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Research Conference 2011  


BACP's 17th Annual Research conference, co-hosted by the Society for Psychotherapy Research (SPR), was entitled 'Research and practice' and took place on 06-07 May 2011. It was held at Liverpool Marriott Hotel City Centre, Liverpool. 

Click here for an evaluation of this year's conference

Abstracts

 

Pre-Conference Workshop

Professor Michael Barkham and Andy Hill

Professional Role: Professor of Clinical Psychology and Director of the Centre for Psychological Services Research, University of Sheffield (MB)
Institution: University of Sheffield
Email: m.barkham@sheffield.ac.uk

Pre-conference workshop (Thurs, 18.00 - 19.30)

School-based counselling Practice Research Network

Supported by the BACP Research Department a Practice Research Network is being developed in this key area. It is estimated that, at any one time in the UK, 10% of children under 16 years of age have a clinically diagnosed mental health disorder (Green, McGinnity, Meltzer, Ford & Goodman, 2004) and that mental health problems among young people are becoming increasingly prevalent (Collishaw, Maughan, Goodman & Pickles, 2004). There have been a variety of responses to this: the Welsh Assembly Government has implemented a national strategy for schools counselling; the UK parliament has taken the decision to roll-out IAPT services in England for children and young people. Counselling and psychological therapy for this age group has become a priority area for policy-makers, researchers and practitioners alike.

The School-based counselling Practice Research aims to bring together practitioners, researchers and trainers to engage in research and evaluation in order to develop the evidence base for school-based counselling. This in turn will provide opportunities to improve the effectiveness and acceptability of counselling interventions and to impact on policy decisions. The workshop will be introduced by Professor Michael Barkham, a leading expert on practice-based research, followed by various members of the PRN presenting from their own perspective (ie researcher, practitioner etc). There will also be ample opportunities for group-discussion and audience participation.  

 

Friday Keynote

Professor Michael Barkham

Professional Role: Professor of Clinical Psychology and Director of the Centre for Psychological Services Research, University of Sheffield
Institution: University of Sheffield
Email: m.barkham@sheffield.ac.uk

Friday Keynote  (Fri, 09.15 - 10.00)

Re-privileging practitioners at the heart of practice-based evidence

The aim of the presentation is to review the developing paradigm of practice-based evidence and to place practitioners at its centre. It will be argued that while trials methodology has led to important advances in our knowledge base of the psychological therapies; it has done so at the expense of valuing practitioners both as equal partners in the research endeavour and also as the focus of research activity regarding their role as agents of therapeutic change. Building research in which practitioners are equal partners requires promotion of the paradigm of practice-based evidence and the adoption of practice research networks in order to develop a research infrastructure that can be owned by practitioners. And a programme of research that has practitioners at its heart required recognition and study of practitioner effects. In particular, there is a need to acknowledge and understand the extent of practitioner variation - something that is masked in trials - and develop better ways of studying the effective practitioner as a complementary approach to the current focus on theoretical models of interventions.

 

Saturday Keynote

Dr Thomas Schröder

Professional Role: Co-Director (Academic & Research), Trent Doctoral Training Programme in Clinical Psychology, Institute of Work, Health and Organisations
Institution: University of Nottingham
Email: thomas.schroder@nottingham.ac.uk

Saturday Keynote (Sat, 09.25 - 10.00)

Researching therapists and their practice - a shift of perspective

Psychotherapy research is influenced by its social context which also shapes prevailing practice. The politics of service delivery have a major impact on current research, much of which concentrates on outcomes and the techniques deemed to be active ingredients in the change processes leading to good outcomes - even though the therapeutic relationship has been consistently demonstrated to be a more potent predictor of success. In the effort to isolate effective techniques, variations introduced by the therapists delivering such techniques are easily either disregarded or treated as ‘error variance'. Redressing the balance between ‘specific effects' and ‘therapist effects' requires a shift of perspective from a view of the therapist as a fixed factor in a randomised controlled trial to a view of therapists as active partners in the numerous interpersonal relationships that constitute their practice.

One way of realising such a shift is to ask therapists directly about their past and current practice and the factors influencing their development. The Collaborative Research Network (CRN) was formed by researchers and research-minded clinicians who, all being members of the Society for Psychotherapy Research, came together to study the development and practices of psychotherapists. Over the past twenty years we have collected data from over 10,000 therapists from 45 countries. A substantial proportion of the UK data have been contributed by BACP members. The address outlines some of the joys and pitfalls of gathering and examining a naturalistic, multi-lingual, cross-cultural, heterogeneous data base collaboratively and reports key findings from this study, both nationally and internationally. Evidence from such a study provides an alternative and complementary perspective to other forms of evidence and has implications for therapeutic practice, supervision and training.



