British Association for Counselling and Psychotherapy

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Research Conference 2008  

BACP's 14th Annual Research conference was entitled 'Research and regulation: towards a knowledge based profession' and took place on 9-10 May 2008. It was held at Cardiff Bay, Cardiff co-hosted by Cardiff University.

Click here for an evaluation of this year's conference



Pre-Conference Workshop  

Professor Robert Elliott and Professor John McLeod

Professional Role (RE): Professor of Counselling
Institution: University of Strathclyde, Scotland, UK
Contact details: Counselling Unit, University of Strathclyde, 76 Southbrae Drive, Glasgow G13 1PP

Professional Role (JM): Professor of Counselling
Institution: University of Abertay Dundee, Scotland, UK
Contact details: Kydd Building, Bell St, Dundee DD1 1HG

Pre-conference workshop

Keywords: qualitative research, research methodology, therapy outcome, therapy process, research-practice integration

Bringing out the quality in qualitative research

Qualitative research has its own standards of good practice, but much qualitative research being produced falls short of its potential for producing interesting, powerful results that can illuminate important therapeutic phenomena and help practitioners work more effectively with clients. In this workshop we will discuss common shortcomings in current qualitative research, their possible causes, and how researchers can realise the promise of qualitative research.   

Friday keynote

Professor Mick Cooper

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: Counselling Unit, University of Strathclyde, 76 Soutbrae Drive, Glasgow G13 1PP

Friday keynote

The facts are friendly: what the research tells us about counselling and psychotherapy

Is CBT the most effective form of therapeutic practice? Do relational interpretations help clients? What kinds of clients get the most out of therapy? In 2005, Professor Cooper received funding from BACP to produce an accessible, engaging and comprehensive introduction to research findings in counselling and psychotherapy. In this talk, he will present the principal findings of his work, offering a state-of-the-art review of the knowledge-base for counselling and psychotherapy. Key issues covered will include:

  • The overall effectiveness of counselling and psychotherapy
  • The comparative effectiveness of different therapeutic orientations
  • The client, therapist and relational factors associated with positive therapeutic outcomes
  • The therapeutic techniques that have been shown to be effective

Professor Cooper will argue that there is a convincing body of evidence to support the practice of counselling and psychotherapy, but that the drivers of therapeutic change may not be the ones that many counsellors and psychotherapists expect.


Saturday keynote

Professor William B Stiles

Professional Role: Professor of Clinical Psychology
Institution: Miami University in Oxford, Ohio, USA
Contact details: Department of Psychology, Miami University, Oxford, OH 45056, USA

Saturday keynote

Using case studies to build theories

Professor Stiles explains the rationale for case studies as scientific evidence and confirms their appropriateness in the context of justification and discovery. Whereas the conventional hierarchy of evidence considers randomised controlled trials above case studies, he suggests that the latter are particularly appropriate for theoretical quality control in counselling and psychotherapy. Case studies differ from hypothesis testing, addressing many theoretical issues in the same study rather than focusing on one or a few. They have distinctive advantages for research in psychotherapy and counselling, such as their ability to incorporate unique features and to study multifaceted phenomena in context. Professor Stiles will draw on examples from his research on a theory of psychological change known as the assimilation model. This is a developmental account of how people's conflicting internal voices come to terms with each other in therapy. It has been constructed primarily from a series of intensive case studies.

Sally Aldridge

Professional Role: PhD student, University of Leicester and Head of Regulatory Policy, British Association of Counselling and Pyschotherapy
Institution: BACP
Contact details: 11 Edward Avenue, Newcastle under Lyme, Staffs ST5 2HB


Keywords: knowledge, professions, exclusion, patriarchy, jurisdiction

What's knowledge got to do with it? What's knowledge but a patriarchal exclusionary device?

Aim/Purpose: The exploration of the concept of "a knowledge based profession" and the various uses of ‘knowledge' by both professions and government in the recent past. This paper aims to outline some of those uses and to pose the question: "what definition of knowledge is being used by whom at the moment?"

Design/Methodology: The methodology comprises an analysis of theories of professionalisation, in particular in relation to the helping professions and BACP, oral and archive histories and participative observation.


  • Early work on professions posit knowledge as an essential element and define it as systematic abstract theory (references available)
  • Knowledge mediated into entry examinations has been used as a means of controlling the size of the occupational field (references available) and thus guarantee income and status (references available)
  • Knowledge used in this way also excludes individuals from professions and occupations from professional status (references available)
  • The use of knowledge cannot be divorced from its social, economic and historical context. (references available)
  • Knowledge alone is not sufficient to justify a claim to professional status (references available)
  • New knowledge that creates new effective ‘treatment' helps a profession gain and maintain jurisdiction over areas of work (references available)
  • Knowledge is used as a patriarchal exclusionary device in relation to predominantly female occupations seeking professional status and females seeking to enter traditionally male professions (references available)
  • Knowledge described in terms of competence to perform specific tasks in the workplace is currently being used as a device for de-professionalisation of the Health Service (references available)

Research Limitations: Counselling in the UK has existed for a relatively short time and lacks any agreed definition of the activity, this presents problems of clarification and shared meanings. The research poses an ethical dilemma in the reporting and analysis of participative observation, and the potential conflict of interest between my research and my job.

Conclusions/Implications: An occupation seeking professional status must define clearly the intended uses for knowledge in order to legitimise its knowledge base.

References available on request, please email

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Dr Penny Amerena

Professional Role: Counsellor and psychotherapist
Institution: MA student, School of Human and Life Sciences, Roehampton University, London
Contact details: 3 Carlton Mews, 37 Arterberry Road, London SW20 8AG


Keywords: renal transplant, experiential, grounded theory

Psychological experiences of renal transplant patients: improving understanding and counselling interventions

Aim/Purpose: Organ-sourcing developments now permit increasing numbers of renal transplants. Recipients commonly experience negative affect pre- and/or post-transplant yet research on patient experience is rare. This study aims to develop theory, based on the lived experience of recipients, to guide psychological and support interventions by counsellors and professional carers.

Design/Methodology: This qualitative research used self-selected sampling to recruit transplantees (eight) for one-two hour audio-taped, semi-structured interviews. Participants met approved ethical criteria to promote inclusivity and ensure participant protection. Grounded theory methodology was adopted to generate theory developed from individual accounts to elucidate the emotional/social experience of transplant.

Results/Findings: Findings suggest that the transition from sense of self as a chronically ill to healthier person is affected by psychological pressures not widely recognised by others. Thus recipients may need to juxtapose fear of morbidity and mortality with hope for a healthy future; balance anger/sadness about years lost with an adaptive attitude to making the most of a second chance at life; negotiate a positive relationship with an ‘alien' organ, and cope with uncertainty about the graft's longevity.

Research Limitations: All participants were white British. Future studies may benefit from larger, more inclusive samples by negotiating NHS ethical approval procedures.

Originality/Value: While Kierans and Maynooth (2001), Griva et al (2002), Olbrisch et al (2002) and others make relevant contributions, no other studies explore the renal transplant experiences of men and women or bridge the gap between interpretive and positivist paradigms by using grounded theory methodology in this area. Uniquely the research was conducted by a renal transplant patient which potentially adds interpretive insight.

Conclusions/Implications: The study provides insight into renal transplant experiences and offers evidence-based guidance to counsellors supporting recipients adjusting to a changing sense of self, and form adaptive relationships with self, others and the new kidney. The research also has implications for improved dialogue between biomedical and psychological approaches to promote pluralistic and collaborative support interventions. Finally the research recommends action on improving awareness of and access to counselling and other support for renal transplantees, and the need for in-depth experiential research in this expanding area.

Griva, K., Ziegelmann, J.P., Thompson, D., Jayasena, D., Davenport, A., Harrison, M., & Stanton, P. N. (2002). Quality of life and emotional responses in cadaver and living related renal transplant recipients. Nephrology Dialysis Transplantation, 17: 2204-2211.
Kierans, C.M., & Maynooth, N.U.I. (2001). Sensory and narrative identity: the narration of illness process among chronic renal sufferers in Ireland. Anthropology and Medicine, 8 (2-3): 237-253.
Olbrisch, M.E., Benedict, S.M., Ashe, K., & Levenson, J. L. (2002) Psychological assessment and care of organ transplant patients. Journal of Counselling and Clinical Psychology, 70 (3): 771-783.

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Penelope Aspinall

Professional Role: Senior Counsellor
Institution: The Student Counselling Centre, the University of Leeds
Contact details: 19 Clarendon Place, Leeds LS2 9JY


Key words: perceptions, awareness, gender, barriers, information

Don't you have to be weak or weird? Research into awareness and perceptions of counselling at the University of Leeds

Aim/Purpose: To explore how the student population of the University of Leeds perceives counselling in general and the Student Counselling Centre specifically, with a view to being able to address misconceptions and target potential client groups more effectively. There was particular concern about certain groups, eg males who consistently under-use the service.

Design/Methodology: A qualitative approach using thematic analysis allowing exploration and discovery was used. To minimise bias we engaged the University Market Research team to help design the research, conduct interviews and analyse data. Individual face-to-face semi-structured interviews lasting 45 minutes were chosen as a methodology, to avoid group consensus and build trust. 26 participants were recruited randomly across the university, using an incentive method; sampling was stratified. Those recruited represented the student population in terms of gender, domicile and level of study, seven of these had previous counselling. Interviews were transcribed and thematically analysed. Saturation point was felt to be reached. Careful attention to ethical considerations was given at all times.

Results/Findings: Gaps between how we perceive and promote ourselves and how students experience us were identified.
Key areas were:

  • Barriers to coming for counselling, especially stigma and how to reduce it
  • Need for better information about counselling (what it is, who it can help and how) presented in an accessible way
  • Stereo-types around counselling in general and what might be expected at a university service
  • Attitudes of international and male students (how they might be better addressed)

Research Limitations: Some of the research is specific to our service and might have limited application for others.

Originality/Value: Although research into perceptions of counselling services has been carried out in the wider community (the results of which were used to inform our research), we are unaware of any similar research having been conducted in a university environment.

Conclusions/Implications: The findings challenge our assumptions about how students perceive counselling and increase our understanding of the blocks to service use. We can now develop appropriate evidence-based strategies for service delivery.

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Jeni Boyd

Professional Role: Research Fellow of the School of Social Community and Health Studies, Faculty of Health and Human Sciences and Counsellor in Primary Care.
Institution: University of Hertfordshire
Contact details: Bigrams Farm, Easton Road, Stonely, St Neots, Cambs PE19 5EW


Keywords: time-limited counselling, dream-work, reflexive action research, NHS, praxis

"In dreams begins responsibility." The use of dream-work within the context of time-limited counselling: the clients' perspective

Aim/Purpose: This paper presents the latest research findings from an NHS approved research project in primary care. The research aims:

  • To develop an understanding of the patient/client's experience of the use of dream-work in time-limited counselling
  • To begin to make judgements about appropriacy and efficacy in order to evaluate and develop practice

Design/Methodology: The approach used is reflexive action research (Lees, 2001) which is closely linked to praxis and utilises both qualitative and quantitative methodology. Sampling is purposive. Data collection consists of four strands:

(i) Process notes from counselling sessions

(ii) 37 semi-structured questionnaires

(iii) 19 semi-structured interviews

(iv) Background or demographic information

Ethical Approval: This research project received a favourable ethical opinion from the NHS Research Ethics Committee (Ref no: 04/Q0104/123).

Results/Findings: The findings indicate many benefits including: facilitating self-awareness or insight, providing information for the therapist, and facilitating the therapeutic process. This is in line with the findings of Eudell-Simmons & Hilsenroth 2005, but extends their research by looking at the value in the telling, the value of interpretation and the role and influence of the therapist in understanding the dream.

Research Limitations: The sample is small and confined to one practice. Limitations due to the chosen methodology, methods and context will be discussed in relation to implications for practice on a personal level and in the wider context of counselling within the NHS.

Originality/Value: As the first piece of practitioner research approved by the NHS in this area, the research contrasts the more widely researched approaches utilising clear outcome measures. This reflects a growing awareness of the value of treatment options and patient choice, as highlighted in BACP's response (2007) to the government inquiry into NICE guidelines. It has relevance outside the NHS also, as the literature search revealed there is still relatively little written about the use of dreams in time-limited counselling or psychotherapy.

Conclusions/Implications: Any conclusions are tentative and local but it is hoped that this paper will stimulate further interest in the use of dream-work and also encourage other counsellors to begin research into areas of their own practice.

References available on request, please email

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Dr Nell Bridges

Professional Role: Deputy Director of Counselling Studies
Institution: Keele University
Contact details: 43 St Mary's Street, Bridgnorth, Shropshire WV16 4DR

ABSTRACT: Theoretical and methodological innovation paper presentation

Keywords: legitimation, agency, discourses, prototypicality, divided profession

Thinking about research and regulation beyond the discourses of our own knowledge-base

This postmodern age is characterised by turmoil and crises, particularly crises of legitimation. Two aspects of this seem relevant for those of us in the cluster of professions which include counselling and psychotherapy. Firstly, there is a crisis of professionalisation. Secondly, there are the crises of legitimation as regards to the status of academic inquiry; it is the intertwining of these two crises that will be focused on.

Other professions are also affected by these twin crises. The professional is under scrutiny as never before since the actions of Beverley Allitt, Harold Shipman, Professor Sir Roy Meadows and others have come into the public gaze. Thus, there is an increased need for public accountability and consequent debates about the form that such accountability should take. However, perceived disconnection between research and practice makes the various therapy professions a soft target for allegations of illegitimacy and even delusion. This is exacerbated by an anti-therapy climate in society and the media, which engenders strenuous attempts to demonstrate rigour within the terms of those raising the objections in some quarters alongside resistance to the underlying terms of the challengers in other quarters.

The growth in strength of the evidence-based movement and the setting up of the National Institute for Clinical Excellence have enormous implications for claims of legitimacy with regard to both therapeutic practice and research. Both become increasingly politicised in the proliferation of claims and counterclaims regarding what counts as legitimate evidence and what can be countenanced as legitimate practice, and a divided profession results.

In this paper a poststructuralist position is taken to argue that our agency as practitioners and researchers is inevitably limited by the discourses to which we are exposed and that this limitation allows retreat to positions of certainty and judgment about those who are not prototypical (Jetten, 2006) of our own groups. Exposure to the discourses of different communities raises our ‘horizon of agency' (Butler, 1995) and enables us to review our values. It is therefore proposed increased, and increasingly open, communication across the divisions.

Butler, J. (1995). For a Careful Reading. In S. Benhabib, J. Butler, D. Cornell & N. Fraser (Eds.), Feminist contentions: A philosophical exchange. New York: Routledge.
Jetten, J. (2006). Living on the edge: Loyalty to the group and intragroup position. The Psychologist, 19 (1): 36-38.

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Pam Brooks

Professional Role: Women and Children's Counsellor
Institution: North Manchester General Hospital, Pennine Acute Hospitals Trust
Contact details: Delauneys Rd, Crumpsall, Manchester M8 5RB


Keywords: antenatal, postnatal, perinatal, depression, counselling

Depression before and after childbirth. An evaluation of a perinatal counselling service

Aim/Purpose: 10 - 13% of women experience emotional distress around the time of pregnancy (perinatally). Depression and anxiety may be experienced before the birth (antenatally), after the birth (postnatally) or both. The purpose of this study was to evaluate the Women and Children's Counselling Service in relation to women who received counselling for perinatal depression (PND). Of particular interest was whether attending counselling antenatally, had any positive effect on postnatal emotional well-being. Community midwives, as referrers to the service were included for purposes of triangulation.

