability of care, support and counselling for children of single parents with drug and alcohol problems and the affect of this availability on the parents' ability to undertake addiction recovery programmes.

Aims: This enquiry arose from my attempts as a counsellor to find care and counselling for Lucy, aged six, and her sister, aged eight, when their mother started on a drug and alcohol recovery programme. I couldn't find any organisation or person in the statutory or voluntary services offering help or advice. I was surprised that the recovery unit did not seem to consider the children of a single parent to be relevant to their service, compared to bereaved children for whom there is a network of organizations. I decided to explore the experiences of other parents in a similar situation.

Method: It was difficult to find people to take part - addicted parents are very reluctant to be identified for fear of having their children taken away. I advertised in the Big Issue and had responses from volunteers by phone, text, email and/or letter, all from women as no men responded. The data collection was taken from responses from emails and letters, as well as taped interviews that were undertaken with three women. The data were analyzed for patterns and emerging themes.

Findings: The impact on these women and consequently their children of poverty, physical and mental health problems, self-image, abuse, isolation and bereavement, emerged as common themes. There is limited availability of any sort of care or counselling for these children. Some recovery units admit children with their mothers but only three out of eleven admit both parents. The number of recovery units for substance abusing women with children does not seem to reflect the number of women with substance abuse problems.

Conclusion: Where does the provision for substance abuse rehabilitation fit in to the political agenda? It seems the lack of adequate provision for mothers, children or families is in contravention of the Children's Act 2004 and if 'every child matters' there needs to be the political enthusiasm and funding to make this happen.

Delia Edwards and Marjorie Reid

Other Authors: Barry Burnett, Hillary Tooze, Loretta Reynolds, Sonya Roach & Su Connan

Professional Roles: Trainee Counsellors and 2nd Year Higher Professional Diploma Students
Institution: Lewisham College, London
Contact details: c/o Chris Brown, Room B215, Lewisham College, Lewisham Way, London SE4 1UT
Email: christine.brown@lewisham.ac.uk

ABSTRACT: Poster

Are there any links between 'Obsessive Thinking' and the subsequent development of bulimia, if so, can these links be used as an early indicator of the condition to inform potential sufferers?

Background: Whilst studying the current literature on bulimia, an article on a condition called 'Pure O' (obsessive thinking) was discovered. This article suggests that such obsessive thinking is a prelude to the subsequent development of bulimia. No such link is to be found in the DSM IV, which raises the question does such a link actually exist; if so, can 'obsessive thinking' be diagnosed as an 'early warning indicator' to potential bulimia sufferers?

Aims: To explore if there are any links between the condition called 'Pure O' and the subsequent development of bulimia, and if so, to identify these links so that they might be highlighted to potential bulimia suffers.

Method: We limited the study to a small research project consistent with the phenomenological research approach, therefore, statistical data will be absent from our findings and generalisations will be made using the Duquesne Method (Moustakas, 1994). Two separate questionnaires were devised: one for clinicians and one for sufferers which focused on inquiring about the thinking patterns of clients and sufferers (respectively) before the onset of bulimia. The sample of respondent sufferers and clinicians were recruited through the Eating Disorders Association (EDA). Both sufferers and clinicians were sent the relevant questionnaire by post via the EDA. These questionnaires were returned directly to the researchers.

Initial Results & Conclusion: Initial results indicate that bulimia sufferers show signs of obsessive thinking patterns before the onset of the condition. No conclusions have yet been made; the completed questionnaires are still being analysed and it is the aim of the researchers to present the qualitative results whilst also proposing a hypothesis on whether an identifiable link exists (as outlined above).

This research has been undertaken to fulfil, in part, the requirements of the City & Guilds Higher Professional Diploma in Counselling @ Lewisham College, London, under the Supervision of Chris Brown MA. and Arike. Stan Grant MA. Approval from an Ethics Committee was not obtained, however, the research was conducted following the BACP Ethical Guidelines for Researching Counselling & Psychotherapy (Bond, 2004).

References:

Moustakas. C. (1994). Phenomenological Research Methods. London: Sage.