Aisha Al Thani

Professional Role: Assistant Professor of Educational Psychology
Institution: Qatar University, School Of Education
Email: aishasalthani@qu.edu.qa

Poster (Sat, 10.10 - 10.40)

Keywords: depression, person centered approach (PCA), HMC

The journey to find oneself

Aim/Purpose: This paper presents a chapter of an interesting case study conducted in 2007 of a 42 year old Muslim depressed female client at HMC hospital. The aim of this study was to examine the effect of a modification of PCA in helping and supporting depressed Muslim clients. In addition to that the purpose was to highlight the positive changes that the case went through during the PCA counselling sessions.

Design/Methodology: The investigation took place at Hamad Medical Corporation (HMC) in Qatar. Fourteen counselling sessions were offered by the researcher, one hour once a week. All the sessions were recorded and transcribed, and video-recorded. The transcripts of these sessions were read by the researcher. The most common themes were chosen and then translated to English by translators. The sessions were analysed for common themes.

Results/Findings: The study has shown the effectiveness of using a modification of PCA to improve the mental health of depressed Muslim clients. The sessions present the positive changes that the case went through helping her to be more aware of improving relationship with self and others. An Arabic version of the Beck Depression Inventory (BDI) was used. The quantitative results were triangulated with qualitative data from the counselling sessions for further evidence of the success or otherwise of the approach. The case showed a positive response to the possibility of applying a modification of person centred counselling. According to the BDI form the case moved from being severely depressed with a score of 39 to moderately depressed with a score of 19, a drop from severe to moderate depression.

Research Limitations: The limitations of this study derive from its nature and the purpose, as it was confined to particular participants at HMC in the private and public sectors. The study was experimental and investigated the effectiveness of applying a modification of the PCA with depressed clients at the Psychiatry Department of HMC. The study sample did not represent the Qatari population because the sample worked with was not large enough to do so. The client was an Arab Muslim; the sample included only educated clients.

Conclusion/Implications: In conclusion the study showed the positive outcomes of applying the PCA in the State of Qatar.

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Laura Baines and Valerie Owen-Pugh

Professional Role: Practitioner (LB)
Institution: University of Leicester Counselling & Psychotherapy Research Clinic
Contact details: Institute of Lifelong Learning, University of Leicester, 128 Regent Road, Leicester, LE1 7PA
Email: bainesball@dsl.pipex.com

Paper (Fri, 16.30 - 17.00)

Keywords: internalised homophobia, sexual minority, critical learning, novice therapists, professional development

A qualitative study of critical learning incidents of recently qualified therapists working with sexual minority clients

Aim/Purpose: To provide a better understanding of how recently qualified therapists view the impact of training as preparation for working with sexual minority clients and how they utilise critical learning incidents to influence future practice and professional development.

Design/Methodology: The study involved 17 recently qualified therapists who, via semi-structured face-to-face or email interviews, described their experiences of training for, and working with, sexual minority clients. The data were subsequently subject to content and thematic analyses.

Results/Findings: Four hundred and twelve meaning units were generated and grouped into 10 sub-categories, three categories and one final core category: working with internalised homophobia. Main findings: irrespective of being client or therapist, tutor or trainee, supervisor or supervisee, gay or straight, internalised homophobia and heterosexist attitudes are in the room because they are part of our lives and culture; all participants felt they needed something more from training to enable them to work effectively with sexual minority clients; and discovering the very real dilemmas faced by sexual minority therapists.

Research Limitations: Small sample size comprising privileged participants in terms of class, race, education and disability; potential for researcher bias.

Conclusions/Implications: Initial therapy training needs to include contemporary, inclusive theory, more open, challenged exploration and facilitated discussion regarding areas of difference and diversity, including sexuality, and provide awareness of some of the specific issues for sexual minority (including transgender) clients and therapists such as internalised homophobia, the constant coming out process, and different boundary issues because of shared space. At the very least, a greater understanding of what it might be like for anyone who feels isolated because of minority status is essential. In parallel, since initial training cannot ensure that therapists are able to respond equally to all clients, irrespective of difference and diversity, consideration regarding funding and provision of subsequent specialist training is necessary.