Design/Methodology: Following ethical approval and piloting, semi-structured questionnaires were distributed among ex-clients, and community midwives. These explored three main areas: service issues (clients and midwives), counselling issues (clients only) and perinatal issues (clients and midwives).

Results/Findings: Both groups expressed general satisfaction with the service with clients being more enthusiastic. Concerning counselling issues clients described themselves as depressed, anxious or having other feelings. Most felt they had benefited from counselling and described emotional changes, and positive effects on parenting and pregnancy. Both groups agreed that antenatal depression was prevalent and that antenatal counselling helped to prevent problems postnatally.

The findings agreed with current literature in that women experience both antenatal and postnatal depression. This study contradicts other research, which is unclear as to whether antenatal interventions can prevent postnatal depression.

Research Limitations: The research was limited in that neither pre-existing depression nor counselling outcomes were assessed using a recognised tool (eg CORE or the Edinburgh Postnatal Depression Scale [EPDS]).

Conclusions/Limitations: This study suggests that professional counselling can help women suffering from perinatal depression, and counselling undertaken antenatally may help to alleviate problems postnatally. It supports the existence of the counselling service and may help to promote other perinatal counselling services. It also includes the voice of clients as recipients of counselling. Finally, it addresses some of the tensions which exist for a counselling practitioner employed within a medical setting, wishing to communicate simultaneously with the counselling and medical worlds.

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Professor Julia Buckroyd and Sharon Rother

Professional Role (JB): Director, Obesity and Eating Disorders Research Unit
Institution: University of Hertfordshire
Contact details: College Lane, Hatfield, Herts AL10 9AB


Keywords: obesity, bariatric surgery, medical model, trauma, affect regulation

Alternative discourses in the treatment of a 34 stone teenager

Aim/Purpose: In 2006, BBC1 showed a programme describing the case of a 19 year old girl who had reached a weight of 34 stone (476 pounds / 216 kilos). The programme was overtly focused on her bariatric surgery. However, alternative discourses were apparent throughout the programme. The presentation, which includes video clips, seeks to investigate whether these alternative discourses suggest other ways of addressing the obesity.

Design/Methodology: The recording of the programme has been taken as the data on this particular young woman. For the purposes of this presentation it is not material whether her life story is accurately presented. The case history is used to illustrate a feature of obesity treatment which deserves attention. The DVD was treated as a piece of qualitative data and analysed thematically. Themes were identified by two independent researchers and verified by discussion.

Three main parallel themes were identified:

  • Obesity as a serious and urgent health hazard warranting radical medical intervention
  • Obesity as a consequence of trauma and overeating as a means of affect regulation
  • Obesity as a social problem interfering with education and social interaction, resulting in poor self-esteem and delay in appropriate social development

Discussion: The most striking thing about the case history is the unquestioned privileging of the medical model. A woman of only 19 years old is given radical and irreversible surgery without any consideration of alternative approaches to the problem. The woman herself states very clearly her understanding of her overeating as a means of affect management. There is no evidence at all that this meaning has any part in the treatment decisions. As remarkable is the story of her stigmatisation from an early age. Serious ethical concerns are raised by a radical, irreversible surgical intervention performed on a teenager when no attention has been paid to the emotional meaning or development of her obesity and its implications for alternative treatment. This piece of qualitative analysis demonstrates the need for research to inform both medical and psychological approaches to obesity.

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Professor Julia Buckroyd      

Other Authors: Sharon Rother and George Green

Professional Role (JB): Professor of Counselling
Institution: University of Hertfordshire
Contact details: Obesity and Eating Disorders Research Unit, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB


Keywords: obesity, emotional eating, binge eating

Therapeutic groups for obese women: preliminary results

Aim/Purpose: There is general consensus that conventional diet, exercise and behaviour management programmes are not effective in delivering maintained weight loss. Pharmacological products seem to be effective only while they continue to be taken. A substantial literature on the relationship between psychological issues and obesity suggests that a therapeutic response to obesity may be appropriate. This paper describes a therapeutic group approach to female obesity.

Design/Methodology: 79 obese women were recruited by referral by primary care health professionals and self-referral by advertising in the local community. The mean age was 46.5 years (range 23-75). The mean baseline weight was 111.5kg (range 76-173). The mean BMI was 41.8.

This study was a before and after uncontrolled study. Of these, 72 attended 36 weekly two hour sessions over the course of a year. The intervention was designed to facilitate lifestyle change and bring about maintained weight loss ≥ 5-10% of baseline weight.

Ethical approval for the study was granted by the relevant NHS Ethics Committee.

BMI was calculated for all participants at baseline and the emotional eating scale (EES), the binge eating scale (BES) and CORE were all administered together with a semi-structured interview. These measures were repeated at 12 weeks, 36 weeks and 36 weeks plus six month follow-up.

Results/Findings: At the end of intervention 21% of completers had lost 5% or more of their baseline weight. At six month follow up 39% of completers lost over 5% of their weight relative to baseline. There were also reductions in CORE, EES and BES scores.

Research Limitations: Results have been collected while telephone support is still continuing, so can only be an indication. The study was uncontrolled; further testing of the concept is needed.

Originality/Value: Research literature suggests that a psychological approach is relevant for a large minority of obese people. This study attempts to integrate this data into a treatment.

Conclusions/Implications: Although these findings are preliminary, the increased number of participants who achieved the target weight loss from end of intervention to six month follow up is a promising indication which if demonstrated, would have implications for healthcare.

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Professor Julia Buckroyd, Kaye Richards et al

Professional Role (JB): Professor of Counselling
Institution: University of Hertfordshire
Contact details: Obesity and Eating Disorders Research Unit, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB

Discussion group on eating disorders: what are the research priorities and ways forward?

The rising tide of disordered eating, be it anorexia nervosa or obesity, indicates that the psychological therapies profession needs to critically examine services, practices, policies and politics in the provision of prevention and intervention strategies for eating disorders. Given this, the psychological therapies research community needs to critically evaluate its current research activity to assess the ways in which it is actively responding to current priorities in this area. This discussion group will provide an opportunity to reflect upon the themes and issues raised in the papers presented on eating disorders: key methodological debates in undertaking eating disorders research will be debated. The forum will also enable delegates to consider wider research activity in this area, identifying key research questions that need to be taken forward. In conclusion, ways forward in tackling the rising tide of disordered eating will be considered in light of the development of a strategic research agenda in this arena of psychological therapies.

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Dr Norman Claringbull

Professional Role: Postgraduate Counselling Studies Co-ordinator
Institution: The University of Southampton
Contact details: 30 White Heather Court, Hythe, Southampton SO45 6DT
Email: or


Keywords: research, regulation, workplace, knowledge-based, specialism

Workplace counselling - a new, knowledge-based, formally regulated specialism?

Aim/Purpose: This paper addresses the possible future of workplace counselling practitioner/researcher education and governance. It also examines the central roles that counselling research and professional regulation should each have in such professional developments. The specialist training proposals offered in this paper are considered in the light of the current debate concerning the provision of the possible graduate/postgraduate education curricula that BACP's Core Curriculum Consortium are currently considering as the likely research training needs of counselling's imminent professional regulation begin to emerge.

Design/Methodology: Two enquiry strands were undertaken into ways that such a specialised, probably postgraduate, training programme might be devised. These investigations (within higher academia and the workplace counselling "community") have led to the specific suggestions made in this paper about possible ways to educate, train and regulate the kinds of putative specialist workplace counselling practitioners/researchers that such an emerging, new, research led and regulated professional specialism might demand.

Strand 1): A series of investigations into

i) The professional developmental potential for workplace counsellor/researchers

ii) The possibility that promoting workplace counselling as a new, regulated, specialism might be a way forward that is acceptable this putative profession's likely "stakeholders" (employee assistance providers [EAPs], possible regulators, researcher/practitioners etc)

Strand 2): An investigation into the academic requirements of Higher Education when offering specialist, postgraduate, workplace counsellor/researcher educational provisions. This investigation was based on the underlying, evidence-based, premise that "true" professions must be knowledge-based, (ie research-based) and so have professional standards that are amenable to formal regulation. This has included an enquiry into the nature of research-driven knowledge from the perspective of the Learning Professional generally, (Gibbons et al, 1994; Scott, Brown, Lunt and Thorne, 2004), and the workplace counselling specialist in particular.

Ethical approval was obtained from the University of Middlesex.

Results/Findings: Support was found for arguing that workplace counselling specialists must be researching professionals. Therefore, recognising this inevitability might be a useful contribution towards the professional regulation of both workplace counselling and counselling in general.

Research Limitations: These enquiries extensively surveyed the needs of the EAPs but had insufficient input from current workplace counselling practitioners.

Originality/Value: Literature reviews indicate that this is so far a largely neglected area of enquiry and so this is a unique investigation into workplace counselling as a putative, knowledge-based specialism.

Conclusions/Implications: The conclusion reached is that there might be benefits if workplace counselling was to become an accredited counselling "Specialism" with its own research-led, professional discourse located within a regulated professional identity.

References available on request, please email

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Ms Alison Cox, Stephen Hubbard and Mark A Winwood

Other Author: John Mellor Clark

Professional Role (AC): Case Consultant Team Leader
Institution: ICAS and CORE-IMS
Contact details: ICAS, 70 Hutcheson Street, Glasgow G1 1SH

ABSTRACT: Workshop

Keywords: outcomes management, performance appraisal, benchmarking, feedback, case/network management

Practitioner performance at its best: the integration of CORE data into case management

Aim/Purpose: This on-going action research project is exploring the impact of introducing outcomes feedback and benchmarking into case management in an employee assistance programme. CORE was first piloted in case management in September 05 when this research began.

Design/Methodology: As an applied research design, the methodology contrasts with more traditional experimental design for a) addressing a pressing organisational problem (ie increased stakeholders demands for transparent data on effectiveness and efficiency), whilst b) iteratively developing empirical and experiential interpretation techniques with the demands of a complex social system. The sample comprises of some one hundred ICAS affiliate therapy practitioners, 14 case managers and over 500 clients. As data were collected as part of routine outcome monitoring, no ethical approval was necessary.

Results/Findings: Results suggest that practitioners value highly the opportunity for both clinical performance feedback from clinically senior peers, and the opportunity to offer progress feedback to clients. There is also early promising evidence of enhanced outcome efficiency and effectiveness mirroring findings in the wider therapy feedback literature.

Research Limitations: Action research methods have great strengths for their internal validity, but have inherent weaknesses in their external generalisability.

Originality/Value: The use of CORE System data in case supervision has appeared in the literature as has the subject of feedback to influence outcomes management. However, it is clear that ICAS's use of CORE data is enhanced by the use of benchmarking feedback to both practitioners and therapy consumers alongside the pioneering use of new CORE Net web-technology.

Conclusions/Implications: By offering practitioners the opportunity to review their own practice against standard benchmarks, we have found that project participants have developed professionally and have begun to use supervision in innovative ways. It has increased our organisational ability to match the intensity and length of treatment to individual client need which not only benefits the client but ensures optimal use of available resources.

The workshop will present the methodology through the innovative use of role play and case study to facilitate structured debate between workshops participants on the relative opportunities and challenges of this innovative way of working.

References available on request, please email

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Ann Dalzell

Professional Role: PhD Student
Institution: University of Bristol
Contact details: University of Bristol, 35 Berkeley Square, Bristol BS8 1JA


Key Words: power inequalities, differences, collaborative research

Looking beyond the obvious - a story of crossing borders and connecting with sameness

Aim/Purpose: Working with intimate autobiographical stories requires an ethical vigilance to the potential differences and power inequalities that exist between the researcher and the narrator (Etherington, 2007). This paper examines how the researcher and a group of five men acknowledged and navigated their differences within a narrative research project focussing on how childless gay men negotiate their ‘procreative consciousness' (Marsiglio et al, 2001) within a society that privileges heterosexual parenting.

Design/Methodology: Working within a narrative framework, the five participants were offered an opportunity to engage in research conversations as a means of generating personal, social and cultural stories (Clandinin and Rosiek, 2007).

Results/Findings: This research demonstrates that working collaboratively with participants sharing intimate stories requires the adoption of ‘participatory ethics' in order to build a bridge across the borders formed by issues of difference and inequality. Furthermore, in considering our differences, unexpected positions of ‘sameness' were identified which generated the co-construction of richer stories.

Research Limitations: The differences identified within this paper are specific to those engaged in this particular research. However, it is suggested that the illustrated ways of working with these differences are transferable to other counselling research projects.

Originality/Value: Available literature tends to focus exclusively on the nature of specific differences, such as gender and race, between the researcher and the participants. In contrast, this research focuses on the process of negotiating difference and sameness in collaboration with research participants.

Conclusions/Implications: Counsellor researchers are encouraged to examine critically how they approach issues of differences and power inequalities, with participants, throughout the research process.

Clandinin, D. J., & Rosiek, J. (2007). Mapping a landscape of narrative inquiry: Borderland spaces and tensions' in D.J. Clandinin (Ed.), Handbook of Narrative Inquiry: Mapping a methodology . Thousand Oaks, CA: Sage.
Etherington, K. (2007). Ethical research in reflexive relationships. Qualitative Inquiry 13 (5): 599 - 616
Marsiglio, W., Hutchinson, S., & Cohan, M. (2001). Young men's procreative identity: Becoming aware, being aware, and being responsible. Journal of Marriage and the Family, 63 (1):123 - 169.

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Anne Davis

Other Author: Dr Ladislav Timulak

Professional Role: PhD Student
Institution: University of Dublin, Trinity College
Contact details: School of Psychology, Aras an Phiarsaigh, Trinity College, Dublin


Keywords: religion, spirituality, psychotherapist

Religious and spiritual experience amongst psychotherapists in Ireland

Aim/Purpose: Historically, psychotherapy theories which were founded on secular philosophy and the natural sciences, have had an uneasy alliance with the concepts of religion and spirituality. However, previous research (Bilgrave & Deluty, 1998) suggests that individuals offering psychotherapy may not experience this dichotomy.

The current study is a contribution to international research exploring the religious and spiritual experiences of psychotherapists (Smith & Orlinsky, 2004) and examines patterns of religiosity and spirituality and their influence on practice.

Design/Methodology: Ethical approval was obtained from the Trinity College School of Psychology Ethics Committee. The participants were 87 Irish psychotherapists with a range of orientations and professional identities. Participants (63 females, 24 males) have been practicing psychotherapy for between 5 to 41 years, with an age range of 32-68. The instrument employed was a self-report questionnaire comprising a shortened version of the ‘Development of Psychotherapist Common Core Questionnaire' (Orlinsky et al, 1999) and the ‘Religious Experiencing Profile' (Orlinsky & Smith, 1995).

Results/Findings: The patterns that emerged suggested that while both religion and spirituality are important to Irish psychotherapists, individual spirituality is more prevalent than adherence to organised religion. Qualitative data shows that the beliefs of participants influences their therapeutic practice in myriad ways.

Research Limitations: It is not clear how representative this sample is as it may have attracted those who are more interested in the topic to participate.