Jane Edwards

Professional Role: Counsellor, Trainer, MSc student.
Institution: University of Strathclyde
Contact details: Simpson House Drugs Counselling Service, 52 Queen Street, Edinburgh EH2 3NS
Email: jane@edwardsjane.wanadoo.co.uk

ABSTRACT: Poster

Being a person-centred counsellor in a postmodern context: a qualitative study of the influence of postmodernism on person-centred counsellors

Rationale: The work of philosophers who are associated with postmodernism has been influential in the social sciences in recent years and in some schools of psychotherapy. This study was conducted to expand on existing research by looking at the influence of postmodern ideas on a sample of person-centred counsellors. The study provides counsellors with possibilities of what they may take from postmodern ideas to use in their practice.

Research design/sample: The study involved conducting semi-structured interviews with seven counsellors, including three academics, trained to at least Diploma level in the person-centred approach. All are practising counsellors except one of the academics who is a practising counsellor trainer. None identified themselves as practising postmodern therapy. Recruitment was through advertising in journals, email circulars, and three academics were approached individually. The aim was not to gain a representative sample, rather purposive sampling was necessary to identify counsellors who had reflected on issues related to the research question. In-depth questions included the participants' understanding of postmodernism, and how it had influenced their thinking about counselling theory and their practice. Interviews were transcribed, and stages of analysis, including immersion, categorisation and phenomenological reduction of the data completed.

Findings: Themes included the significance of narrative, identity as socially constructed and awareness of how power is constructed and operates in society, as well as power within the therapist-client relationship. Participants identified the concept of the loss of grand-narratives as leading them to look beyond a particular counselling theory to explain how they work and what they believe counselling to be. The limitations of the study include sample size, and different understandings of postmodernism.

Conclusions: The study enabled exploration of the impact of postmodern ideas on a small sample of counsellors' thinking and practice. Participants suggested that postmodern ideas lead them to re-think the place of theory in their understanding of their work. Possible areas for further research include focusing on the influence of postmodernism on counsellors who were trained in other schools of psychotherapy.

Christine English

Professional Role: Psychodynamic Counsellor
Institution: The University of Reading
Contact details: School of Health and Social Care, The University of Reading, Bulmershe Court, Woodlands Avenue, Woodley, Berkshire RG6 1HY
Email: c.l.english@reading.ac.uk

ABSTRACT: Paper

An exploration of the meaning of addiction through an analysis of the countertransference experience of psychodynamic therapists working with drug or alcohol addicted clients

Background: Drug and alcohol misuse are grave social problems, yet preferred treatment modalities, such as substitute prescribing and relapse prevention education, are perhaps used in response to a need to alleviate the social costs of substance misuse. These then tend to focus largely on the symptoms of underlying psychological distress at the expense of an exploration of its causes. This qualitative research sought to consider the possible 'meanings' of addiction through an exploration of the experiences of psychodynamic therapists working with addicted clients. It was felt that such research could inform counselling practice with drug and alcohol addicted clients.

Research design: Letters inviting participation in the research were sent to a purposive sample of 120 psychodynamic practitioners, selected from the registers of the UK Council for Psychotherapy and the British Confederation of Psychotherapists. 36 therapists responded with nine agreeing to participate in the research. Nine semi-structured interviews were tape-recorded and transcribed, and analysis was informed by the ideas of immersion, categorisation, phenomenological reduction, triangulation and interpretation (McLeod, 1994:89-90).

Findings: Data analysis revealed several common themes in work drug and alcohol clients: relationship difficulties, use of primitive defence mechanisms, narcissistic vulnerability, and inability to cope with psychic pain. Common countertransference responses to work with this client group included a sense of meaninglessness about therapy, wishing to terminate therapy, and a sense of 'contamination' by the toxicity of the addicted clients' material.

Conclusions: Several possible 'meanings' of addiction were revealed: drug and alcohol addiction as a defensive withdrawal from reality, a turning away from unsatisfactory relationships and an attempt by a weak ego to tolerate or avoid psychic pain. It is hoped that a greater understanding of the common psychological difficulties of the drug or alcohol addicted client, and the countertransference they may evoke, could enable practitioners to work more successfully with this growing group of consumers of counselling.