Click here to view the powerpoint for this presentation

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Kevin Burrows

Professional Role: Counsellor, Teacher of people who have special needs, PhD student
Institution: Creation Counselling, Seevic College, Anglia Ruskin University
Contact details: 67 Woodleigh Avenue, Leigh-on-sea, Essex, SS9 4JA
Email: creationcounselling@hotmail.com

Poster (Sat, 10.10 - 10.40)

Keywords: arts based research, expressive arts therapies, autism, gestalt perception

The arts as an experiential methodology into autistic spectrum perception

Aim/Purpose: The researcher's PhD research explores how creative and natural environments can promote relational experiences for people with autism as a meaningful intervention. Participants engage in sculpting, dance and creative endeavour within a two acre Forest School and ecotherapy, woodland area in the grounds of a Further Education College. Likewise the viewer is invited to participate in a creative response to their work, replicating the engagement of the person with autism. Making a creative response to a stimulus may provide insights to autistic spectrum perception. For the researcher this may then be harnessed as a method for triangulating interpretation of their responses.

Design/Methodology: The researcher suggests that ‘arts based research' can form appropriate qualitative and experiential research methodologies that enable the non-autistic ‘neural typical' researcher to experience heuristic research of an autistic spectrum perception. Qualitative ‘arts based research' methods in natural environments put an emphasis on the experiential, rather than the reductionist abstract approach of positivistic research methods. Barone and Eisner state that ‘arts based research' requires a fundamental shift from the modernist research quest for certainties, towards a concept of research that enhances meaning through the experience and reflection of process as artist / audience. Fundamental within ‘arts based research' are the emergent qualities intrinsic in the creative process of 'artist's knowing' which questions certainties and opens up notions of meaning through experience.

Results/Findings: The researcher anticipates that ‘arts based research' methods can address Cozilino and Minshew's neurological findings that people within the autistic spectrum process information better through the visual cortex than from the language centres of the frontal lobes. The researcher sees an ‘arts based research' auto-ethnography operating within the visual and creative neural pathways as part of the researchers own ‘neural typical' heuristic experience of the autistic spectrum participant's story, where the unprocessed and the experiential are simultaneously perceived perceptions of self and world.

Research Limitations: Sample group is limited to teaching group of mixed autistic spectrum special educational needs students between 16 to 19 years old.

Conclusions/Implications: As research and field work are in the early stages conclusions have not yet been fully realised.

References available on request, please email research@bacp.co.uk

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Ann Campbell

Other Author: Robert Elliott

Professional Role: MSc student in Counselling
Institution: University of Strathclyde
Email: a.b.campbell@strath.ac.uk

Paper (Fri, 16.30 - 17.00)

Keywords: actualising tendency, life-limiting illness, agency, qualitative, hospice care

Levels of personal agency during a life-limiting illness: a qualitative study of the actualising tendency

Aim/Purpose: To investigate how the actualising tendency, expressed as human agency, occurs in experiences and communications of individuals receiving naturalistic counselling sessions within a hospice setting.

Design/Methodology: This study used a qualitative interpretive approach to enable the subjective lived experience of participants to emerge from their own frame of reference in the absence of pre-defined categories. Ethical approval was obtained from the University Ethics Committee. A multiple case study design was elected as strategy of inquiry to preserve uniqueness of the individual and learn from possible commonalties within and across cases.  Using purposeful sampling, four female participants with life-limiting illnesses agreed to take part and were provided with four or more individual sessions of person-centred counselling, affording them the freedom and safety to evaluate their own experience. Interpretive discourse analysis was later used to analyse therapy transcripts, generating categories that addressed how participants made meaning of the constraints of their circumstances.

Results/Findings: The categories that emerged represented how participants constructed self, to various degrees along a continuum of agency: non-agentic (0); limited (1); reflexive (2); collective (3); reactive (4); motivated (5); enriched (6); self responsible, accountable, autonomous (7). This hierarchy of agency was common across all four cases, with different levels of agency more strongly represented in different cases.

Research Limitations: Although counselling and research phases were carefully separated regarding time and role, ethical complexities are inevitable in working as both counsellor and researcher, especially with medically and psychologically vulnerable participants. Priority was given to the integrity, sensitivity and quality of the counselling, creating a naturalistic corpus of counselling session transcripts that only later were discourse analysed.

Conclusions/Implications: Strong commonalties were found across all four cases, reflecting the general experience of the phenomena as experienced by all four participants, and allowing a move from idiographic to nomothetic. This study has the potential to enhance the training of post-graduate counselling students who engage with people who have a life-limiting illness. In addition, participants reported that they found the counselling helped them make sense of their experience.

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Evanne Constantine and Wesley Freeman-Smith

Other Authors: Vicki Badham, Bev-elise Carpenter, Ruth Davis, Ann Levene, Mary Lewis and Helen Strutt

Professional Role: Student Counsellors and Volunteer Counsellors
Institution: LC&CTA: Lewisham Counselling and Counsellor Associates
Contact details: c/o Chris Brown LC&CTA Broadway House, 15-16 Deptford Broadway, London, SE8 4PA
Email: c/o christine.brown@lcandcta.co.uk

Poster (Fri, 10.00 - 10.30)

Keywords: Bipolar disorder, nutrition, diet, treatment, phenomenology.