Originality/Value: Despite an increased interest in the integration of psychotherapy, religion and spirituality, little research has been undertaken in either the United Kingdom or Ireland.

Conclusions/Implications: This study supports international research suggesting that spirituality and religion play an important role in the lives of psychotherapists. Consequently, their affect on the therapeutic relationship and practice merit reflection. Furthermore, their inclusion within training and continuing professional development is recommended.

Bilgrave, D.P., & Deluty, R.H. (1998). Religious beliefs and therapeutic orientations of clinical and counseling psychologists. Psychotherapy: Theory, Research, Practice and Training, 39: 245-260.
Orlinsky, D.E., Ambuhl, H., Ronnestad, M.H., Davis, J.D., Gerin, P., & Davis, M. (1999). The development of psychotherapists: concepts, questions and methods of a collaborative international study. Psychotherapy Research. 9: 127-153.
Orlinsky, D.E., & Smith, D.P. (1995). Religious Experience Profile. Unpublished questionnaire. University of Chicago, Committee on Human Development.
Smith, D.P., & Orlinsky, D.E. (2004). Religious and spiritual experience among psychotherapists. Psychotherapy: Theory, Research, Practice, Training, 41 (2): 144-151.

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Dr Linda Dubrow-Marshall, Professor Rod Dubrow-Marshall and Dr Paul Martin

Professional Role (LDM): Visiting Fellow in Psychology & Student Counsellor
Institution: University of Glamorgan
Contact details: 70 Merthyr Road, Pontypridd CF37 4DD

ABSTRACT: Workshop

Keywords: harmful groups, undue influence, group practices, psychotherapy cults, treatment approaches

Identifying unethical and harmful group practices and treatment approaches for survivors of harmful groups

Aim/Purpose: This workshop aims to explore methods that have been developed (cf. Dubrow-Marshall & Dubrow-Marshall, 2007; Singer & Lalich, 1995) to identify unethical and harmful practices in a variety of group settings and to discuss approaches to treatment for the specific types of harm that result (Martin, 1993).

Design/Methodology: Previous research has identified criteria for harmful group settings or cults, including psychotherapy cults (Temerlin & Temerlin, 1982) or multifarious ideologically based groups (Lifton, 2000). Research has shown how the group leader, whether as a therapist or religious or political leader, unethically wields power via the creation and use of local discourses which ideologically define the cultural norms and practices of the group (cf. Billig, 1986; Edwards & Potter, 1992). Research also shows particular patterns of harm involving depression, dissociation and anxiety resulting from prolonged exposure to undue influence practices (Martin, Langone, Dole & Wiltrout, 1992; Dubrow-Marshall, Martin & Burks 2005).

This workshop will:

  • Briefly present the criteria for unethically run groups including psychotherapy cults and other forms of cults and an analysis of the harm suffered by those who have left such groups and sought treatment
  • Allow for small group discussion, facilitated by the presenters, of how these criteria can be used to identify different forms of undue influence and the potential for psychological harm, including in psychotherapy cult settings, using case study examples
  • Provide a short overview of the treatments used with survivors of harmful groups including at the Wellspring Retreat and Resource Center in Ohio, a residential psychotherapeutic treatment programme for group survivors (eg Martin, 1993). This approach has utilised and developed the diagnostic approach to undue and harmful influence formulated by Lifton (1961, 2000) and adapted in clinical settings by Singer (1978) and others (cf. Aronoff, Malinoski & Lynn, 2002)
  • Anonymous case studies will be used to allow workshop participants to explore in smaller groups, the different ways in which survivors of harmful groups can be successfully treated

Originality/Value: The workshop will allow participants to explore contemporary methods for the identification of group based harm and useful approaches to treatment.

References available on request, please email

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Professor Robert Elliott     

Other Authors: Beth Freire and Professor Mick Cooper

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: Counselling Unit, University of Strathclyde, 76 Southbrae Drive, Glasgow G13 1PP


Keywords: person-centred, experiential therapy, outcome research, meta-analysis, mental health policy

Empirical support for person-centred/experiential psychotherapies: meta-analysis update 2008

Aim/Purpose: For reasons that are not clear, the large empirical literature that supports the person-centred/experiential (PCE) practice is generally not known or reflected in mental health policy, a problematic situation that extends to PCE therapists and counsellors themselves. In this paper, we summarize the results of these studies along three lines of evidence on the effectiveness of these therapies, encompassing across a broad range of client presenting problems.

Design/Methodology: Using state-of-the-art meta-analytic techniques, and building on previous meta-analytic research (ie Elliott, Greenberg & Lietaer, 2004), we added another 40 predominantly recent outcomes studies to the large sample previously reported, for a total of roughly 150 quantitative outcome studies on person-centred, process-experiential/emotion-focused, gestalt and related experiential therapies.

Results/Findings: The following results hold across both previous and current replication samples of quantitative therapy outcome research: (1) Clients in PCE therapies experienced large amounts of pre-post change. (2) Post therapy gains were maintained over early and late follow-ups. (3) In controlled studies, clients experienced large gains relative to untreated groups. (4) In general, PCE therapies appeared to be statistically and clinically equivalent when compared to non-PCE therapies including CBT. (5) In some analyses, CBTs did slightly better than person-centred or nondirective therapies, but the difference is small, and is likely to be due to researcher allegiance. (6) The strongest support for PCE therapies is for couples problems, depression and PTSD/trauma, where they meet standard criteria for Evidence Based Practice. (7) There is suggestive evidence of effectiveness for severe disorders (schizophrenia, borderline process) and psychosomatic problems.

Conclusions/Implications: These results are consistent with complementary lines of evidence relating empathy to outcome (Bohart et al, 2002), and client treatment preference data. Taken together, the body of evidence clearly indicates that relevant NICE guidelines should be modified to include PCE therapies for depression and that these therapies should be offered to clients in primary care, NHS, and other mental health settings. Relying on multiple lines of evidence, such as provided in the present study, provides a sound basis for public mental health policy.

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Professor Kim Etherington

Institution: University of Bristol

Abstract: Paper

Key words: life story research, knowledge creation, narrative knowledge, research participation

Life story research - a relevant contribution to a knowledge based profession

Focus of paper: This paper focuses on the use of life stories as an important, relevant and appropriate contribution to knowledge based professions such as counselling and psychotherapy.

Aim/Purpose: It aims to show how narrative knowledge is created and constructed through the stories people tell about their lived experiences and explores the concept of ‘narrative knowing' (Bruner, 1986).

Research: It is based upon life story research with eight people who linked their history of problematic drug use with experiences of childhood trauma/abuse. Ethical approval was granted through university faculty ethics committee.

Limitations: As several journal articles (Etherington, 2005, and a book 2007) are already available for those interested in the content of that study, this paper addresses instead epistemological and methodological issues. Although abstract guidelines suggest that only five minutes of a paper should focus on methodology, this paper offers a different choice for conference participants who are interested in finding creative, arts-based ways to conduct research that help us to make sense of the ambiguity and complexity that is often attached to human lives.

Originality/Value: As well as drawing attention to how new knowledge of the topic is created through this methodology, the paper also highlights what participants said about how their involvement in this study created new knowledge/insights for them and their understanding of how that occurred. They also compare the learning created through research participation with their learning through therapy.

Conclusions/Implications: The paper suggests that therapists (and counselling researchers) could learn from what participants tell us about the therapeutic value of life story research which one participant described as helping him to face ‘...out into the world...without unduly or specifically delving into, or focusing on [my] emotional state'. This learning may be particularly relevant for therapists working with traumatised clients.

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Ariana Faris

Professional Role: Senior Lecturer and UKCP registered Psychotherapist
Institution: University of Wales, Newport
Contact details: 56 Richards Terrace, Roath, Cardiff CF24 1RX


Key words: refugee, community, systemic, ritual, group

Community approaches to working with asylum seeking women

Aim/Purpose: This paper is an account of an enquiry into asylum seeking and refugee women's experience of participation in a therapeutic group in Wales. The group structure and facilitation was informed by systemic and community healing/psychology practices and the use of ritual as a tool for healing.

The research question was in two parts; how useful are the rituals and artefacts of Western psychotherapies alone in being able to respond usefully to the complex multilayered contexts of refugees' lives; what other models including collective and community based approaches could contribute to the delivery of flexible and culturally sensitive therapeutic services. The literature highlights a need to understand how refugees and asylum seekers experience the therapeutic services available to them (Woodcock, 1997).

This study used Interpretative Phenomenological Analysis (IPA) as a means of gaining understanding of the experience of participation in this process. It draws conclusions that might inform practice and service development for refugee populations as well as for other marginalised groups.

Design/Methodology: This was a qualitative study using IPA with semi structured interviews (Smith et al, 2003). Four participants gave informed consent. Ethical approval was gained from The Family Institute, University of Glamorgan.

Results/Findings: Three overarching themes were identified: the importance of mutual identification and shared experience; ambivalence in giving testimony and bearing witness; the benefits on well being of providing support to others.

Research Limitations: Small sample from one therapeutic group.

Originality/Value: This study enquires into the experience of refugee women on their participation in a therapeutic group. The findings offer guidelines for practice particularly into community and group therapy approaches for this population.

Conclusions/Implications: Therapeutic groups for refugee women facilitated using ritual and vehicles for cultural enactment can re-establish community and ameliorate against the negative effects of displacement and refugee experience. Therapeutic groups can provide a normalising context that improves participants' well being. Bearing witness and giving testimony carry both risk and protective factors. Supporting each other repositions group members as survivors rather than victims of their experience. These findings suggest collective therapeutic models have much to offer not only to this as well as other marginalised populations.

Smith, J., & Osborn, M. (2004). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology. A practical guide to Research methods. London: Sage.
Woodcock, J. (1997). Group work with refugees and asylum seekers. In T. Mistry & A. Brown (Eds.), (1997) Race and Group work. London: Whiting & Birch.

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Eugénia Fernandes

Other Author: Ana Borges

Professional Role: Teacher
Institution: University of Minho
Contact details: Departamento de Psicologia, Universidade do Minho, Campus de Gualtar, 4700 Braga, Portugal


Keywords: constructivist psychotherapy, change events, client's agency, client's perspective, qualitative analysis

Are change events identified by clients in constructivist therapy related to the emergence of a new sense of agency?

Aim/Purpose: Personal construct psychotherapy presumes that therapists and clients bring to therapy different kinds of knowledge, useful to successful process and outcomes. Informed by this assumption, personal constructivist therapists work in a collaborative way, promoting proactive behaviour and a self sense of agency in clients (Fernandes, 2007). Believing that clients' implicit theories impact on their psychotherapy change, change should be analysed, not only from the therapist's perspective, but also from the client's (Elliott, R. & Shapiro, D. A., 1992). This study aimed to understand if clients undertaking brief constructivist therapy (Senra, Feixas & Fernandes, 2007) demonstrate the development of a self sense of agency, and how this is associated with the significant change events identified by clients along the process.

Design/Methodology: Six clients undertaking treatment for personal dilemmas gave consent to take part in this research. Throughout the 12 session therapy processes, clients answered the Helpful Aspects of Therapy form (HAT; Elliott, Slatick & Urman, 2001) to identify any significant change events occurring in each session. Based on these change events a Brief Structured Recall (BSR) (Elliott & Shapiro, 1988) measure was used. Thematic categorisation of the change events and a narrative analysis of BSR data will be made.

Results/Findings: Data from this study will be presented at the conference. Comparing significant change events identified on the initial sessions with those identified on later sessions, we expect to gradually find more "internal experience centred" themes in clients such as "clients' insight" (Elliott & James, 1989). With regard to narrative analysis of clients' experiences during significant events, we expect to find increased self-disclosure of the clients' sense of agency, grounded on proactivity expressions, on self diversity and on self reconstruction.

Research Limitations: The brief therapy proposal for treatment of personal dilemmas, used in this study, is still used on some cases, limiting the analysis to a small sample of therapy process.

Conclusions/Implications: In this poster we will discuss the results, considering the constructivist therapy goals and the relevance of attending clients' perspectives throughout the therapeutic process.

References available on request, please email

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Jan Grove and Simon Blasby

Professional Role (JG): Senior Lecturer in Counselling
Institution: Newman University College
Contact details: Newman University College, Genners Lane, Bartley Green, Birmingham B32 3NT


Keywords: same-sex relationships, counselling, validation, models of relationships, support

A pilot project to gain insight into client experiences in same-sex couple counselling

Aim/Purpose: To explore how gay and lesbian couples seek counselling, and how the counsellor can help or hinder the therapeutic process. This is an under-researched area with a need for more sensitive and in depth analysis of same-sex relationships (Beals & Peplau, 2001).

Design/Methodology: Nine participants who had experience of same-sex couple counselling were interviewed, and the results analysed using a grounded theory approach (Charmaz, 2006). Participants were recruited through advertisements and personal contact email networks. Venues for the semi structured interviews were chosen by the respondents. Ethical approval was gained from the University of Birmingham Centre for Lifelong Learning research committee.

Results/Findings: Initial results indicate that respondents were sensitive to signs of validation in finding a counsellor and of their affirmation of the same-sex relationship during counselling. The counsellor's ability to avoid both stereotyping same-sex relationships and applying heterosexual couple models facilitated deeper work. External support was qualified with an underlying theme that same-sex relationships are inferior compared to heterosexual coupling.

Research Limitations: It is not possible to generalise the results due to the small sample size, further research will be undertaken building on the results of this pilot project. The homogeneity of the sample in terms of educational background and profession also limits the results.

Originality/Value: Same-sex relationships acquired legal status with the Civil Partnership Act (2005), however these couple relationships are formed within a culture where the dominant discourse in the Western world assumes the ‘normality' of heterosexuality and the deviance of all other sexual orientations (Bieschke, 2002). This research begins to identify ways of therapeutically supporting same-sex relationships.

Conclusions: Counselling agencies and counsellors need to be aware of the importance of validation of the relationship both within and outside of the therapeutic space.

Implications: Services that specifically state that they work with same-sex couples will demonstrate their inclusiveness and facilitate clients making contact. Training implications include the need to affirm same-sex relationships, and a sufficient knowledge base to be aware of the diversity of relationships. This would include avoiding stereotyping same-sex relationships and applying theoretical models devised for heterosexual couples.

Beals, K. P., & Peplau, L. A. (2001). Social involvement, disclosure of sexual orientation, and the quality of lesbian relationships. Psychology of Women Quarterly, 25: 10 - 19.
Bieschke, K. J. (2002). Charting the waters. The Counselling Psychologist, 30: 575 - 581.
Charmaz, K. (2006). Constructing grounded theory, London, Sage.

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Terry Hanley

Professional Role: Lecturer in Counselling and ESRC funded PhD student
Institution: University of Manchester
Contact details: Educational Support & Inclusion, School of Education, Ellen Wilkinson Building, The University of Manchester, Oxford Road, Manchester M13 9PL


Keywords: online, counselling, culture, research, adolescents

The therapeutic alliance in online counselling with young people

Aim/Purpose: In recent years online counselling services have begun to develop with the purpose of increasing access to young people. This work has been conducted alongside one such organisation (Kooth) with the hope of gaining a greater understanding of the experiences that service users have when they access therapy online. The specific focus of this paper is upon examining the quality of the therapeutic alliance that can be developed using synchronous and asynchronous text based media to offer therapeutic support.