Reference:

McLeod, J. (1994). Doing Counselling research. London: Sage.

Dr Kim Etherington

Professional Role: Reader in Counselling and Research and Senior Research Fellow
Institution: University of Bristol
Contact details: University of Bristol, 8-10 Berkeley Square, Clifton, Bristol BS8 IHH
Email: k.etherington@bristol.ac.uk

ABSTRACT: Paper

Narratives of identity: from 'recreational drug user' to 'druggie'

This paper addresses issues of identity construction among people who have misused drugs and invites counsellors, psychotherapists, researchers and workers in the drugs field to notice how traditional psychological and socio-cultural notions of identity formation (Erikson 1968; Mead 1934; Vygotsky 1978) might shape their responses to clients' life stories.

The paper focuses on two of eight life stories gathered as part of an ongoing narrative inquiry. The inquiry was commissioned by a community based drugs project that provides free counselling for abuse/trauma survivors in recognition of the frequency of such histories among clients using the methadone, outreach and other drug services provided. It uses parts of the two life stories to address the question: what can we learn from a person's story about how they change their view of themselves as 'someone who occasionally would take drugs at the weekend', to being 'a druggie'.
The stories are analysed using narrative analysis to show how narrative and identity are not separable but, instead, constitute one another, and how, by using narrative approaches, new identities can emerge as the teller moves actively between private and public, personal and cultural, past and present. It also adds to the growing awareness of the therapeutic value of qualitative (particularly narrative) methods for research.

The work suggests that counsellors working in the drugs field who position themselves firmly within modernist notions of self and identity might miss opportunities to enable clients to re-story their lives in ways that can allow the emergence of healing connections between their historic childhood trauma and subsequent drug misuse. By focusing on the question 'Why?'- a question often discouraged during counsellor training - we can invite clients to make sense of their lives and drug misuse in ways that do not re-inforce internalised negative and stigmatising stereotypes based on concepts of identity as fixed and 'damaged'. Instead they can restore 'the valued sense of who they are, the preferred sense of identity or personhood' that Michael White (2004: 47) refers to as 'a sense of myself', which can then become 'the foundation for a rich story development of the person's life'.

Sally Flatteau Taylor (paper)

Professional Role: Service Director
Institution: The Maypole Project
Contact details: The Maypole Project, 203-205 High Street, Orpington BR6 0PF
Email: sallytaylor@themaypoleproject.fsnet.co.uk

ABSTRACT: Paper

The Maypole Dance: developing a support service with and for families with a child/children with life limiting/life threatening illnesses

Background: The Maypole Project, created in 2003, provides flexible, holistic, family centred emotional support - from psychotherapy to a "listening ear" - to families with a child with illnesses which are life threatening/life shortening. This unique service pattern and philosophy has been developed from a foundation of research and experience of previous service provision to families with children with cancer, and its evaluation by families and health professionals. The aim of the project is to enhance this service by weaving existing research of supporting families in loss and bereavement into service delivery, as well as by integrating the families' ongoing evaluation of service received.

Research Methods: The user perspective is gained by invitation to all families referred to enter into research, participating families sign consent forms. The methods used are completion of evaluation forms and focus groups. The questions raised in both methods are in two sections. Firstly, relating to the structure of the support - referral, place, timing, etc, and secondly, the content of the support - therapy or listening ear, ability to relate to key worker, ease of talking through issues. The information gained forms a cyclical process - information gained is analysed and comments fed back into the service provision. Ethical approval was gained from a steering committee and external supervisor.

Results: Twelve evaluation forms were sent with eight returned and two focus groups held with 12 families attending. Responses have been positive. From the viewpoint of the structure of the Maypole Project they note the benefits of support received from diagnosis onwards and their ability to "dip in" to support as and when needed. Regarding the content of support, some families benefit from counselling, whilst others appreciated speaking to "almost a friend". All families felt able to talk about all issues. Recommendations of the service to other families was highlighted, which is reflected by an increase in families self-referring. Delays in referral to the service and issues with other services i.e. communication with health professionals were also noted.