What impact, if any, does diet and nutrition have on a person with bipolar disorder and what are the implications of this on psychotherapeutic practice?

Aims/Purpose: To explore if links exist between diet/nutrition and the manifestation or phases of bipolar disorder. Purpose: To understand more about such links, if these exist, and the implications for psychotherapeutic practice.

Design/Methodology: Fifteen questionnaires and two 1:1 semi-structured interviews were completed by South London based practitioners/clinicians working in the field. The Duquesne Method of Empirical Phenomenology (Moustakas, 1994) was used to analyse our data, therefore, findings have been generalised. We followed the BACP Guidelines for Researching Counselling and Psychotherapy (Bond, 2004).

Results/Findings: Results based on practitioners' views suggest that:

a)   A link does exist between diet and bipolar disorder; Omega 3, Magnesium, Vitamin B and a low sugar intake seem helpful in minimising the intensity and frequency of the mood swings bipolar disorder sufferers' experience

b)   There seems to be notable differences in sufferers eating patterns at the onset of bipolar disorder; a sudden increase/decrease in appetite and/or erratic eating patterns can occur. Results also suggest that nutritional intake changes in direct correlation with the constraints the phases' of bipolar places on suffers

c)   The treatment of bipolar disorder seldom appears to consider suffers' diet; there is some practitioner stigma attached to assessing the impact diet has on the condition because of its perceived association with alternative medicine.

Research Limitation: The researchers were limited to investigating the experiences of practitioners working in the field; this was a small research project and were unable to provide relevant post interview support for clients should they be adversely affected by the study. The research data was gleaned from the South London area only, therefore results may not reflect national tendencies.

Conclusions/Implications: Whilst further research is required, treatment of this disorder may require revaluation as results imply that bipolar disordered clients would benefit from knowledge of the role diet can play in alleviating the condition's symptoms.

Implications for practice may mean that counsellors/psychotherapist working with bipolar clients will benefit from greater awareness of how:

  • diet affects such clients
  • nutritional intake changes may be an indication that an acute phase of the illness is about to manifest
  • that liaison with dieticians/nutritionists might be a beneficial aspect of treatment for clients.

References available on request, please email research@bacp.co.uk

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Sharon Cox

Professional Role: Part-time PhD Student and Counsellor/Supervisor
Institution: York St John University, Faculty of Life and Health Sciences
Contact details: 33 Chirton West View, North Shields, Tyne and Wear, NE29 0EP
Email: sharon.cox@live.com

Poster (Fri, 10.00 - 10.30)

Keywords: embodied subjectivity, eating disorders, grounded theory, heuristic research, autoethnography

Changing the researcher, changing the research: the impact of exploring the embodied subjectivities of counsellors working with eating disordered clients

Aim/Purpose: To illustrate how engaging in qualitative research can affect the researcher and how the research questions can inform the researchers own methodologies.

Design/Methodology: It was originally anticipated that the overall study would follow a grounded theory methodology. However, due to the subjective nature of the topic and the impact the research began to have on the researcher as a counselling practitioner and an individual, the methodology has been expanded to incorporate both heuristic research and autoethnography.

Results/Findings: The paper maps the twists and turns followed by both the research and researcher as the study has evolved. As a counsellor working with clients presenting with eating disorder symptomatology and a woman with historic personal experience of eating disorders, the research began to challenge the researchers own embodied subjectivity. To ensure that the research was not adversely affected, the researcher was forced to revisit previous understandings and experiences in a reflexive and reflective manner, and felt it necessary to incorporate this knowledge into the research.

Research Limitations: This paper forms part of a larger research project and focuses on the study's methodological development, rather than the outcome. To a large extent, it focuses on the researcher and their experiences, as opposed to the participants. However, the personal is often indicative of the wider picture and it appears that the experiences of conducting the research interviews may well mirror the potential impact on counsellors of working with this client group.

Conclusions/Implications: For reflexive, reflective counselling practitioners, conducting qualitative research can have a deep impact, especially if the topic has personal significance for the researcher. As well as informing their own self-awareness and therapeutic practice, this accumulated, experiential knowledge can be used to broaden the scope of the research and add another valuable source of data.

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Duncan Craig

Professional Role: Service Director - Survivors Manchester
Institution: University of Manchester (former student)
Email: duncan@survivorsmanchester.org.uk

Paper (Sat, 15.05 - 15.35)

Keywords: childhood sexual abuse, male, survivors, internet, mixed methods

An exploration of the use of the internet and online resources by adult male survivors of childhood sexual abuse

Aim/Purpose: The sexual abuse of boys is one of the most under-reported crimes worldwide. Unable to speak out, many victims carry this ‘secret' into adulthood. However, the internet is offering a way to break the silence. This study explored the use of specialist websites by adult male survivors of childhood sexual abuse (CSA).