Design/Methodology: A mixed methods approach has been adopted which utilises self-report quantitative measures (the ‘Strengths and Difficulties Questionnaire' [n=96] and the ‘Therapeutic Alliance Quality Scale' [n=45]) and qualitative interviews with service users to gain insight into the nature of the online therapeutic alliance [n=15].

This study adheres to the BACP's ethical framework and is further informed by the same organisation statement upon research ethics and the BPS's guidance upon conducting research online. Ethical approval was granted by the University of Manchester and Kooth's management.

Results/Findings: Findings prove positive with approximately three quarters of respondents reporting the working alliance to have been of a medium or high quality. The key themes that arose within the interviews included a valuing of the anonymous nature of such a service, a sense of more control within the relationship with their counsellor, and the perception that the counsellor empathically understood the issues that they were bringing to therapy.

Research Limitations: Numerous difficulties were encountered whilst conducting a research project online. Major challenges included recruiting individuals to take part and obtaining responses to the follow up SDQ questionnaire.

Originality/Value: This research adds to the slowly developing pool of research which reports that quality therapeutic relationships can be developed online.

Conclusions/Implications: The findings of this study suggest that it is possible to create therapeutic relationships of a sufficient quality to offer appropriate support to young people utilising the Internet. Such findings may be useful to organisations contemplating developing youth service online.

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Lorna Henderson and Dr Diane Hazlett

Professional Role (LH): Post Graduate student
Institution: University of Ulster


Keywords: emotional detachment, trauma, challenge, relationships, safety, awareness

An investigation of counsellors' therapeutic strategies for managing emotionally detached clients

Aim/Purpose: This poster explores the implications of working with a client who appears to be emotionally detached. The poster focuses on the strategies employed by therapists to manage clients such as these. This research sought to provide an insight into the needs of this client group.

The study aimed to understand therapist strategies for effective therapeutic interaction and management of emotion and thus to establish meaningful and helpful methods to work with clients who are emotionally detached, which is a clinical barrier to therapeutic interaction and management.

Design/Methodology: Primary data were gathered from semi-structured qualitative interviews from five counsellors with varying levels of experience.

Research/Findings: The study highlights the diversity in the awareness and understanding of emotional detachment. It recognised the challenges and difficulties for the therapist working with trauma clients, while endeavouring to understand the meaning of emotional detachment and how it becomes established. The key research findings reinforced the importance of managing and containing the therapeutic relationship, while recognising the individuality of the clients. Each therapist identified different theoretical perspectives and definitions, while agreeing that this client group could be difficult and challenging.

The strategies found in relation to managing this client group included the importance of safety, professional boundaries being maintained, development of trust and therapeutic alliance and therapists having the necessary training, knowledge and skills.

Research Limitations: One of the limitations of this project may be a lack of recognition of emotional detachment amongst therapists. This small-scale study highlighted the complexity of this concept, emphasising the need for further research to raise awareness of potential therapeutic strategies and approaches.

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Andrew Hill and Alison Brettle

Other Authors: Peter Jenkins and Claire Hulme

Professional Role (AH): Senior Lecturer in Counselling
Institution: University of Salford
Contact details: School of Community Health Science and Social Care, University of Salford, Frederick Road, Salford M6 6PU


Keywords: counselling, primary care, systematic review, evidence-based practice

Counselling in primary care: a systematic review

Aim/Purpose: Systematically to locate, appraise and synthesise evidence from scientific studies in order to obtain a reliable overview of the clinical and cost effectiveness of counselling in primary care and to summarise user perspectives.

Design/Methodology: Comprehensive searches were undertaken on seven electronic databases, supplemented by the hand-searching of six journals and a call for grey literature. This located a potential 3193 unique studies for inclusion. Following the screening of abstracts 338 studies were obtained and further screening resulted in the inclusion of 30 unique studies for the final review. EPPI Reviewer Software (University of London, 2006) was used to track all studies passing through the review process. Studies were graded high (++), good (+) or poor (-) and the findings drawn from 27 studies that were graded good or high quality.

Results/Findings: In the treatment of non-specific, generic psychological problems and in the treatment of anxiety and depression, brief counselling is more effective than routine primary care in the short term. Counselling is as effective as medication and counselling and medication in combination are more effective than either intervention offered as a single treatment. Counselling is as effective as CBT with typical heterogeneous primary care populations. Primary care patients prefer counselling to medication and the preference for counselling is unaffected by factors such as age, presence of mental health problems, or problem severity. There is no clear evidence that patients prefer one type of counselling above another, although evidence indicates that patients prefer individual rather than group counselling. Both patients and GP's are highly satisfied with counselling in primary care.

Research Limitations: The lack of well-conducted cost-effectiveness studies renders the evidence inconclusive in this area. The paucity of published studies using the CORE outcome measure limits the amount and quality of practice-based evidence.

Originality/Value: This study builds upon previous systematic reviews in this area (Bower and Rowland, 2006; Hemmings, 1999) supplementing research into effectiveness and cost-effectiveness with a detailed critique of research into patient preferences.

Conclusions/Implications: Brief counselling is an effective treatment in primary care particularly with non-specific, generic psychological problems.

Bower, P., & Rowland, N. (2006). Effectiveness and cost effectiveness of counselling in primary care. Cochrane Database of Systematic Reviews.
Hemmings, A. (1999). A systematic review of brief psychological therapies in primary health care. Counselling in Primary Care Trust and The Association of Counsellors and Psychotherapists in Primary Care.
University of London (2006). EPPI Reviewer 3.0, EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

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David Jackson

Institution: University of Bristol
Contact details: 86 North Road, Saltash, Cornwall

ABSTRACT: Pre-breakfast workshop

Keywords: ethno autobiographical, memory work, multi modal, Fyttes war veteran

Fitting the flatness: an ethno autobiographical exploration of living with a mental health disability from my experience of war

This is a highly exploratory experiential workshop that uses a piece of non traditional research as a backdrop to exploring some of the issues when representing client experience. In the first half of the workshop participants will experience an experiential performance piece which uses PowerPoint as its medium.

Within the canvass of the PowerPoint the audience will experience a multimodal approach to research which represents the author's narrative of depression. Using postmodern methodologies it will communicate an event which is expressed, produced as a performance, and finally allows interpretation by the watcher. It offers a new way of knowing beyond current counselling research paradigms.

Using this canvas as a place for memory work and for performing the self it offers a window into a lived life. Within the canvas are many types of documentations from the author's life. They include critical text, voices, images, personal photographs, written notes, poems and music. The documentation is chronologically arranged over a timeline of an autoethnography course he attended at the University of Bristol. It flickers back to memories of his time as a Royal Marine to Norway, Belize, Northern Ireland, ‘down south' to the Falklands conflict and to his academic life as an Open University student and during his Masters course. The ‘insider voice' is heard from an absence, from tiled faces, from poetry and music.

In the second half of the workshop there will be an opportunity to discuss the experience in small groups and in turn offer an invitation to represent, through poetic representation, the multi interpretations of hearing a marginalised voice. Each participant will have an opportunity to offer parts of their own poetic representations to enable a collective interpretation of hearing this voice.

It will also offer an opportunity for the audience to reflect and discuss the use of documents of life to present different types of stories from clients.

There is an opportunity to discuss how creative, poetic, experimental and evocative research can contribute to informing practise or contribute towards research and raises awareness about the use of insider voice or collaborative research when representing client's experiences.

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Jyoti Joshi and Angela Sweeney

Other Authors: Angelina Ray and Winsome Pryce

Professional Roles: HPD in Counselling Students / Volunteer Counsellors
Institution: Lewisham Counselling & Counselling Training Associates (LC&CTA) and Lewisham College
Contact details: c/o Chris Brown Room B134, Lewisham College, Lewisham Way, London SE4 1UT


Keywords: OCD, self-harm, anxiety, ritual, coping

Anxiety in obsessive compulsive disorders and self-harm - exploring commonalities and implications for classification and regulation of treatment

Aim/Purpose: OCD and self harming behaviours often have underlying emotional or experiential beginnings, yet current treatment focuses more on treating the dysfunctional behaviour only. Documented evidence strongly indicates that anxiety figures highly in both OCD and self-harm, however, whilst OCD is classified as an anxiety disorder in the DSM-IV, self-harm is not. This study explores potential commonalities between OCD and self-harm in relation to peak experience of anxiety, ritualistic behaviour and the release/suppression of feelings. The researchers seek to ascertain whether there is a case to be made for self-harm being classified as an anxiety disorder and if so, the potential implications this may have on how and what type of support/treatment is provided to sufferers.

Design/Methodology: The Duquesne Method of Empirical Phenomenology (Moustakas, 1994) was employed, and generalisations will be drawn from identifying common themes and threads evident in our data.

Research respondents included 28 practitioners, with clinical experience of OCD or self-harm sufferers, who answered a questionnaire or engaged in a one to one audio taped interview focusing on three broad areas of enquiry:

  • Anxiety
  • Ritualistic behaviour
  • Release/suppression of feelings

The research was conducted following the BACP ethical guidelines for researching counselling and psychotherapy (Bond, 2004).

Results/Findings: Initial results indicate that commonality exists between OCD and Self-harm sufferers' experience of anxiety. No conclusions have yet been drawn as data is still being analysed. Our qualitative results will be ready for presentation at the BACP Research Conference in May 2008.

Research Limitations: The research project was limited by time and resources and due to ethical considerations, sufferers themselves could not be interviewed.

Originality/Value: This research looks at evidenced similarities in anxiety levels, ritualistic behaviours and experience of feelings in OCDs and self harming behaviours rather than the differences between the disorders.

Conclusions/Implications: This study has implications for classifying self-harm in the DSM-V (due to be published in 2011) as an anxiety disorder and may potentially improve the knowledge base for regulation and effective treatment of the disorder.

References available on request, please email

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Nicholas Ladany, PhD

Other Author: Jessica A. Walker, PhD.

Professional Role: Professor of Counseling Psychology
Institution: Lehigh University
Contact details: Counseling Psychology Program, Lehigh University, Bethlehem, Pennsylvania 18015


Keywords: training, supervision, education, case study, process

Lydia's story: a supervisee's search for supervisor competence and client progress

Aim/Purpose: The purpose of this case study was to examine the linkages between supervision process and outcome, and psychotherapy process and outcome.

Design/Methodology: The participants in the study consisted of a beginning therapy trainee, her two supervisors, and her six clients. All therapy and supervision session were videotaped. Post session qualitative interviews were conducted after every supervision and therapy session, with the trainee, supervisor, and clients. In all, 89 sessions over an eight-month period were reviewed, along with two-year follow-up questionnaires. Participation was voluntary, participants could withdraw from the study at any time, and all identifying information has been removed.

Results/Findings: Six themes emerged from the data in relation to Lydia's work in supervision and therapy and they included: (1) abandonment and termination (eg client grief and bereavement, supervisor abandonment), (2) boundary issues with time (eg parallel process), (3) countertransference (eg successful and unsuccessful management), (4) Lydia's anxiety (eg feeling overwhelmed), (5) successful moments (eg in unexpected places), and (6) therapist pain (eg what happens when clients do not get better).

Research Limitations: Due to the case study nature of our investigation, the generalizability and practical applicability is limited to one specific trainee case. Moreover, because this trainee was a beginning therapist in a graduate program, extensions to post-degreed clinicians should be tempered.

Originality/Value: To date there are less than a handful of case studies that have examined supervision process and outcome in relation to psychotherapy process and outcome, and none have used such an extensive examination of a case.

Conclusions/Implications: The observational approach proved to result in data that were rich with examples of successes and failures that offered real-life practice implications. For example, we were able to track how a supervisor's approach to time limits in supervision had a direct impact on the trainee's approach to time limits in therapy. These examples, in turn, will be used to discuss how parallel process can be interpreted and discussed in supervision.

References available on request, please email

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Julia McLeod et al

Other Authors: John McLeod, Alison Shoemark 1 and Mick Cooper 2

Professional Role (JM): Lecturer in Counselling
Institution: Tayside Institute for Health Studies, University of Abertay Dundee; School of Education, University of Aberdeen 1, Counselling Unit, University of Strathclyde 2
Contact details: Tayside Institute for Health Studies, University of Abertay Dundee, Bell St, Dundee DD1 1HG


Keywords: outcome, qualitative, user perspectives

Clients' views of the outcome of counselling in primary care

Aim/Purpose: The aim of this study is to investigate the ways in which clients who have received counselling from a primary care service, define and understand the outcomes of therapy, and to articulate a model of user-constructed outcomes.

Design/Methodology: Patients were referred for counselling by GPs, and were invited to take part in a research project, following a protocol approved by the local NHS Research Ethics Committee. Research participants completed a range of process and outcome measures, at the start of counselling, weekly, and at termination. The significance of these data, in relation to client perceptions of outcome, were explored in individual dialogical follow-up interviews. Interviews were transcribed and subjected to a form of qualitative case analysis, in relation to five key domains: (i) causes of problems and ways of dealing with them; (ii) intervention concepts and strategies; (iii) use of social and community resources; (iv) criteria for evaluating the helpfulness of treatment; (v) maintaining gains in everyday life settings. The present paper reports on early returns from an analysis of the first 12 participants in the study.

Results/Findings: Client criteria for outcome include: moving on, achieving personal goals, learning about therapy, and repairing a life. Material from three cases is provided to illustrate contrasting patient pathways through counselling.

Research Limitations: This study is based on a relatively small sample of clients in one agency - further research is required in order to assess the extent to which these findings can be generalised to other client groups and therapy settings.

Originality/Value: The findings of this study provide the basis for an alternative framework from which therapy outcomes can be evaluated, based on user perspectives.

Conclusions/Implications: Clients are actively engaged in constructing outcomes, in terms of their personal goals and criteria. In some cases, clients' views of outcome differ from those held by health professionals. The implications of these findings for research and practice are discussed.

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John Mellor-Clark and Barry McInnes

Professional Role: Director (JMC) and Head of Training (BM)
Institution: CORE Information Management Systems Ltd
Contact details: CORE IMS, 47 Windsor Street, Rugby CV21 3NZ


Keywords: benchmarking, workplace counselling, CORE System, CORE National Research Database, performance management

Benchmarking key service performance indicators in UK workplace counselling

Aim/Purpose: The aim of this paper is to present a sub-set of data drawn from UK workplace counselling data collected from an on-going naturalistic action research project known as the CORE project (Mellor-Clark & Barkham, 2006a). This initiative offers psychological therapy services a series of tools and support resources that collectively make up the common CORE methodology (Mellor-Clark et al, 2006) that's currently used by over 250 UK services. The purpose of the wider project is to empirically inform continuing professional development for both services and practitioners by offering a range of ‘performance indicators' and support training to resource service quality benchmarking.

Design/Methodology: The paper uses both the CORE National Research Database for primary care (n=34,000+) and the more recent CORE National Research Database for workplace counselling (n=14,000+). From each we collated benchmark profiles for a range of five key service quality indicators that included: (a) waiting times; (b) outcome measurement; (c) risk assessment; (d) client attrition; and (e) improvement and recovery.

Results/Findings: The benchmark profiles show wide inter-service and intra-service variation in the quality of service provision that raise questions for further on-going action research and national service developments for the role and function of in-house performance management.