Conclusions: This ongoing research confirms that flexible ongoing and holistic support is of great importance to families who, from diagnosis, suddenly find themselves being "fitted" into a medical world. The cyclical process of this research also enables regular reflection on practice and allows "fine tuning" of the service. The need is highlighted for future research across other interconnected services.

Sally Flatteau Taylor (poster)

Professional Role: Service Director
Institution: The Maypole Project
Contact details: The Maypole Project, 203-205 High Street, Orpington BR6 0PF
Email: sallytaylor@themaypoleproject.fsnet.co.uk

ABSTRACT: Poster

Between the notion and the act - some realities of putting a research study into practice

Background and Introduction: In a recent research study into the counselling experiences of bereaved clients who have sensed the presence of the deceased (Flatteau Taylor 2002), an assumption was made that, in today's economic climate of high demand on funding where evidence of best practice is essential, counselling service providers would work to enabling research through safe and confidential access to their previous service users. This was not the reality of putting the study into practice, and this paper explores this question; What difficulties were found in engaging "gatekeepers" to access previous service users?

Methodology: Loss and bereavement is a sensitive issue and it is important to create a safe structure within which participants would feel able to recount their stories. (The findings of participants' experiences recounted in interviews can be found in Between the Idea and the Reality (Flatteau Taylor, 2005)). In gaining ethical approval, it was agreed to engage counselling service co-ordinators to act as "gatekeepers" to address letters to previous service users requesting a response to the researcher, thus holding their anonymity from the study until they chose to participate. The findings of these approaches is detailed below:

Key Findings: The findings highlight some significant issues; 12 approaches were made and three agencies participated. Of the negative responses, four agencies said "yes" and then "no". Reasons given for this were; non-approval by ethics committee & management committee. Three co-ordinators insisted on a full explanation of what "sense of presence" meant as an issue for bereaved people, before the research began.

Discussion: Tension is highlighted between the need for research and difficulties in accessing participants, which, if we need to provide more "proof" of what works in counselling in future will become more essential. There was an interesting contrast between the three co-ordinators who required an explanation of sense of presence, and the 10 interviewees who all talked of their experience without needing or wanting an explanation. This may parallel to the findings of the main study where the majority of counsellors did not work with their clients sense of presence as the natural and normal experience they described.

Kevin Friery

Professional Role: Clinical Director
Institution: Right Corecare
Contact details: Right Corecare, 3500 Solent Business Park, Whiteley, Fareham, PO15 7AL
Email: kevin.friery@right.com

ABSTRACT: Work in progress symposium

Employee Assistance Programmes: who is the customer?

Background: For many people, access to counselling is through their Employee Assistance Programme (EAP). This potentially introduces a new dynamic into the counselling relationship and raises the question of the nature of the customer from a number of angles. The research question is 'who is the customer and what is s/he buying?' This question is addressed to both the employer (purchaser of EAP) and the counselling clients (user of EAP).

Aim: The aim is twofold: firstly, to develop a clearer understanding of the identity and needs of the counselling customer from the purchaser and user perspectives, and secondly to identify the issues that users bring to sessions thus identifying the profile of service users.

Research Design/Sample: All customers (employers) who use Right Corecare EAP services (n>200) were asked to complete a questionnaire which included items identifying the reasons they had purchased an EAP. To date, responses exceed 50 but the survey is currently ongoing. In addition, a whole-sample (n= 5877) analysis was made of every client who had accessed face-to-face counselling in 2005 through Right Corecare's EAP programme. The quantitative methodology was the most simple - count every case and log each presenting problem.

Results: Whilst this is research in progress, results continue to emerge. Perhaps unsurprisingly, relationships and loss featured highly in the issues that were presented. Organisational change was a feature in certain clusters but, interestingly, there were organisations which went through great changes without this being reflected in the counselling referrals, leaving a question about what leads change to become an issue in counselling.