Design/Methodology: This mixed methods research was designed to be conducive to the subject matter. A micro-site provided audio and textual information on the research ethos and procedure and ended with an anonymous online survey. Participants first provided minimal demographical information, then statistical quantitative data relating to previous and current use of specialist websites. This was followed by the collection of narrative qualitative data using open questions. The data was analysed using a mixed methods approach. Standard statistical analysis methods described quantitative data whilst thematic analysis to examined the qualitative.

Results/Findings: The results showed three overriding reasons why online resources were being used: the anonymity afforded online, that cannot be offered face-to-face, when discussing issues often shrouded in shame; the importance of connecting with others with similar experiences, thus feeling less-isolated, whilst retaining a level of anonymity; and most interestingly, contradicting the need for anonymity, the reality of the lack of offline face-to-face services for male survivors of CSA that is often afforded to women.

Research Limitations: Anonymity provided by the research design meant further lines of enquiry could not be followed. Similarly, this also meant the researcher was unable to clarify any misunderstanding with the participants. Thematic analysis on single sentence answers proved difficult and was arguably 'content analysis'.

Conclusions/Implications: The study concluded that whilst face-to-face support was still desired by participants, the internet and specialist websites had provided an important part of their healing. Provided that websites were functional, informative, inclusive and easy to navigate, participants had demonstrated that the internet and online resources were often the initial catalysts to beginning their healing journey, and importantly, continued to be an open source of support.  The author concludes that more research and investment in the areas of help for male survivors and use of technology in men's health must be explored.

Click here to view the powerpoint for this presentation

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Rosemary Decker-Thomas

Other Authors: Julia Buckroyd, Janice Cook and Roger Green

Professional Role: PhD Student; Director of Services, Voluntary Sector Counselling Agency; Counsellor; Supervisor
Institution: University of Hertfordshire
Contact details: 42a Station Road, New Barnet, Herts, EN5 1QH
Email: r.deckerthomas@btinternet.com

Poster (Sat, 10.10 - 10.40)

Keywords: voluntary sector counselling agency, good quality, thematic analysis, qualitative analysis

"If this isn't quality I don't know what is!" Defining key characteristics of a good quality voluntary sector counselling agency

Aim/Purpose: Although much counselling is delivered through voluntary sector counselling agencies (VSCAs) at little or no cost to the public purse, such services are a neglected area of counselling research (Armstrong & McLeod, 2003). How can we define good quality in a therapeutic organisation? This paper will present some distinctive attributes of good quality in VSCAs.

Design/Methodology: Ethical Approval was obtained from the University of Hertfordshire Ethics Committee. In this first phase of the study, semi-structured interviews with clinical directors of two VSCAs were conducted. The directors' views were sought on their understanding of a good quality VSCA. Coding and thematic analysis were used to identify key themes and working definitions of good quality.

Results/Findings: A number of characteristics have been identified which will be presented in the paper. Some are specific attributes of therapeutic work in voluntary sector organisations and this paper will examine these as well as more generic characteristics. The paper will consider the implications for practice in VSCAs.

Research Limitations: This was a small scale pilot phase of a larger project and the findings are at a preliminary stage and have not yet been tested or refined.

Conclusions/Implications: This is a unique study whose aim is to help VSCAs develop into first-rate, sustainable and credible services. As cutbacks in statutory services escalate, the role of the voluntary sector in providing low cost counselling for those in need becomes crucial. In the second phase of the study the attributes of 'good quality' will be tested and refined through mixed methods case studies of four VSCAs. Recommendations for developing and maintaining good quality VSCas will be of interest to the counselling community, funders and referrers.

Reference:

Armstrong, J. & McLeod, J. (2003). Research into the organisation, training and effectiveness of counsellors who work for free. Counselling and Psychotherapy Research 3(4): 255-259.

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Chris Evans

Professional Role: Consultant Psychotherapist
Institution: Nottinghamshire Healthcare NHS Trust
Contact details: c.o. NPDDNet, Mandala Centre, Gregory Boulevard, Nottingham, NG7 6LG
Email: chris@psyctc.org

Poster (Sat, 10.10 - 10.40)

Keywords: CORE measures, translations, culture, methodology, psychometrics

Translating the CORE-OM and short forms into other languages

Aim/Purpose: To update interested practitioners about the availability of translations of the CORE-OM, to present the methodology that produces excellent translations and seek collaborators for further translations or evaluation of existing translations.