Originality/Value: The CORE initiative has a unique methodology in the UK that's now used by over 250 services. This methodology comprises: (a) a set of well-validated measurement tools focussed on quality assurance; (b) a bespoke software platform for collation, analysis and benchmarking; and (c) a recognised CORE User group committed to donating anonymous CORE System data to resource the creation of a CORE National Research database. We hope to emphasise originality through a profile of the potential contributions of the unique methodology (Mellor-Clark et al 2006b), and value by the potential utility of the benchmarks for reflecting on the relative quality of service delivery and deployment (McInnes, 2006).

Research Limitations: Limitations will be addressed at the conference

Conclusions/Implications: With the national interest in developing stepped psychological care, payment by results, and commissioning for recovery in psychological therapy, it is timely for us to reflect on the relative strengths and weaknesses of local and national service provision. Crystal-ball conclusions will thus focus on profiling the (hypothetical) Utopian Workplace Counselling Service and their on-going development of counselling excellence through performance management values, methods, technologies and practise.

References available on request, please email

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David Murphy

Professional Role: Chartered Counselling Psychologist
Institution: De Montfort University, Leicester.
Contact details: Gateway House, The Gateway, Leicester LE1 9BH


Keywords: counselling, psychotherapy, mutuality, intersubjectivity, therapeutic relationship, outcome

Counselling and psychotherapy: a mutual encounter?

Aim/Purpose: The therapeutic relationship is recognised as a well established factor in producing positive change. This has meant a positive therapeutic outcome results from the extent to which the client perceives the therapeutic conditions of empathy, acceptance and genuineness. The current study assesses the effects of the bi-directional flow of attitudes between client and therapist on outcome and specifically the effect of mutually high levels of the therapeutic conditions.

Design/Methodology: In a longitudinal and naturalistic study participants (n = 25 clients, n = 10 therapists) agreed to take part and informed consent was obtained. Both client and therapist participants completed a shortened version of the Barrett-Lennard Relationship Inventory (B-L RI) measuring their own attitudes and the perceived attitudes of the other at session one, three and five. In addition clients simultaneously completed the CORE-OM.

The data is being analysed using correlations to test the association between the relationship and outcome and path analysis will be used to further explore these effects. The effect of mutuality on outcome is being explored by examining the interaction of ‘level of relationship conditions' X ‘mutuality'.

Results/Findings: It is anticipated that the results will support the hypothesis that when the therapeutic relationship is viewed positively by clients then successful outcome will be achieved. However, it is also anticipated that when mutually high levels of the therapeutic conditions of empathy, acceptance and genuineness are present, then outcome will be predicted more strongly.

Research Limitations: The study is currently at an early stage in data collection and this means that sample size is small. Due to this the results are tentative.

Originality/Value: There is a growing body of literature in both person centred and psychodynamic theory that is concerned with intersubjectivity within the therapeutic relationship. However, little quantitative research exists to test the notion of ‘relational depth' and ‘mutual empathy'. The current study makes a first attempt to empirically test this theory.

Conclusions/Implications: This study calls researchers and practitioners to consider the therapeutic relationship as a bi-directional phenomenon.

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Graham North

Professional Role: Primary Care Counsellor and Primary Care Mental Health Worker
Institution: Manchester University
Contact details: 2 Embankment Road, Sheffield S10-2EZ


Keywords: counselling, supervision, audio-recording, reflective-practice, stress

Recording supervision: educational and therapeutic?

Aim/Purpose: To explore the impact on counsellors of listening to an audio-recording of their latest supervision session.

Design/Methodology: The study was conducted using qualitative, semi-structured interviews, which were transcribed and analysed using grounded theory methodology (Glaser and Strauss, 1967; and Strauss and Corbin, 1998). Grounded theory methodology is compatible with understanding the phenomena associated with a hitherto un-researched area, such as my research question.

Participants were a convenience sample of nine counsellors, working in different settings, using various counselling models but necessarily in an established supervision relationship. They were also previously unknown by me, so that I could maintain sufficient emotional distance (Strauss and Corbin, 1998).

Results/Findings: It was as if listening to the audio-recording allowed participants to ‘reflect-in-action' (Schön, 1983) in the supervision room, as they re-experienced their original thoughts and emotions, just as in Interpersonal Process Recall research (Elliott, 1986), but arguably with less emotional intensity. Participants were able to recall experiences in supervision that they had forgotten, not noticed or (arguably) repressed, along with the associated thoughts and feelings. Finally, they were able to integrate this ‘forgotten' data with their knowledge of counselling and with their own self-awareness, enabling them to extend their awareness of themselves, their supervisor and their clients. Listening to the recording is much more than ‘reflecting-on-action' (Schön, 1983) in the counselling room.

Research Limitations: Theoretical saturation (Strauss and Corbin, 1998) was not achieved with this small sample (McLeod, 2001).

Originality/Value: Supervision is mandatory for counsellors and most psychotherapists in Britain (Feltham, 2002); and audio-recording supervision has been advocated as a quality control measure for supervisors (Page and Wosket, 2001; Walker and Jacobs, 2004: 79-80; West and Clark, 2004: 25). However, I found only one reference commending it as a direct benefit to supervisees (Houston, 1995: 75) and then, in the absence of any evidence-base. This research attempts to provide that evidence-base.

Conclusion/Implications: Listening to the recording of the supervision session is educational. It may also have been therapeutic for those counsellors, who exposed themselves to disturbing information and challenged their own beliefs and behaviours, which could spill into the counselling room.

References available on request, please email

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Michelle Oldale and Hazel Flynn

Professional Role (MO): Psychotherapist/Counsellor and Lecturer in Counselling
Professional Role (HF): Head of Counselling
Institution: SignHealth Counselling
Contact details: 13 Wilson Patten Street, Warrington, Cheshire WA1 1PG
Email: and


Keywords: Deaf Culture, British Sign Language, psychotherapy/counselling, therapeutic relationships.

What are the impacts of Deaf Culture and British Sign Language on the therapeutic relationship from the therapist's perspective?

Aim/Purpose: To investigate the therapeutic relationship conducted in British Sign Language (BSL) with Deaf clients. "Therapeutic Relationship" is defined as encompassing the wider field of training and supervisory relationships as well as client-therapist. There is little prior research into the area, although literature exists (eg Corker, 1994; Leigh, 1999) proposing the uniqueness of the therapeutic relationship with Deaf people.

Design/Methodology: A phenomenological enquiry was undertaken using semi-structured interviews with therapists (n=10, four of whom considered themselves D/deaf and six Hearing) working with Deaf people. Data were analysed in line with The Duquesne school (McLeod, 2001).

Results/Findings: In line with the phenomenological approach findings reveal the impacts on the therapeutic relationship as experienced by the participating therapists:

  • BSL is integral to Deaf Culture. Attending to the client's own perception of Deaf Culture and communication mode is key to establishing the therapeutic relationship
  • Boundaries and confidentiality are of great importance due to the small size of the Deaf Community
  • There is frustration at the lack of culturally aware approaches to training with the impacts of:
    o Geographical distance between and resulting marginalisation of therapists
    o Lack of therapeutic provision for Deaf clients in BSL
  • Supervisory relationships are impacted by lack of awareness of the uniqueness of Deaf Culture
  • The possibility of an increased affective response for therapist and client when therapy is conducted in BSL warrants further research

Originality/Value: Qualitative evidence is provided for the unique nature of the signed relationship suggested by previous authors. Important questions raised about access to the profession and services by culturally and linguistically diverse groups are particularly important in light of the current regulation dialogue.

Research Limitations:

  • As the hearing child of Deaf parents the researcher acknowledges prior involvement in Deaf Culture
  • Some interviews were not conducted in first or preferred language due to lack of interpreter resource

Conclusions/Implications: To fully utilise findings it is hoped they will be used as the basis for development of culturally inclusive training programmes.

References available on request, please email

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Katerine Osatuke

Other Authors: Sue Dyrenforth (VHA National Center for Organization Development) and Linda Belton (Veterans' Integrated Network System 11)

Professional Role: Psychologist and Researcher in Organizational Development
Institution: Veterans' Health Administration (VHA) National Center for Organization Development, U.S.A.
Contact details: VHA National Center for Organization Development, Suite 230, 11500 Northlake Drive, Cincinnati OH 45249


Keywords: civility, responsiveness, change, organizational interventions

Organizational change towards greater civility: what helps intervention success?

Civility, Respect, and Engagement in the Workforce (CREW) is a Veterans' Health Administration (VHA) initiative to facilitate organizational culture change towards greater workplace civility. Civility is assessed through employee workgroup climate ratings: respect; cooperation and teamwork; conflict resolution; coworkers' personal interest; coworkers' reliability; no discrimination; valuing of individual differences; and supervisors' ability to work well with employees of different backgrounds. CREW interventions are conducted nation-wide at VHA hospitals that chose to participate. Interventions are led by local coordinators, trained and supported by the VHA National Center for Organization Development (NCOD). Pre- and post-intervention results, now available from two administrations (28 facilities total), suggested (a) an overall success of CREW (Osatuke & Dyrenforth, 2006; Osatuke, Ward, Dyrenforth, & Belton, 2007); and (b) large outcome variation across sites.

This study examines variability in CREW outcomes applying a concept from psychotherapy research, responsiveness (Stiles, 1988; Stiles, Honos-Webb, & Surko, 1998). Responsiveness refers to flexibly adjusting the intervention to clients' emerging needs (in contrast to "ballistic" interventions fully specified in advance). CREW is based on process consultation philosophy (Reddy, 1994; Reddy & Phillips, 1992; Schein, 1988, 1990, 1992, 1999, 2006), influenced by action science and action inquiry (Argyris, Putnam, & Smith, 1985; Argyris & Schon, 1974, 1978, 1996; Torbert, 1989, 1991a, 1991b). Intervention foci and procedures are therefore defined by workgroup participants, are unique to each group, and are expected to change over time. The resulting variation makes intervention contents and techniques incomparable across sites. Responsiveness, however, offers a common metric. We examine aspects of responsiveness to explain variation in CREW intervention outcomes, including (a) pre- to post-changes in workgroup mean civility levels, and (b) individual respondents' perceptions of post-intervention changes in civility. We compare the CREW model of organizational change to process-oriented models of therapeutic work. These encompass approaches that see clients as movers of change, planners, organizers, and experts on their specific needs and interests. Therapists provide their expertise in interpersonal processes as a resource to clients, their role is therefore consultative, not authoritative or prescriptive.

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Vicky Oteiza

Professional Role: Counsellor and MSc student
Institution: Birmingham City University
Contact details: Calle Santa Bárbara 4-1D, 31600 Burlada, Spain


Keywords: personal therapy, therapist's experience, requirements for psychotherapists, phenomenological study

A descriptive phenomenological study on therapists' experience of personal therapy

Aim/Purpose: This research aimed to present a descriptive account of therapists' experience of personal therapy, and to explore therapists' attitudes to mandatory personal therapy.

There is debate about whether practitioners should undergo personal therapy. Different therapeutic approaches (eg psychoanalysis, cognitive-behavioural, etc.) have different views. Therapy tends to be demanding time-wise, financially and emotionally, and investigation into the impact of personal therapy on therapists may add depth to the debate.

Design/Methodology: The methodology employed was phenomenological, using data obtained from individual audiotaped semi-structured interviews. The Faculty Ethics Committee of Birmingham City University approved the procedures and the methodology. Ten Spanish psychotherapists were selected (convenience sample) and interviewed about their experiences of personal therapy. Transcripts were analysed using a systematic thematic approach. This involved a process of constant comparison of the data across the transcripts in order to identify emergent patterns and subsequent themes. Themes were named and related coded data organised and presented in order to best capture their descriptive content.

Results/Findings: Six main themes were identified through the process of constant comparison across the transcripts to find patterns and consistency in the data, including different approaches to personal therapy; time in therapy; choosing a personal therapist; experience of personal therapy; contribution of personal therapy to therapists' professional and affective development.

Research Limitations: The findings are tentative and limited by the researcher's positionality and the restricted sample of participants. Another bias may be willingness to take part in the study indicating that the sample were interested in discussing their experiences of personal therapy.

Originality/Value: Knowing more about the impact of personal therapy on therapists is relevant to further understanding the therapists' dynamics, and could influence the take-up of personal therapy when becoming a therapist. The study, involving English language based literature and Spanish fieldwork was challenging and allowed the exploration of particular issues related to positionality.

Conclusions/Implications: The findings indicate that participants' experiences of personal therapy have positively impacted on them, to the point that all participants recommend therapy. Whether personal therapy constitutes the only form of acquiring such gain is questioned.

References available on request, please email

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Sue Pattison, Karen Cromarty and Kaye Richards

Other Authors: Nancy Rowland (BACP), Professor Mick Cooper (University of Strathclyde), Peter Jenkins (University of Salford) and Filiz Polat (University of Bristol)

Professional Roles: Degree Programme Director (SP), Lead Advisor for Children and Young People (KC), Research Facilitator (KR)
Institution: University of Newcastle / BACP
Contact details: BACP House, 15 St John's Business Park, Lutterworth, Leicestershire LE17 4HB
Email: or


School counselling in Wales: a research study into services for children and young people

Aim/Purpose: The research project was commissioned by the Welsh Assembly Government and aimed to assess whether current models of counselling service provision used in Wales and other parts of the UK are sufficiently robust and flexible enough to apply more widely throughout Wales and whether they are adaptable enough to fit in with the new planning and joint working arrangements put in place to address the Children Act 2004.

Design/Methodology: The research involved desk research, a survey of schools and educational agencies in Wales and consultation with a wide group of stakeholders including teachers, counsellors, young people, and other professionals. A total of 123 schools responded to the survey that was sent out to 445 schools; 54 young people and 32 school professionals were interviewed across 12 different schools/youth agencies in North, Mid and South Wales, and 16 stakeholder interviews were completed.

Results/Findings: The desk research identified 12 models of school counselling operating across the UK, the majority of which were also operational in Wales. Practice and service delivery components were identified and used to assess the advantages and disadvantages of the models and to inform good practice recommendations. The survey found that levels of satisfaction were high where a counselling service was provided, however, strong views were expressed on ways of improving funding for services. The study recommended that the implementation of the WAG strategy for counselling in schools in Wales should include an evaluation of services.

Research Limitations: The fieldwork interviews were largely opportunistic. Interview data were not captured from children undertaking summer exams, or from those who had left at the end of their exams. It was not always possible to interview children on a one to one basis.

Originality/Value: The Welsh Assembly Government will use these recommendations to inform their national strategy to make counselling available in all secondary schools in Wales.

Conclusions/implications: This study has far-reaching implications for the policy and practice of counselling in schools, (eg counsellor competencies in working with children and young people) and this is set against the backdrop of the forthcoming regulation of the profession.

A copy of the full report is available from

References available on request, please email

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Frances Reynolds

Professional Role: Reader in Health Psychology
Institution: School of Health Sciences and Social Care, Brunel University
Contact details: School of Health Sciences and Social Care, Brunel University, Mary Seacole Building, Uxbridge Campus, Middlesex UB8 3PH


Keywords: chronic fatigue, art, narrative, well-being, identity

Learning to live with chronic fatigue syndrome through art-making: narratives of loss, struggle and quest

Aim/Purpose: This qualitative study took a narrative approach to explore the meanings of art-making for women living with chronic fatigue syndrome (CFS). The conditions of great uncertainty in which people with CFS live encourage profoundly revised narratives about self and lifestyle, making this approach to analysis very appropriate (Whitehead, 2006).