Conclusion: It is too early to be definitive about the conclusions of this research, but it is already emerging that there are differences between the employer as customer and the service user as customer. When we discuss the customer in counselling, it is often assumed that we are talking only of the service user whereas this research suggests we are meeting the needs of more than one customer, and understanding this is essential in developing services that meet the needs and expectations of all our customers.

Audrey Gachen and Patti Wallace

Professional Role (AG): Psychological Counsellor
Institution: Roehampton University
Contact details: Postgraduate Studies, School of Human and Life Sciences, Roehampton University, Whitelands College, Holybourne Ave, London SW15 4JD
Email: mscresearch@onetel.com

ABSTRACT: Paper

The consumers' voice: feeling or not feeling respected during hospitalisation: what counselling and psychotherapy have to learn from the psychiatric-inpatient experience

Aims: To explore individuals' experiences of feeling respected during psychiatric hospitalisation and to consider implications for outcome and for counselling/ psychotherapy practice.

Background: This study is rooted in the researcher's own experiences of feeling/not feeling respected during psychiatric hospitalisation. Previous research has considered respect as one of a number of elements of care (eg, Rose, 2001); this study is the first UK qualitative research to focus specifically on the concept of respect.

Research design: This qualitative study interviewed eleven individuals about their psychiatric inpatient-care. Data incorporated experiences in 17 hospitals/units, across 21 wards. Interviews were semi-structured and data were analysed using a model of Grounded Theory.

Results: In line with Rogers' thinking (1965, as cited in Farson, 1977) the data indicate that an individual's perception of whether or not they feel respected communicates to that person a sense of their value as a human being. This in turn impacts on self-esteem and potentially on outcome. The environment of the ward, the quality of patient/staff interactions, and individuals' sense of involvement in their treatment emerged as key themes. Although experiences were predominantly negative, occasions on which individuals felt respected were reported as having an enabling and lasting impact.

Conclusions: The psychiatric inpatient-unit is often perceived as an inappropriate arena for counselling/psychotherapy. Inpatient psychiatry, therefore, generally remains a disconnected realm to which we 'refer on', and yet, in reality, the seeds of extreme psychological disturbance can be present in our day-to-day client work. This study highlights the universality of human need and challenges the myth of an inpatient/outpatient divide. This research also highlights that a knowledge and application of basic Rogerian principals and fundamental psychodynamics by ward staff would significantly improve inpatient-experience. Areas for future research include closer links during psychotherapy training with inpatient-psychiatry, and training of ward staff in basic Rogerian and psychodynamic principles.

References:

Rogers, C. (1965). A humanistic conception of man. In R.E. Farson (Ed.), (1977). Science and human affairs. California: Science and Behavior Books Inc.

Rose, D. (2001). Users' voices. London: Sainsbury Centre for Mental Health.

Barbara Gerber, Donna Dunlop, Karen Smith and Lorraine Conway

Other Author: Sandy Kemp

Professional Role (BG): Psychotherapist
Contact details: 6 Erskine Road, Whitecraigs, Glasgow G46 6TQ
Email: gerberkb@aol.com

ABSTRACT: Paper

A quantitative study into whether the use of CBT self help materials could lead to a reduction in stress and anxiety scores and development of coping skills in year 11 school pupils

Background: Research has suggested that CBT self help materials are helpful in developing coping skills for anxiety. 24,000 teenagers are admitted to hospital each year having utilised unhelpful coping mechanisms; our aim was to see whether self help materials could help school pupils develop helpful coping mechanisms.

Aims: This investigation explored whether the use of CBT self help material results in reducing anxiety and depression scores in Year 11 school pupils.

Method: Renfrewshire Association for Mental Health (RAMH) provide counsellors in two of East Renfrewshire's seven secondary schools, a relatively high achieving area in the South East of Glasgow. We worked with one of these secondary schools. Sixty children from Year 11 were assessed before and after the experimental period. Half were randomly assigned to the control and half to the experimental group. We produced and presented four self-help booklets during four school periods. We utilised Beck's Anxiety and Depression Scales as our scoring tools. We scored before and after the experimental period.

