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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.

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
Email: mick.cooper@strath.ac.uk

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
Email: stileswb@muohio.edu

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.

Abstracts

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
Email: sally.aldridge@bacp.co.uk

ABSTRACT: Paper

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.

Results/Findings:

• 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 research@bacp.co.uk

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
Email: pennyamerena@yahoo.com

ABSTRACT: Paper

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.

References:
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.

Penelope Aspinall

Professional Role: Senior Counsellor
Institution: The Student Counselling Centre, the University of Leeds
Contact details: 19 Clarendon Place, Leeds LS2 9JY
Email: p.c.aspinall@leeds.ac.uk

ABSTRACT: Paper

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.

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
Email: jeni.boyd@virgin.net

ABSTRACT: Paper

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 research@bacp.co.uk

Dr Nell Bridges

Professional Role: Deputy Director of Counselling Studies
Institution: Keele University
Contact details: 43 St Mary's Street, Bridgnorth, Shropshire WV16 4DR
Email: n.e.bridges@psy.keele.ac.uk

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.

References:
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.

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
Email: pamela.brooks@pat.NHS.uk

ABSTRACT: Poster

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.

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
b j.buckroyd@herts.ac.uk

ABSTRACT: Paper

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.

Results/Findings:
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.

Professor Julia Buckroyd      

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
Email: j.buckroyd@herts.ac.uk

ABSTRACT: Paper

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.

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
Email: j.buckroyd@herts.ac.uk

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.

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: norman.claringbull@btinternet.com or nwc1@soton.ac.uk

ABSTRACT: Poster

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 research@bacp.co.uk

Ms Alison Cox, Stephen Hubbard and Mark A Winwood

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

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 research@bacp.co.uk

Ann Dalzell

Professional Role: PhD Student
Institution: University of Bristol
Contact details: University of Bristol, 35 Berkeley Square, Bristol BS8 1JA
Email: ann.dalzell@bristol.ac.uk

ABSTRACT: Paper

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.

References:
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.

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
Email: davisan@tcd.ie

ABSTRACT: Paper

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.

References
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.

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
Email: LJDMarshall@aol.com

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 research@bacp.co.uk

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
Email: fac0029@gmail.com

Professional Role (JM): Professor of Counselling
Institution: University of Abertay Dundee, Scotland, UK
Contact details: Kydd Building, Bell St, Dundee DD1 1HG
Email: J.McLeod@abertay.ac.uk

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.

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
Email: fac0029@gmail.com

ABSTRACT: Paper

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.

Professor Kim Etherington

Institution: University of Bristol
Email: kim.etherington@bristol.ac.uk

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.

Ariana Faris

Professional Role: Senior Lecturer and UKCP registered Psychotherapist
Institution: University of Wales, Newport
Contact details: 56 Richards Terrace, Roath, Cardiff CF24 1RX
Email: Ariana.faris@newport.ac.uk

ABSTRACT: Paper

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.

References:
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.

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
Email: eugeniaf@iep.uminho.pt

ABSTRACT: Poster

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 research@bacp.co.uk

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
Email: j.grove@newman.ac.uk

ABSTRACT: Paper

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.

References
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.

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
Email: terry.hanley@manchester.ac.uk

ABSTRACT: Paper

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.

Lorna Henderson and Dr Diane Hazlett

Professional Role (LH): Post Graduate student
Institution: University of Ulster
Email: Henderson-L@ulster.ac.uk

ABSTRACT: Poster

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.

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
Email: a.hill@salford.ac.uk

ABSTRACT: Paper

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.

References:
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.

David Jackson

Institution: University of Bristol
Contact details: 86 North Road, Saltash, Cornwall
Email: djackson.counselling@btopenworld.com

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.

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
Email: christine.brown@lewisham.ac.uk

ABSTRACT: Poster

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 research@bacp.co.uk

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
Email: nil3@lehigh.edu

ABSTRACT: Paper

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 research@bacp.co.uk

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
Email: j.mcleod@abertay.ac.uk

ABSTRACT: Paper

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