Design/Methodology: Ethical approval was received from Brunel University Research Ethics Committee. Ten women who had taken up art-making after the onset of chronic fatigue syndrome were interviewed; three provided lengthy written accounts. Interviews explored the meanings of illness, the discovery of art-making and its contribution to subjective well-being. Analysis was informed by the narrative typologies suggested by Crossley (2000) and Frank (1995).

Results/Findings: Some participants regarded their art-making as supporting a process of meaning-making that they had begun in psychotherapy. Most used art-making as part of a wider self-help project to regain well-being after the onset of CFS. A few participants storied art as a means of exploring multiple losses associated with CFS, not only of health, but also roles and relationships. Some recounted their engagement in art as expressing a protracted struggle to come to terms with ill-health and to regain a positive identity. Others offered ‘quest' narratives in which art was represented as instrumental in finding a new way forwards in their lives.

Research Limitations: Both the small sample size and its self-selected characteristics make generalization difficult. Further research is needed to increase understanding of how people use creative activities to re-establish coherence and identity following the onset of chronic illness.

Originality/Value: Whilst previous research presents distinctive narratives of illness, very little prior research examines the stories that people tell about meaningful creative activities and their role in mourning losses and re-establishing coherence.

Conclusions/Implications: Visual art-making seems rarely used as a form of ‘homework' in psychotherapy. Yet these findings indicate that art-making at home could be a useful adjunct to therapy, helping clients devise new stories for themselves, and supporting reclamation of identity in the context of chronic fatigue syndrome, and perhaps also in other chronic illnesses.

Crossley, M. (2000). Introducing narrative psychology: Self, trauma and the construction of meaning. Buckingham: Open University Press.
Frank, A. (1995). The wounded storyteller: Body, illness and ethics. Chicago: University of Chicago Press.
Whitehead, L. (2006). Quest, chaos and restitution: Living with chronic fatigue syndrome/myalgic encephalomyelitis. Social Science and Medicine, 62 (9): 2236-2245.

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Kaye Richards, Dr Jenny Peel and Barbara Smith

Professional Role (KR): Research Facilitator
Institution: BACP/ Liverpool John Moores University (LJMU)
Contact details: BACP House, 15 St John's Business Park, Lutterworth, Leicestershire LE17 4HB


Keywords: adventure therapy, eating disorders, feminist therapy, action research

An analysis of developing and using adventure therapy for the treatment of eating disorders in women

Aim/Purpose: Over recent years outdoor adventure programmes have established an increasingly strong reputation as an effective form of treatment for a range of psychological problems and therapeutic practice outdoors is commonly termed adventure therapy. This paper will examine an action research project that developed an adventure therapy programme for women with eating disorders. The research examined practical ways of working therapeutically outdoors and of developing adventure therapy for this client group. It also examined the processes by which and the extent to which the outdoor intervention produced psychological benefits.

Design/Methodology: Three therapists were recruited, who with the researcher, developed the intervention, whereby a feminist approach was adopted. Six women were recruited who participated in the programme. Both qualitative (semi-structured interviews, focus groups, journal writing, Interpersonal Process Recall (IPR) and reflexive notes) and quantitative (eating disorders and self-esteem inventories) methods were used. Ethical approval was obtained from LJMU's Ethics Committee.

Results/Findings: The research findings indicate that therapists can work effectively with clients in an outdoor setting and that such work speeds up the therapeutic process. The approach also offers unique opportunities for working at psychological depth. The positive impact on women who participated included increased motivation for change, changes in behaviours and thinking patterns related to eating, more positive attitudes to body image, together with increased self-confidence and self-awareness.

Research Limitations: The study was somewhat exploratory in nature. Being a small-scale study, generalisations can not be made and it is difficult to identify which specific aspects of the intervention facilitated change.

Originality/Value: This is the first adventure therapy research project and programme to have been designed specifically for the treatment of women with eating disorders in the UK.

Conclusions/Implications: This study illustrates how an adventure therapy programme can be used as a psychotherapeutic intervention. It also highlights some of the practical and ethical issues of working in this setting and offers a platform for the future development of research and practice in adventure therapy.

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Edward H Robinson III PhD, Jacqueline M Swank, Jonathan H Ohrt and K Dayle Jones PhD

Professional Role (E. H. R.): Professor and Heintzelman Eminent Scholar Chair
Institution: University of Central Florida
Contact details: College of Education, PO Box 161250; Orlando FL 32816


Keywords: self-efficacy, symptom distress, counseling students

An exploratory study investigating the relationship between self-efficacy and symptom distress among counseling students

Aim/Purpose: The purpose of this study was to explore the relationship between counselor self-efficacy and symptom distress in counseling students entering a graduate level counseling training program.

Design/Methodology: A quantitative research approach using purposive sampling was chosen for the study. The study included 81 masters' level students entering the program. The participants completed the Counseling Self-Efficacy Scale (CSES) and the OQ-45.2 (Outcome Questionnaire). Institutional Review Board approval was obtained by the researchers for this secondary data analysis.

Results/Findings: Data will be analyzed using the Statistical Package for the Social Sciences. Data analysis will include: Multiple Regression and ANOVA.

Research Limitations: Data collected for the study were obtained through assessments requiring self-reporting. Additionally, the study involved a specific population (counseling students from only one university) and contained a relatively small sample size.

Originality/Value: Research has not explored the relationship between self-efficacy and symptom distress among counseling students. This exploratory study will investigate this relationship.

Conclusions/Implications: Implications include directions for future research to further explore this relationship and the impact it has on counselor training programs. Initial findings identify a statistically significant relationship between counselor self-efficacy and symptom distress.

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Edward H Robinson III PhD, Sandra Robinson, Jacqueline M Swank and Jonathan H Ohrt

Professional Role (E. H. R.): Professor and Heintzelman Eminent Scholar Chair
Institution: University of Central Florida
Contact details: College of Education, PO Box 161250; Orlando FL 32816


Keywords: altruism, counselling students, and phenomenological study

A qualitative exploration of counseling students' perception of altruism

Aim/Purpose: The purpose of this study was to explore the applicability of a model of altruistic behavior for counseling students. The model was proposed in a previous study by Robinson and Curry conducted with members of a Quaker retirement community. The conceptual framework for the contributing factors of altruism proposed by Robinson and Curry consisted of biological factors, social learning, cognitions, and spirituality.

Design/Methodology: A qualitative research approach was chosen to use in conducting this phenomenological study. The study explored counseling students' perceptions using an interview format. Purposive sampling was used in this study. Participants consisted of master's level counseling students at a university in Florida. Institutional Review Board approval was obtained and access to recruit participants was granted by the counseling education program at the university. Participation in the study was voluntary. The study was piloted to evaluate the questions. Interviews were then conducted using a series of questions focusing on the perception of the development of altruism and the benefits and risks of being altruistic. The interviews were recorded using digital audio recording technology and transcribed to analyze the data and to identify emerging themes.

Results/Findings: The data collected during the interviews will be analyzed using NVivo to identify emerging themes.

Research Limitations: The study involved a specific population (counseling students from only one university).

Originality/Value: A previous study was conducted to explore a proposed model of altruistic behavior. This study expands upon the previous study to explore the proposed model specifically for counseling students.

Conclusions/Implications: Implications include identifying factors in career selection and altruistic behaviors and perceived conditions within the counseling process.

Robinson, E., & Curry, J. (In press). Altruism: A study on the development of unselfish caring. Thresholds.

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Julia Shearn

Other Author: Professor Antony Manstead

Professional Role: Student and Staff Counsellor
Institution: Cardiff University Counselling Service and Cardiff University Psychology Department
Contact details: Cardiff University


Keywords: dysphoria, depression, anxiety, theory of mind, emotion

Dysphoria, anxiety and the ability to decode others' emotional states in university students

Aim/Purpose: Depression often involves difficulties in social functioning. These difficulties may arise from problems in understanding others' mental states, including their emotions. Harkness et al (2005) examined emotion decoding ability in students using the Eyes Test, a task that involves attributing emotional states to photographs of eyes. Surprisingly, they found that dysphoria was associated with greater accuracy on this task. This suggests that people who are dysphoric might be highly sensitive to subtle cues about others' mental states. Harkness et al (2005) studied a non-clinical sample. The aims of the present study were to explore whether their findings generalise to a more severely depressed group and to see whether performance on the Eyes Test would change following counselling.

Design/Methodology: 114 undergraduate students, who were clients of a university counselling service (counselling group), and 74 students who were not receiving counselling (control group), completed three measures: the BDI -II, the Hospital Anxiety and Depression Scale (HADS), and the Eyes Test. A subset of 35 students in the counselling group was retested after their fourth session of counselling.

Results/Findings: The counselling group scored significantly higher on depression and significantly lower on the Eyes Test than the control group. Within the counselling group Eyes Test scores were negatively associated with depression, with those who were more depressed performing worse on the Eyes Test. Depression scores of those retested after four counselling sessions were lower and the negative relation with emotion decoding ability became non-significant.

Research Limitations: A larger scale prospective study is needed to examine the causal relation between emotion decoding ability and depression.

Originality/Value: Harkness et al's (2005) findings suggested that dysphoria might stem from a dysfunctional sensitivity to nonverbal cues. By showing that Harkness et al's results do not generalize to a more severely depressed group, the present research casts serious doubt on this suggestion.

Conclusions/Implications: We will discuss possible reasons for failure to replicate Harkness et al's findings, including differences in sample and procedure. Our findings support the view that poorer emotion decoding ability is associated with social difficulties that might in turn be a trigger for depression.

Harkness, K. L., Sabbagh, M. A., Jacobson, J., Chowdrey, N., & Chen, T. (2005). Sensitivity to subtle social information in dysphoric college sdtudents: Evidence for an enhanced theory of mind. Cognition & Emotion, 19,: 999-1026.

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Ms Vicki Smith

Professional Role: Senior Lecturer in Counselling Studies
Institution: University of Huddersfield
Contact address: Department of Behavioural Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3LR

ABSTRACT: Workshop

Keywords: research, training, discussion, practice, reflect

From training to practice: new directions for counsellor training?

Introduction: This workshop is similar to one offered at the last conference in that it enables participants to engage in a pilot study for a larger piece of research. The expectation is that counsellors tend to draw on certain aspects of their initial training, such as learning obtained through supervised client work, while making much less use of other elements such as theoretical models (Feltham, 1997, 1999). It is likely to appeal to students, practitioners and counsellor trainers and any findings will have implications for counsellor training courses as well as for reflective practitioners.

Aim/Purpose: To identify which elements of their training counsellors:

  • Actively use in their counselling practice and why
  • Use less frequently in practice and why


  • To provide participants with an opportunity to reflect on their practice and to gain insights into how they could draw on their training in different ways
  • To help counsellor trainers identify which aspects of counsellor training may need reviewing

The data obtained will be analysed qualitatively and the findings, in report format, will be made available to participants via email.

Approach: Group members will participate in a piece of research which will take the form of a structured group discussion.

Design/Methodology: The workshop will comprise:

  • Introduction including completion of consent forms, session topic, format, research method and how the data will be analysed
  • Structured discussion in small groups aimed, firstly, at identifying the common elements of participants' training courses and, secondly, at identifying which of these components participants regularly utilise in their counselling practice and which they regard as less relevan
  • Feedback to the large group aiming to identify common themes

Research limitations:

  • Small sample size
  • Difficulties of obtaining in-depth / accurate findings in a group setting


  • To provide detailed evidence showing which elements of their training counsellors find most and least useful in practice

Conclusions/Implications: This pilot study is of intrinsic use but also for the way it may feed into a larger piece of research with likely implications for the training of counsellors.

References available on request, please email

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Zita Sousa

Other Authors: Eugénia Fernandes and Adam Horvath

Professional Role: PhD Student (Clinical Psychology)
Institution: University of Minho
Contact details: Departmento de Psicologia, Universidade do Minho, Campus de Gualtar, 4700 Braga, Portugal


Keywords: therapeutic responsiveness, alliance, process research, task analysis, observational system

Therapeutic responsiveness: a moment-to-moment observational system

Aim/Purpose: Empirical evidence demonstrates the quality of the alliance as a strong predictor of outcomes, independently of the type of therapy (eg Horvath, 2001; Horvath & Bedi, 2002; Horvath & Symonds, 1991).

Just how the alliance is responsible for positive outcomes is not often addressed directly. Research needs to focus at the micro-level, identifying relational processes situated in the context of therapy tasks and specific goals (Horvath, 2006), which are associated with positive alliances (Horvath, 2005).

Therapeutic responsiveness (TR) can be conceptualized as the therapist's ability and willingness to tailor decisions and interventions in response to client's needs. These interactive micro-processes occur within specific relationship conditions and therapeutic goals (eg Stiles, Honos-Webb & Surko, 1998; Gibbons, Crits-Christoph, Levinson & Barber, 2003).
Focusing on TR as an interactive micro-process between client and therapist, we are constructing an understanding of how therapy works, through the development of the quality of the alliance.

This study aims to understand the concept of TR and to develop a method of measuring it as a moment-to-moment process. The researchers are examining: (1) What processes characterize TR? (2) How does TR develop throughout the therapeutic process? And (3) How does TR contribute to therapeutic alliance formation?

Design/Methodology: Utilising a task-analytic paradigm (eg Greenberg, 2007), and through a systematic process of observation, categorization and analysis, the researchers have constructed a method of measuring the components of TR.

Results/Findings: We will present the ongoing process of the emergence of a moment-to-moment observational system of TR, drawing from the study's conceptual basis and observational data.

Conclusions/Implications: We will discuss the usefulness of the observational system of TR regarding the development of the therapeutic alliance, as well as its potential contribution for the training and supervision of therapists and for the therapy practice quality.

References available on request, please email

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Jane Speedy

Professional Role: Director: Centre for Narratives and Transformative learning, Co-ordinator: Doctoral programme in narrative and life story research
Institution: University of Bristol
Contact details: Graduate School of Education, 8-10 Berkeley Square, Bristol BS8 1HH

ABSTRACT: Theoretical and methodological innovation paper presentation

Keywords: magical-realism, post-psychological knowledge, 'real-life' research, beyond regulation, critical thinking

'My mother in law swallowed me whole': magical realism as a research paradigm that stretches beyond a psychological knowledge basis for counselling and psychotherapy research

Despite the arts-based origins of many UK counselling and psychotherapy professionals (McLeod, 2001 and Speedy, 2007 both cite the anthropological, theological, historical, political, literary and arts-based backgrounds of many counsellors and psychotherapists) counselling research, and indeed, the tone of this conference, continues to be dominated by the social sciences, specifically the 'psychological' as a knowledge base. In this paper I argue that the counselling profession in this post-modern and post-psychological era would benefit not only from maintaining its arts-informed practices and but also extending them into ways of critically researching itself. I use extensive, detailed narrative data from my own research with counselling clients and students, to advocate magical realism as a surprising, subversive research paradigm that shifts and challenges commonly held understandings about fact, fiction and fantasy within therapeutic conversations and within concomitant research traditions. I plot shifts in my own understanding of the work that I do, both as a researcher and a practitioner, in light of the new vantage point of the constantly and seamlessly shifting lenses afforded by magical realism. I suggest that magical realism, an art form emerging from the margins and borders of the 'developed' world, might provide a particular resonance with the positions and life spaces inhabited by clients entering therapeutic relationships. I also suggest that arts-based lenses provide a multiplicity of ways of seeing, and therefore knowing, the worlds that we and our clients inhabit that are positioned very differently from 'psychological' forms of knowledge. Perhaps the counselling profession would gain from making better use of this complex and 'wild profusion' (Lather, 2006) of research methodologies, if it is to see its way beyond the next horizon of 'regulation' towards becoming a more critical, influential and self-regulating profession.