Results: We utilized a Wilcoxon Statistical test for related designs. The control group for both anxiety and depression scores suggested no statistical difference between the scores before and after. However, there was a significant reduction in both the depression and anxiety scores in the experimental group in this same period. The results supported our hypothesis 'the use of CBT self help materials could lead to a reduction in stress and anxiety scores on a rating scale, and lead to the development of coping skills in Year 11 school pupils'.

Discussion: We believe the promotion of a universal school based CBT programme, designed to prevent depression and anxiety in adolescents could be effectively implemented in the school environment. This fits with the objectives of both the Children's Scotland ACT 1995, which provides for local authorities having a duty to safeguard and promote the welfare of children in need, and with NSF objectives.

Mary Glover

Professional Role: Counsellor and Psychotherapist
Institution: Dept Clinical Psychology, Birmingham Children's Hospital
Contact details: Birmingham, B4 6NH
Email: mary.glover@bch.nhs.uk

ABSTRACT: Paper

Researching sensitive issues with vulnerable groups: shame in adolescence as an exempler

Research Question: How can counsellors and psychotherapists conduct research on sensitive subjects with a vulnerable group?

Research Rationale: Focus groups are cited as an effective approach in counselling and psychotherapy research, however, there is limited research that examines using focus groups for sensitive topics and the literature does not report on group dynamics. The aim of this study was to explore differences in reported shame between adolescent renal patients and a healthy group of adolescents (matched for age, ethnicity and gender) and consider these differences in focus group dynamics.

Research Design: A questionnaire survey compared reported shame in the two groups (no modification was made to the pilot of the quantitative research protocol). The qualitative investigation, utilising interviews and focus groups, was designed to provide an in depth understanding of the aetiology of shame and how this influences individuals' behaviour during a focus group. No modification was made to the semi-structured interview schedule, however, a pilot of a focus group exposed flaws in utilising a moderator's stance with adolescents and the approach was modified. At the end of each session notes were made on the group dynamics and the audio taped discussions were transcribed, summarised then given to participants for feedback. A total of eleven participants aged 12- 16 years participated in two series of focus groups.

Results: Shame is associated with being defined as part of an 'out group', which is brought into sharp focus in adolescent peer interactions. Focus groups are an appropriate means of enquiry with vulnerable clients, but only when the group leader has significant therapeutic skills.

Conclusion: In this study it emerged that significant therapeutic skills were needed in order to support the focus group enquiry. All the participants remained keen group members but acted out shame. This raises the possibility that researching sensitive issues with vulnerable clients should be conducted by competent therapists who understand issues of transference and counter-transference. This study indicates that counselling and psychotherapy research is needed in order to explore how the moderator role in a focus group needs to be developed in order to examine sensitive issues with vulnerable clients.

Terry Hanley

Professional Role: Lecturer in Counselling/ESRC Funded
Institution: University of Manchester
Contact details: ESI, School of Education, University of Manchester, Oxford Road, Manchester M13 9PL
Email: terry.hanley@manchester.ac.uk

ABSTRACT: Paper

An investigation exploring the potential challenges and opportunities that surround the development of online counselling services for young people in the United Kingdom

Background: Services for young people should be relevant and accessible to those seeking support. Within the UK precedents for the provision of successful mediated youth counselling have been set by telephone services such as ChildLine. With these points in mind, and with the acknowledgment that the Internet is steadily becoming a 'majority technology', youth counsellors need to be prepared for a move to online counselling.

Aims/Method: This study aimed to pool together the views of a small group of counsellors with an interest in online counselling to explore the perceptions that they held regarding the development of such services for young people. To do so an online asynchronous focus group was set up and hosted for a one-month period to create a dynamic dialogue regarding the topic. A grounded theory analysis of the forum transcripts was used to make sense of the data generated.

Findings: Findings displayed that the participants in the study accepted the potential of the medium for offering therapy; this particularly related to reaching groups of young people who would not ordinarily use a counselling service. They also suggested that there is a need for online counselling services to be regulated and good practice to be promoted.