Design/Methodology: The translation of measures has often involved forward translation and checking by back-translation. Unfortunately this can lead to bad translations, wooden transliteration of the source language with no exploration of linguistic and cultural issues to which change measures for psychological therapies are particularly vulnerable. The researcher has worked with people from many other countries to evolve a method that involves multiple forward translations, including at least two from lay people, a focus group that looks at the differences between these translations and agrees a penultimate draft, and a set of "talk through" checks done in parallel with a back translation. This has consistently produced excellent translations. Interestingly, and coming from a very different background, ISPOR, the International Society for Pharmacoeconomics and Outcomes Research have independently come to recommend a very similar method for outcome measure translation. The method and the state of play in translations and evaluation of these in different countries and settings will be presented.

Results/Findings: As of mid-November 2010 the CORE-OM has been translated into 17 languages and seven more including British Sign Language will be completed by January. By the conference the researcher may have reached the point of completing all EU and wider European languages and should have pushed further with Indian subcontinent languages and started some more far Eastern and African languages. Psychometric evaluation is available for Norwegian, Italian, Portuguese, Greek, Dutch, Danish and developing rapidly for other languages and will be summarised.

Research Limitations: The research is unfunded so proceeds by serendipity making coverage of languages and availability of psychometrics and referential data variable.

Conclusions/Implications: The poster format should make it easy to find people interested in using translations in the UK and/or joining in to help translate languages that may not yet be completed. Imminent completion of the EU languages will start grant applications for collaborative evaluations across Europe.

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Merih Fidan

Professional Role: Doctorate Student
Institution: Lifelong Learning, University of Leicester
Contact details: The University of Leicester, University Road, Leicester, LE1 7RH
Email: merih@fidan.co.uk

Poster (Sat, 10.10 - 10.40)

Keywords: interpreters, counsellors, mental health communication, ethnic minority

What matters for language interpreters?

Aim/Purpose: To explore the nature of the triadic relationship between client, interpreter and counsellor from both interpreters' and therapists' point of view.

Design/Methodology: This study is the first stage of the research. The participants were asked some questions in a semi-structured focus group session. A socio-demographic questionnaire was used to establish the descriptive nature of the study. Five interpreters with the mean age of 41.8 took part.

The ethical approval was obtained from Leicester University. Confidentiality and anonymity were ensured. Conversations were recorded and transcribed. Thematic analysis was used to interpret the themes and categories emerged.

Results/Findings: The data show that interpreters were mostly concerned about what interpreting should be and how trust is achieved within the triadic relationship.

They described interpreting as social interaction, empathy and dealing with stress. They regarded ability to concentrate, translate emotions and establish the bond, good mother tongue, awareness of non-verbal clues as important skills in their job.

The participants reported that in order to establish trust, one should have short prior conversation with client, speak the same dialect with client and working like a culture broker. They saw the following as main obstacles in achieving trust in the therapeutic relationship: having a busy schedule, mismatch with the client, gender issues and the mode of interpreting. They reported that being forced to wait in long queues, not being signed by the right staff, mistreated, dealing with overwhelmed staff, mismatch clients and ignoring interpreters' needs as agency related and institutional matters.

Participants finally emphasised importance of training that should include supervision, role play, clinical training, coping strategies and staff training on multiculturalism.

Research Limitations: Due to the small number of participants generalisation cannot be made.   

Conclusions/Implications: The research is aimed to inform academia and the related fields in order to develop culture sensitive mental health services and training programmes for ethnically different clients.

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Julie Folkes-Skinner

Other Author: Robert Elliott

Professional Role: Lecturer in Psychodynamic Counselling
Institution: University of Leicester
Contact details: Vaughan College, St. Nicholas Circle, Leicester, LE1 4LB
Email: jafs1@le.ac.uk

Paper (Fri, 13.50 - 14.20)

Keywords: healing, involvement, counsellors, training

Healing involvement in trainees: an investigation into the impact of training on a cohort of person-centred trainee counsellors

Aim/Purpose: Healing Involvement (Orlinsky & Ronnestad, 2005) describes the positive therapeutic work experience of therapists and is comprised of a number of specific characteristics eg personal commitment, effectiveness, warmth, etc. The aim of the study was to test the proposition that if formal counsellor training had a positive impact on trainees then, by its end, they would report higher levels of healing involvement, emotional fluidity, and lower levels of distress.

Design/Methodology: Data were derived from the 'Development of Psychotherapists Common Core Questionnaire - Trainee Version (Process Form)', the CORE-OM (34) and the 'Strathclyde Inventory (SI)'. Trainee counsellors (n=20), engaged in a part-time person-centred training programme that was taught over 60 weeks, completed the measures in week six and week 58. Mean scores were calculated for the beginning and end of training and a paired sample t-test was conducted using SPSS, followed by a Cohen's d effect size calculation.