Lather, P. (2006). Paradigm proliferation as a good thing to think with: Teaching qualitative research as a wild profusion. Qualitative Studies in Education, 19(1): 35-57.
McLeod, J. (2001). Developing a research tradition consistent with the practices and values of counselling and psychotherapy: Why counselling and psychotherapy research is necessary. Counselling and Psychotherapy Research, 1(1): 3-12.
Speedy, J. (2007). Narrative inquiry and psychotherapy. Houndmills: Palgrave Macmillan.

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Jo Surridge and Nicola Vanlint

Other Authors: Allison Webber, Kate Comens, Paul Moody, Mavis Lartey, Marcia Corlis and Ilona Ozolina

Professional Role: Trainee Counsellors with LC&CTA & Lewisham College
Institution: LC&CTA and Lewisham College
Contact Details: c/o Chris Brown, LC&CTA, Room B134, Lewisham College, Lewisham Way, London SE4 1UT


Keywords: dissociative, identity, diagnosis, disparity, training

Why is dissociative identity disorder accepted and diagnosed more readily in the United States than in the United Kingdom?

Aim/Purpose: Our research aim is to identify what has led to the discrepancy in the frequency of diagnosis of dissociative identity disorder (DID) in the United States as opposed to a far less incidence of diagnosis in the United Kingdom.

Design/Methodology: A broad spectrum of literature written by clinicians, practitioners and sufferers was contrasted to ascertain the common threads inherent in the material. These common threads were then compared to the common themes inherent in our own primary data; gathered through one to one audio recorded interviews with mental health clinicians/psychiatrists working at the Maudsley, Imperial College and Lewisham University Hospitals.

The researchers employed the Duquesne method of empirical phenomenological (Moustakas, 1994) to analyze our primary data and followed BACP ethical guidelines for researching counselling (Bond, 2004).

Initial Results/Findings: Initial research findings indicate there is not only a disparity in the frequency of DID diagnosis between the US and the UK but also a disparity within the psychiatric/mental health profession itself in the UK in relation to the diagnosis of DID.

It appears there is far less diagnosis of DID in the UK (if any) if practitioners have never worked with a DID sufferer, where there is a lack of training, awareness or practitioner understanding of DID as a valid mental disorder.

As yet we have made no final conclusions because our primary data is still being analyzed. However, our conclusions will be drawn and ready for presentation at the BACP Research Conference in May 2008.

Originality/Value: We could find no other research which explores the disparity in frequency of DID diagnosis between the US and the UK and suggest that uncovering these reasons will be beneficial to the psychiatric/psychotherapeutic field; making a contribution to an increased knowledge based profession.

Conclusion/Implications: Initial results are pointing toward the suggestion that in the UK there is a need for improved training in understanding and recognizing Dissociative Identity Disorder, which may in turn lead to a higher frequency of diagnosis of the condition in this country.

Bond, T. (2004). BACP ethical guidelines of researching counselling & psychotherapy. Rugby: BACP.
Moustakas, C. (1994). Phenomenological research methods. London: Sage Publications.

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Clare Symons

Professional Role: Lecturer in Psychodynamic Counselling
Institution: The University of Leicester
Contact details: Vaughan College, St Nicholas Circle, Leicester LE1 4LB


Keywords: professional conduct, complaints, audit, ethical practice

Allegations of serious professional misconduct: an audit of BACP's Article 4.6 cases

Aim/Purpose: The Government White Paper (DoH, 2007) calls for statutory regulation of counselling and psychotherapy because of risk to the public when this work is done badly. Evidence of the prevalence of malpractice and research into how such practice is dealt with by professional bodies is scant. Much can be learned from the nature of complaints that could inform the development of ethical codes, counsellor training, professional development initiatives, and contributing to the regulation debate.

In autumn 2006 BACP approved a proposal to conduct an independent audit of their complaints. The first stage of that audit, examining case information from the professional conduct procedure, was presented at conference in 2007 (Wheeler et al). Prior to this there was no systematic research in the public domain about complaints made against counsellors or psychotherapists in the UK. This paper will present findings of the second stage of the audit, examining information from the Article 4.6 cases - the Association's procedure whereby serious allegations of professional misconduct are considered.

Design/Methodology: All completed Article 4.6 cases received between 1999 and 2007 have been identified. Ongoing cases as at November 2007 have been excluded. The audit identifies and reports on the following: biographical information about complainants and members complained against, timescale involved from receipt of initial enquiry until case closure, outcomes of the procedures, and the main issues that form the substance of the complaints. Data is analysed using quantitative methods to provide detailed descriptive statistics on the cases and is compared with findings from stage one of the audit.

Results/Findings: Analysis of the data is currently in progress and results will be available at the conference.

Conclusions/Implications: Stage one of the audit has revealed many facts and figures not previously in the public domain. Exploration of Article 4.6 cases will give a broader perspective on complaints and generate more potential research questions.

DoH (2007). Trust, assurance and safety: The regulation of Health Professionals in the 21st Century London: The Stationery Office.
Wheeler, S., Khele, S., & Symons, C. (2007). An audit of BACP complaints. Paper presented at BACP Research Conference, York, May 2007.

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Rob Turner

Professional Role: Head of Service: Student Counselling
Institution: Swansea University
Contact details: The Student Counselling Service, The Botanical Gardens, Singleton Park, Swansea SA2 8PP


Keywords: collaborative inquiry, dissociation, person centred approach, case study, therapeutic relationship

Collaborative research with an ex-client on effective therapy for dissociation

My client in person-centred therapy, "Mary Morris" (pseudonym) was enabled to develop an effective way of working on her childhood trauma. The relationship opened access to a dissociated, hidden "self" that appeared to have been created as a way of hiding the extreme abuse Mary experienced in early childhood.

Mary wanted other therapists and clients working with dissociated process to be able to read our accounts as therapist and client to assist the effectiveness of their therapy. Six months after the therapy ended we embarked on a research project and approached Professor Gary Rolfe of Swansea University to be our academic supervisor. We wrote up individual first drafts of the therapeutic experience without exposure to each other's writings.

Our approach to research has historical roots grounded in case study approaches such as those used by Freud (1893) and approaches that included input from clients such as videos made by Rogers et al (1962) and Rogers (1980). A professional practitioner joining in a research partnership with an ex-client is an example of co-operative inquiry, an approach advocated by Heron & Reason (2001).

The validity of the research is in depth, focus, and what some qualitative researchers refer to as thick description. B.F. Skinner acknowledged that:

Instead of studying a thousand rats for one hour each, or a hundred rats for ten hours each the [good] investigator is likely to study one rat for a thousand hours. (Skinner, 1966: 21)

The papers were published (with Rolfe) in an international journal (2007) and we have gone on to jointly deliver several conference workshops which explore the ethics, difficulties and advantages of undertaking collaborative counsellor and client research work in this important area of case study development and dissociation.

Freud, S. (1893). The psychotherapy of hysteria from studies on hysteria.
Rogers, C., Perls, F., & Ellis, A. (1962). Gloria.
Rogers, C. (1980). Sylvia: The struggle for self-acceptance.
Heron, J. & Reason, P. (2001). The practice of co-operative inquiry: Research ‘with' rather than ‘on' people. In P. Reason & H. Bradbury (Eds.), Handbook of action research.
Morris, Turner and Rolfe. (2007). A Collaborative Inquiry between a person- centered therapist and a client: Working with an emerging dissociated self. Person-Centered and Experiential Psychotherapies, 6(2).

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Gisela Unsworth

Professional Role: Head of Psychological Well Being Service (Senior Adult Psychotherapist), Occupational Health Department
Institution: Kingston Hospital NHS Trust
Contact details: Kingston Hospital NHS Trust, Occupational Health Department, Galsworthy Road, Kingston-upon-Thames, Surrey KT2 7QB


Keywords: CORE system, employee support, practice-based evidence, alliance measure, routine outcome measurement

Therapists' and clients' perceptions of using CORE-Net and ARM-5 in the NHS

Aim/Purpose: This qualitative study elicited the perceptions of both therapists and clients in the use of outcome measurement (CORE-Net) where instant visual feedback was given on a computer and the use of an alliance measure (ARM-5) at each therapy session for session tracking. It also elicited how therapists viewed its potential value in supervision and their suggestions for improving training in it. Some research evidence suggests that when this is used with clients it may increase their motivation in therapy thereby potentially improving attendance rates, clinical outcomes and increased efficiency of services.

Design/Methodology: A purposive sample of convenience was used with a primary care setting (PCC) who are the longest users of CORE-Net in the UK and an employee counselling service (OH) in the NHS just beginning to use CORE-Net and ARM-5. Data were collected using a variety of methods including: focus groups with the therapists; one to one telephone interviews with therapists (PCC) who had not yet started to use CORE-Net but were about to begin; one to one face to face interviews with clients (OH) within one month of ending therapy; OH therapists' process diaries on their first two clients and researchers field notes. All interviews have been analysed inductively using a general inductive approach and the process diaries and researcher reflective field notes using content analysis. The main ethical issue to consider is that the researcher is also a manager and lead psychotherapist on the (OH) team and this frames the context of the research.

Results/Findings: This is work in progress and preliminary findings will be ready to present at the conference.

Research Limitations: Having an independent external researcher verify the themes would have added credibility to the study.

Originality/Value: This is the first qualitative study in the UK in which CORE-Net and the alliance measure (ARM-5) are used for session tracking in therapy.

Conclusions/Implications: Currently CORE-Net is used by GPs and psychological therapists in the UK and this study may lay a basis for further research into the use of session tracking with CORE-Net by other professionals in other settings.

References available on request, please email

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Els van Ooijen

Professional Role: Senior Lecturer
Institution: Department of Health and Social Care, University of Wales
Contact details: Newport, NP20 5XR, P O Box 180


Keywords: praxis, integrative, heuristic, reflection, metaphor

Searching for the magic crystal: an inquiry into the praxis of integration

This practice-based inquiry focussed on my lived phenomenology as a therapist, to create practical knowledge (Heron, 1996) and reduce the research-practice gap (McLeod, 1999, 2002).

Aim/Purpose: My research question was "How am I developing an integrative way of working, both through the moment-by-moment decisions made during the therapeutic process and through reflection?"

Design/Methodology: I used a heuristic methodology, which allowed the findings to emerge from the data via tacit processes (Moustakas, 1990). The research involved a close tracking of my phenomenological experience both during and following each session with three clients for four months (Schon, 1983). For this I used a variety of creative methods, including artwork and focusing. These reflections were then discussed in my supervision sessions, which were recorded. The clients were aware of the inquiry and given the option to see any material through which they might be recognised. They were assured that no such material would be used against their will. All clients chose to see such material and signed an agreement.

Results/Findings: The creative synthesis, the final stage of the heuristic process, constitutes a "bricolage" (Denzin and Lincoln, 2000-6), and includes a symbolic narrative, which expresses the essential themes and meanings of the therapeutic process with each client metaphorically. This was because I wanted to express my reflections in a way that honours the work done by all concerned, but protects the clients' confidentiality. It is also in line with Moustakas' view of the researcher as a "scientist-artist" who "develops an aesthetic rendition of the themes and essential meanings of the phenomenon" (Moustakas: 1990: 51).

Research Limitations: As this was a reflective/supervision project the voice of my clients has not been included. Further research might utilise a collaborative methodology and involve clients more directly.

Originality/Value: I have created a conceptualisation of my integrative practice, which is a further development of a model I conceived of earlier (van Ooijen, 2000).

Conclusions/Implications: I aim to communicate the personal and professional learning from this inquiry through my ongoing work with clients and through teaching and writing.

References available on request, please email

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Dr Biljana van Rijn

Professional Role: Clinical Services Manager
Institution: Metanoia Institute
Contact details: 21 Kingsham Avenue, Chichester, W Sussex PO19 8AW


Keywords: psychotherapy training, counselling training, action research, evaluation

I'm doing so well, why do I feel so bad? Action research in psychotherapy training

Aim/Purpose: Evaluation of an 'internship' based approach to clinical training in relation to:

  • effectiveness of student's placement practice
  • students' personal and professional development

The research was carried out within transactional analysis training, but aimed to explore wider themes of effectiveness of clinical training, applicable to other theoretical approaches.


  • Sample: second year students, their tutors, supervisors and placements
  • Methodology: action research
  • Methods of analysis:
    • CORE System, used to evaluate placement practice
    • Qualitative analysis of student's written work, placement and supervision reports
    • Thematic analysis (Miles and Huberman, 1994) of feedback given in research meetings with participants during the year

All the participants gave informed consent, had access to transcripts and the research findings. Ethical issues were also addressed during the research process.

Results/Findings: The title of this paper reflects a degree of contradiction between the clinical effectiveness achieved by students and their experiences of training and research:

  • The quantitative analysis (CORE System) shows that students evaluated their practice more fully and were on the whole more effective than other students at the same stage of training
  • The qualitative analysis demonstrates students' increased relational depth, as well as anxiety and anger arising from the new programme and research process

Research Limitations:

  • Naturalistic study limitations - complexity of variables and data
  • The limited size of the research group impacted the volume of quantitative data and depth of quantitative analysis
  • Single organisational system normally raises questions of wider applicability


  • Addresses the paucity of research into psychotherapy training
  • Evaluates training in relation to clinical effectiveness
  • Demonstrates application of action research and a training method


  • The application of action research challenged students into deepening reflection and evaluation of clinical practice and resulted in increased effectiveness
  • The challenge of the year and process of change it instigated resulted in high levels of anxiety. This raises questions whether the experience and management of strong feelings were a necessary contributor to successful practice
  • The programme offers a framework for introducing practice based research and action research methodology within wider psychotherapy training

References available on request, please email

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Dot Weaks and John McLeod

Other Authors: Julia McLeod and Heather Wilkinson

Professional Role: Nurse Consultant in Dementia
Institution: University of Abertay Dundee and NHS Tayside
Contact details: Tayside Institute for Health Studies, University of Abertay Dundee, Bell Street, Dundee DD1 1HG


The development of an enhanced counselling role for community nurses working with people with an early diagnosis of dementia: a collaborative research project

Aim/Purpose: Nurses are at the forefront of developing innovative ways of delivering early intervention for people with early dementia. However, nurses may lack the skills and confidence in responding effectively to the complex emotional and psychological needs of people in the immediate post-diagnostic period. This study examines the early part of the journey of a group of experienced Community Mental Health Nurses (RMNs) working with people with dementia, embarking on a COSCA (Counselling and Psychotherapy in Scotland) counselling skills programme and collaborative learning set.

Design/Methodology: The experiences of participants, and the impact of training on their practice, have been evaluated using a mixed method action research approach, involving data gathered through individual and focus group interviews, and questionnaires.

Results/Findings: This paper will offer the analysis of the key themes emerging from the findings of the first phase of this project. Key themes include: the personal impact of training; application of counselling skills in work with patients and family members, and the experience of engaging in counselling training.