Conclusion: The Internet has great potential for the development of easily accessible and relevant counselling services for young people. However, caution should be heeded before jumping headlong into such uncharted territory. This paper ends by raising a number of questions that potential service providers should consider when developing a service of this kind. It also discusses the challenges of regulating such a varied and dynamic medium. Some suggestions for the minimum requirements of counsellors working in this field are made.

Andrew Hill

Professional Role: Senior Lecturer in Counselling
Institution: University of Salford
Contact details: School of Community Health Sciences and Social Care, University of Salford, Allerton Building, Frederick Road, SALFORD M6 6PU
Email: a.hill@salford.ac.uk

ABSTRACT: Paper

Developing an evidence base in counselling and psychotherapy: methodological issues encountered in a systematic review of counselling older people

Research Question: What are key methodological issues in developing an evidence base for counselling and psychotherapy?

Background: Central to the theme of the consumer and counselling research is the notion of evidence. All consumers view research findings as potential sources of evidence to shape policy and guide action. From the results of a systematic review of research into counselling and older people (Hill and Brettle, 2004) methodological and quality issues are discussed with reference to developing an evidence base in counselling and psychotherapy.

Method: Six electronic databases were searched and 10 key journals hand-searched. Reference lists of relevant studies were searched to identify further relevant studies. Forty-seven studies met the inclusion criteria and formed the body of research to be reviewed. Each paper was critically appraised by two independent reviewers and a summary of each study agreed. The summaries were organised into a table to facilitate analysis and the results presented in a narrative report.

Results: CBT was the most commonly-researched intervention. Of the 47 included papers only seven were studies carried out in the U.K., the majority being North American. Twenty studies were randomised controlled trials and a further 12 were pre- and post-test outcome studies. There were nine systematic reviews, one survey, one mixed-method study, one statistical analysis of case notes and just three qualitative studies. The process of critical appraisal identified a variety of methodological issues relevant to the question of what constitutes evidence in counselling and psychotherapy.

Conclusions: To generate a viable evidence base there is need for research to be carried out by U.K. counsellors on U.K. populations, in U.K. health and social care settings and using routine counselling approaches. Rather than focus on 'laboratory-type' efficacy research, there is a need to generate practice-based evidence by researching the effects of counselling in naturalistic settings. Pragmatic research designs will be needed to meet the exigencies of such settings. As a consequence, systematic reviews which have to date used the RCT as gold-standard for good evidence will need to take a more pluralistic and inclusive approach to hierarchies of evidence. The paucity of well-conducted qualitative research suggests that these methods are under-recognised and could usefully contribute to the evidence base.

Reference

Hill. A., and Brettle, A. (2004). Counselling older people: a systematic review. Rugby: BACP.

Carol Holtom

Professional Role: Counsellor
Institution: Consulting & Clinical Psychology Services, NHS Ayrshire & Arran
Contact details: Counsellor in Adult Psychological Therapies Service, CCPS, Pavilion 7, Ayrshire Central Hospital, Kilwinning Road, Irvine KA12 8SS
Email: Carol.Holtom@aapct.scot.nhs.uk

ABSTRACT: Paper

Telecounselling to Arran: a qualitative analysis exploring client experience

Research Question: To explore the experience of clients engaging in person-centred therapy through the medium of telecounselling; the effect of the telecounselling environment on clients and how the telecounselling environment affects the therapeutic process.

Research Rationale: Since 2003 videoconferencing has been used by Consulting and Clinical Psychology Services, NHS Ayrshire & Arran, to provide person-centred counselling during the winter months to clients on the Isle of Arran. Although evidence suggests that it is possible to build therapeutic rapport and a working alliance when delivering CBT via this medium, there is a dearth of evidence concerning a person-centred approach. Since the client-counsellor relationship is the vehicle of therapeutic change in person-centred therapy, it is important to discover if there are elements of this distance technology which prevent relational depth.

Research Design: A semi-structured interview format was used. The interviews were recorded, transcribed and analysed by the researcher using grounded theory methodology. The research design received ethical approval from the local NHS Re