Results/Findings: Levels of healing involvement increased and this increase was significant (p<0.05, two tailed, df = 15, t = -2.37) and represented a large effect size (d=0.63). There was an increase for congruence/emotional fluidity but this was not statistically significant (p=0.07, df = 17, t = -1.953) but there was a medium effect size, (d=0.5). The mean CORE-OM(34) score decreased. This was not statistically significant, (p= 0.60 df =19 (19), t = -0.596) but there was a small effect size (d=0.1).

Research Limitations: Only self-report measures were completed by trainees, therefore the absence of outcome data from their work with clients is the main limitation of this study.

Conclusions/Implications: These findings indicate that formal training has a large positive impact on trainee counsellors' experiences of healing involvement with clients and a medium to small effect on their emotional functioning.

References available on request, please email research@bacp.co.uk

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Isabel Gibbard

Other Author: Terry Hanley

Professional Role: Lead Counsellor
Institution: Primary Mental Health Team, NHS Central Lancashire
Contact details: Jubilee House, Centurian Way, Lancashire Business Park, Leyland PR
Email: isabel.gibbard@centrallancashire.nhs.uk

Paper (Sat, 15.05 - 15.35)

Keywords: cognitive behavioural, person-centred, grounded theory, client experience, client activity

How do clients make therapy work? A comparison of exit questionnaires returned from CBT and person centred counselling clients in primary care

Aim/Purpose: This paper presents the findings from an investigation of clients` experiences of two therapies, cognitive behavioural (CBT) and person-centred (PCT). The aim of both CBT and PCT is for the client to feel and function better but the way they go about it is very different. Historically, research questions about therapy have therefore asked "Does this therapy work?" (outcome research) and "How does this therapy work?" (process research). In contrast, this study views clients as active agents who use interventions in their own unique and creative ways and aims to investigate how clients have done this in order to make the therapy work for them.

Design/Methodology: This is a qualitative comparative study. It involved the collection of exit questionnaires from routine clinical practice, returned by clients who had finished an episode of either CBT or PCT. Forty five questionnaires from each therapy were analysed for key themes using the grounded theory approach. As this study was a qualitative audit as part of routine service evaluation an ethical review was not necessary. Management permission was obtained for the findings to be presented.

Results/Findings: The findings from the analysis of the exit questionnaire responses demonstrate how clients describe the activity they have engaged in whilst in therapy. Some of these activities such as talking, learning and understanding are common to both therapies. In contrast, for example, CBT clients discussed and practised strategies and found the process fun, while PCT clients explored deeper into their issues, finding it emotionally draining and stressful.

Research Limitations: The sample is limited to the two therapies offered by the primary mental health service and by the participants' willingness to complete and return their exit questionnaire. The responses are brief and raise further questions and lines of inquiry for further research have been identified.

Conclusions/Implications: This study furthers our understanding of how clients perceive therapy and ultimately make it work for them. It outlines the process of the two therapies in the words used by clients and outlines where differences can be observed. The findings act to inform the assessment and decision making process regarding an individual`s suitability for the different therapies. Such a process will help sensitise therapists to particular needs of clients and help ensure that clients are directed towards the most appropriate therapy.

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Jeremy Halstead 1

Other Authors: Chris Leach and Sam Tucker

Professional Role: Consultant Clinical Psychologist
Institution: South West Yorkshire Partnership Foundation Trust
Email: spruksec@gmail.com

Poster (Fri, 10.00 - 10.30)

Keywords: outcome measure, counselling, psychotherapy, change

A brief history of sPaCE

Aim/Purpose: To present a summary of research findings on sPaCE (shorter Psychotherapy and Counselling Evaluation).

Design/Methodology: sPaCE is a shorter version of the PaCE measure presented at the 1999 BACP research conference. It is a brief measure of symptoms designed to screen for anxiety and depression measure change.

Results/Findings: Although brief sPaCE has a robust factor structure, which means that it has the potential to be more informative than some global measures of a similar length. Data is presented showing its relationship to a number of widely used measures including: BDI, BAI, PHQ9 and CORE-OM. There is a brief discussion of the relationship between the concepts of depression and anxiety and the components that make them up.

Information is provided about two official translations (Spanish and Italian) and the version used for session by session data collection.

Research Limitations: sPaCE has been validated in secondary care psychological therapy settings in the UK and Chile. It would be interesting to see how sensitive it is in other English and non English speaking settings. There are non clinical norms but again it would be useful to extend these.