Research Limitations: This pilot project has a small sample of seven Registered Mental Health Nurses working in the community with people with early dementia. This paper is reporting on the early findings as the project will not reach completion until 2009.

Originality/Value: The study documents an innovative approach to equipping registered mental health nurses (RMNs) with counselling skills in order to enhance the post-diagnostic care of people with an early dementia who are seldom offered counselling interventions. The study also explores the nature of embedded counselling in health settings and has implications for other areas of health care.

Conclusions/Implications: Early findings suggest that mental health nurses working in the field of dementia perceive the value of counselling interventions, and can be trained to deliver counselling relationships within a relatively brief period of training. The study highlights a number of implications for trainers and training courses operating in this domain, including the use of methods for evaluating the effectiveness of training.

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Dr William West

Professional Role: Reader in Counselling
Institution: University of Manchester
Contact details: ESI, School of Education, University of Manchester, Oxford Road, Manchester M13 9PL


Keywords: culture, training, Western, qualitative

One Western size fits all? Counsellor trainers in different countries

Aim/Purpose: The aim of this research is to critically explore the experiences of counsellor trainers teaching counselling in differing countries. Since all of these trainers draw on Western models of counselling the research sought to explore how this was carried out in practice including what challenges were faced.

Design/Methodology: I recently established a long term research project into counsellor training across cultures. The initial phase involved interviews (Kvale 1997) with students about to undertake a Masters in Counselling programme in Nairobi (West 2007). The current includes:

1) Group interview in Nairobi with 4 Kenyan based trainers and their British external examiner
2) Interview with the Director of the Counselling courses at the Moscow School of Social Science
3) Interview with the Director of Counselling courses in Bangalore, India
4) Group interview with trainers from the North West England held in Manchester

Ethical approval was obtained from the participants and this research is undertaken in line with BACP ethical guidelines (Bond, 2004).

Results/Findings: The themes that emerged were:

  • That counselling was developing in differing contexts in each country - access to counselling was limited to mostly Westernised city dwellers
  • That problems presented for counselling had local variations as well as common problems
  • The development of professional counselling bodies was at different stages in each country
  • There was little contact or course content covering traditional care/healing apart from The Bangalore course
  • Despite criticism relatively little practical steps had been taken to develop more locally relevant counselling approaches by the trainers

Research Limitations: This research is opportunistic and carried out by a sole researcher. This inevitably impacts on the findings as the social backgrounds of the researcher and researchee are a context within which the interview occurs.

Originality/Value: Although there are studies carried out in individual countries this research draws participants from four countries in three different continents.

Conclusions/Implications: In multicultural Britain it is important to reflect on the cultural assumptions underpinning our counselling model and to what extent one approach to counselling fits all people. With increasing globalisation the export of Western models of counselling needs to be critically examined.

References available on request, please email

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Tony Weston

Professional Role: Counselling Psychotherapist and Researcher
Institution: Private Practice
Contact details: Lyndale Cottage, Horseheath, Cambridge CB21 4QR


Keywords: person-centred, effectiveness, depression, anxiety, trauma

Clinical effectiveness of the person-centred approach: a preliminary study

Aim/Purpose: NICE warn against ‘counselling' for severe depression, anxiety, panic attacks or PTSD. This research investigates whether clients with these problems benefit from person-centred therapy.

Design/Methodology: A sample of clients at UEA University Counselling Service (UCS) and the author's private practice (PP) had start and end levels of distress (CORE-OM), depression (BDI-II) and anxiety (BAI) measured. Data collection evolved so not all data is available for every client. The research was approved by UEA Research Ethics Committee.

Results/Findings: 291 clients start research (188 UCS, 103 PP):

Distress - 84 clients have both a clinical start score and a subsequent score, of these 50 (60%) end with a ‘non-clinical' score, ‘large' improvement d=1.909.

Depression - 88 clients clinical start/subsequent score, 56 (64%) end with a ‘non-clinical' score, ‘large' improvement d=1.618.

Anxiety - 76 clients clinical start/subsequent score, 40 (53%) end with a ‘non-clinical' score, ‘large' improvement d=1.384.

Included within this there are also ‘large' improvements in:

(1) Severe depression (31 clients start/subsequent score, 17 (55%) end ‘non-clinical', d=2.188)

(2) Panic (26 clients start with BAI panic subscale score>=3 and a subsequent score, 20 (77%) end below this criteria, d=1.933)

(3) Trauma (56 clients start with CORE trauma subscale score>=4 and a subsequent score, 36 (64%) end below this criteria, d=1.842)

Research Limitations: Some of the clients who agreed to participate were not included as they were subsequently allocated to therapists not taking part in the study. Not all clients completed counselling, especially at UCS, partly due to nature of transient population of student clients and student therapists. Moreover, naturalistic research of this kind suffers from limited treatment specification, non-random assignment, lack of a control group and missing data. The investigator has an allegiance to the person-centred approach.

Originality/Value: Findings from this study are comparable to other studies (e.g. Stiles et al, 2007; Minami et al, 2007) and raises questions about NICE recommendations.

Conclusions/Implications: In contrast to NICE recommendations, based on RCTs and so-called ‘expert opinion', a naturalistic study of person-centred therapy appears to show some clients with severe depression, anxiety, panic or symptoms associated with trauma benefit from person-centred therapy.

References available on request, please email

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Professor Sue Wheeler    

Professional Role: Director of Counselling and Psychotherapy Programme, University of Leicester
Institution: Institute of Lifelong Learning
Contact details: 128 Regent Road, Leicester LE1 7PA

ABSTRACT: Workshop

Keywords: counselling and psychotherapy research, core curriculum

Research as an integral part of the core curriculum for counselling and psychotherapy training: rising to the challenge

Aim/Purpose: The aims of this workshop are a) to provide information about the research component of the core curriculum project, b) to provide an opportunity for discussion about training needs of counsellor trainers to deliver the curriculum, c) to invite participants to engage in a self-assessment of their research skills and capabilities and d) to provide information about future training opportunities.

Background: In December 2006 BACP commissioned an independent report to produce core competencies for counselling and psychotherapy. In April 2007, BACP commissioned a similar team to produce a core curriculum for counselling and psychotherapy. Research methods training and research awareness are integral to the core curriculum; research will need to have a significant profile in counselling and psychotherapy training courses. This poses a challenge for many trainers who will need to enhance their own skills and experience of research in order to teach and support their students. This workshop will focus on the research requirements of the core curriculum and ways in which counsellor trainers can update their own professional development in order to fulfil current and future responsibilities with respect to research. Professor Sue Wheeler, in association with BACP and other contributors, has recently been awarded a grant by the ESRC as part of the Research Development Initiative, to enhance research awareness in the profession.

Workshop Structure: There will be a brief presentation related to the research elements of the core curriculum. A focused discussion will be facilitated related to the needs of trainers to implement the research aspects of it. A self assessment questionnaire that has been developed for use with the ESRC RDI project will be administered, a brainstorming exercise will identify needs and means of further support required and information about future training will be offered.

The target audience for this workshop is Counselling and psychotherapy trainers.

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Professor Sue Wheeler and Nancy Rowland

Professional Role (SW): Director of Counselling and Psychotherapy Programme University of Leicester
Professional Role (NR): Head of Research, British Association for Counselling and Psychotherapy (BACP), UK
Institution (SW): Institute of Lifelong Learning
Contact details (SW): 128 Regent Road, Leicester LE1 7PA


Keywords: research capacity, research training, counselling and psychotherapy, core curriculum

Training the trainers to develop and enhance research capacity in counselling and psychotherapy

BACP's core strategic aims for research have been to develop a research culture within the organization and the profession, and to contribute to the evidence base for counselling and psychotherapy. With this strategic aim in mind a successful bid was made to the ESRC Research and Development Initiative in partnership with the University of Leicester for a project entitled "Training the trainers to develop and enhance research capacity in counselling and psychotherapy ".

The aim of the project is to provide high-quality national and regional training and development activities for researchers and research trainers in counselling and psychotherapy.

The project has four specific objectives:

1. To address the research skills and expertise shortage by training the trainers to incorporate research into the counselling and psychotherapy curriculum and deliver research methods training and research supervision
2. To make research methods training (including ESRC resources) more accessible to counsellors and psychotherapy at all stages of their research careers by providing relevant information via the BACP web site and printed material
3. To inform researchers and about the research requirements of a core curriculum that will be essential for regulation and promote the development of new skills and planning and delivering the curriculum
4. To produce tools and packages for trainers to support their teaching of research methods

The objectives will be achieved through various strategies.

1. There will be a five-day summer school in July 2008 to train the trainers in research methods
2. There will be five one-day regional workshops in different locations that will focus on the research aspects of the core curriculum
3. There will be a research methods training manual and DVD produced and distributed by BACP
4. There will be a web site to inform researchers and trainers about opportunities for enhancing research capacity through training networks, activities and workshops

The poster will provide more details of the project and report on the evaluation strategy for the programme including the development of a training needs analysis questionnaire.

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Jane Whitehead

Professional Role: Counsellor/trainer/programme manager
Institution: Bridgwater College, Somerset
Contact details: 2, Little Hill, Buckland St. Mary, Chard, Somerset TA20 3SS


Keywords: training, integration, framework, practice, model

Researching the core model; a qualitative study of the usefulness of a core model to counsellors in practice

Aim/Purpose: The way in which trainee counsellors experience the core theoretical model and its subsequent relevance to practice is under researched, as a consequence this project aimed to explore how relevant Clarkson's (1992) integrative framework is to practicing post graduate counsellors. Further, the research seeks to explore the extent to which the training framework allows a ‘spirit of openness and enquiry` to exist (Connor, 2000) and to afford an opportunity to consider ways in which trainers can actively improve the structure, content and delivery of counselling training.

Design/Methodology: Data was collected via two mixed focus groups of post qualifying cohorts, who completed their training between 2002-2006, providing an accurate representation of students' views and a valid method of triangulation. Audio recordings were used and data transcribed, verbatim accounts were used for analysis. The first readings of data material followed Owen's (1984) criteria for thematic analysis, producing conceptual ‘themes', identified as ‘five fields' of discourse. Further analysis of data was undertaken, utilising the guiding principles of discourse analysis (DA) and attended to the overall rhetorical effects of the text, revealing a sixth ‘theme' from the unintended or unconscious results of the participants' repertoire.

Research Limitations: Employing DA for a final reflection of data highlighted the group tendency towards conformity (Morgan, 1997) and thus the potential weakness of using self-contained focus groups for this study is recognised.

Originality/Value: As the first independent evaluation of the Clarkson model (1992), these research findings offer a contribution to the debate concerning the value of a core theoretical model in counselling training.

Conclusions: The results indicate the framework provides compatibility between the epistemological commitments of the model and trainees' own personal and professional philosophy. It is flexible enough to provide solid integrative training, where practice is well grounded (Fear & Woolfe, 2000), allowing practitioners to retain their individual strengths and preferences. Accordingly the model accommodates the three positions of integration referred to by Hollanders (2000).These findings provide evidence in support of recommendations for core competences (BACP, 2007).

References available on request, please email

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Martin Williams

Other Authors: Lynne Stevens, Emma Whelan, John Sivill and Stuart Cameron

Professional Role: Trainee and Volunteer Counsellors
Institution: LC&CTA and Lewisham College
Contact details: C/O Chris Brown B134, Lewisham College, London SE4 1UT


Key Words: addiction, spirituality, recovery, therapeutic, link

What role does spirituality play, in the therapeutic setting, as an agent in the recovery from addiction?

Aim/Purpose: Inspired by Carl Jung's thoughts on addiction and spirituality and his influence on Alcohols' Anonymous 12-Step programme (Jung, 1961), our aim was to establish if there is a link between spirituality and the recovery process for addicts. Our purpose is to use the findings of the research to inform counsellors working with clients suffering from addiction and to identify possible areas for further research within this area.

Design/Methodology: 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 generalisation will be made using the Duquesne method (Moustakas, 1994).

We gathered data via a questionnaire mailed to counsellors and individual semi-structured interviews with counsellors (over the phone). We also interviewed three members of the group who are recovering addicts.

Initial Results/Findings: Many of the research respondents identified spirituality as playing a significant role in their recovery from addiction. Spirituality is seen as a very personal experience and a very powerful agent for change in the recovery process. There was acknowledgment that, for some, spirituality may become a replacement addiction with views varying as to whether this was a cause for concern.

Research Limitations: Due to ethical considerations and guidelines set out by BACP, it was not appropriate to interview clients who suffer from addiction (Bond, 2004), apart from the three consenting members of the research group. Due to time and resource constraints the research project was kept small.

Originality/Value: Although some research has been done in the area of spirituality, it is very limited. Grounding our research in Carl Jung's hypothesis ‘spirituus contra spiritum' (Jung, 1961), we believe there is value in investigating a potential link between the recovery from addiction and spirituality - particularly for counsellors working in the area of addiction.

Conclusions/Implications: By being aware and open to the potential of a client's spiritual experiences, a counsellor can help create an open and accepting environment for the addict to explore aspects of his or her spirituality in relation to their addiction and disease.

Bond, T. (2004). BACP ethical guidelines for research counselling & psychotherapy. Rugby: BACP.
Jung, C. (1961). Letter to Bill Wilson sourced from [Accessed 27th March 2007]
Moustakas, C. (1994). Phenomenological research methods. London: Sage.

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Dr Mark A Winwood

Professional Role: Clinical Director
Institution: AXA PPP healthcare Employee Support
Contact details: The Quadrangle, 106-118 Station Road, Redhill, Surrey RH1 1PR


Keywords: telephone counselling, psychological assessment, EAP, qualitative methodology, research

Qualitative exploration of the experience of psychological assessment in the context of EAP

Aim/Purpose: The research aimed to address: How do clients experience the process of psychological assessment delivered over the telephone?

Design/Methodology: The research used qualitative methods to explore the experience of receiving psychological assessment over the telephone in the context of an employee assistance programme. 14 participants who presented to the service with work related problems underwent semi-structured telephone interview. Interpretative Phenomenological Analysis (IPA), devised by Smith (1999), was used to analysis the transcribed interviews.

Results/Findings: Interestingly participants described indifference towards the method of delivery of assessment, convenience and timing were more important factors.

The ability to choose environment was reported favourably along with a reduction in the anxiety of being assessed. Although the usefulness of assessment was appreciated by the participants the investment in building a therapeutic alliance with the psychologist was minimal. Absence of visual cues had a clear advantage for more anxious clients who were not used to receiving psychological support. The employee assistance programme was described as a good source of support.

Research Limitations:

1. Small sample size effects generalisability
2. Length of interview
3. Language of participants
4. Motivation of participants

Originality/Value: The findings of the research may be interesting to EA professionals, counsellors who work telephonically as well as psychologists. The telephone and indeed other new medias can be a valuable source of support for those individuals who cannot or would not ordinarily access psychological therapies.

Conclusions/Implications: Paradoxically, many of the reported positive aspects of telephone assessment are also its disadvantages. The absence of face to face contact and close physical proximity can be unsettling to clients who require significant feedback to feel comfortable in an intimate situation. The distance involved in the use of the telephone, while frustrating to those able to tolerate greater levels of intimacy, usually due to previous experience of therapy, is a comfort to some clients and an aid to disclosure.