Conclusions/Implications: This is a presentation of an alternative, brief, free to use symptom measure for use in psychotherapy and counselling.

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Trish Hobman

Other Author: Bonnie Meekums and Anna Madill

Professional Role: Senior Lecturer
Institution: York St John University
Contact details: Faculty of Heath & Life Sciences, Lord Mayor's Walk, York, YO31 7EX
Email: t.hobman@yorksj.ac.uk

Poster (Fri, 10.00 - 10.30)

Keywords: supervisory relationship, relationship, narrative, supervisor's clinical experience, experienced counsellors

An exploration into the impact of supervision on experienced counsellors: a pilot study

Aim/Purpose: The aim of this research is to understand how supervision impacts experienced counsellors. The results from a pilot interview will be used to inform the development of a larger study.

Design/Methodology: Ethical approval has been granted for this study by the University of Leeds. One experienced female counsellor was recruited through word of mouth to undertake a pilot interview. She was interviewed by the researcher using a semi-structured interview schedule. The content of the pilot interview and the interviewee's reflections were reviewed for information helpful to the development of the larger study. Eight to 10 experienced counsellors will be recruited to the larger study and will be interviewed twice over three months. The initial interview will be transcribed and sent to the participant to invite comments and will inform the second interview. The study will tap developments in the participants' experience of supervision and incorporate participant reflection on the researcher's on-going analysis. Interview transcipts will be analysed using narrative methodology (eg Etherington, 2000; Speedy, 2007; Chase, 2005; Hollway & Jefferson, 2000).

Results/Findings: The pilot participant indicated that a positive relationship with a supervisor is important in facilitating the process of supervision and that this can have a direct and beneficial impact on client work. She also felt that the level of experience of the supervisor was an important factor in building and maintaining the supervisory relationship. Her experience is consistent with research which suggests that therapist factors, and in particular the therapeutic relationship, is more important than therapeutic orientation or approach used by the counsellor (eg Cooper, 2008).

Research Limitations: As this is a qualitative and narrative study with a relatively small sample, care must be taken in generalising the findings to other populations. In particular, participants and their training are limited in respect to geographical location (ie North of England).

Conclusions/Implications: The experience of conducting the pilot interview has implications in terms of increasing the rigour and hence, quality of the main study. The main study will highlight implications and offer recommendations for improving the supervision of experienced counsellors and the training of supervisors.

References available on request, please email research@bacp.co.uk

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Nicky Holland

Professional Role: Counsellor in Primary Care
Institution: Oxford University Department of Continuing Education (OUDCE)
Contact details: Psychodynamic Studies, Oxford University Department of Continuing Education, Rewley House, 1 Wellington Square, Oxford, OX1 2JA
Email: nicky.holland@btinternet.com

Paper (Fri, 15.55 - 16.25)

Keywords: counselling trainees, mandatory therapy, narrative

Whose therapy is it? A qualitative investigation into the experience of psychodynamic counselling trainees in mandatory therapy

Aim/Purpose: To investigate the experience of students undertaking mandatory therapy and its relationship to their experience of counselling training. Previous research has focussed on the value of personal therapy for personal and professional development and often interrogated the experience of practitioners rather than students.

Design/Methodology: This research was a small-scale qualitative study of the experience of counselling students in mandatory therapy during their training. Semi-structured interviews were conducted with nine students from three post-graduate psychodynamic counselling courses. Material was interrogated using narrative analysis.

Results/Findings: Student participants reported that the presenting factor of ‘being a student' introduced a complex interaction between therapy and the training course. This had some positive outcomes, as mandatory personal therapy was valued for both personal and professional development and provided a resource to process training anxieties and clinical work. Negative reporting focussed on intrusions from the training experience into the therapeutic relationship, including restrictions on the choice of therapist, boundaries around confidentiality and knowledge of theory which allowed criticism of the therapist. Participants identified mandatory requirement as a key difference from their elective therapy experience.

Research Limitations: Participants valued the research interview as a means to voice their experience, however the subject may have acted as an attractor for students who had strong feelings about their course and therapy.

Conclusions/Implications: Recommendations identified for course providers, therapists and students aim to enhance students' ownership of mandatory personal therapy and strengthen the therapeutic relationship. These include: provision of information about assessment and the expectations of the course; awareness of and clarity of boundaries, especially concerns around confidentiality; strengthening the working alliance between student and therapist by using therapy as a context in which to work through conflicts. Future research could investigate trainees' experience of the process and whether it changed their perspective on their course or therapy. Ideally a longitudinal study could examine changes in views at a later stage in training or after completion of counselling.

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Carol Holliday

Professional Role: Affiliated Lecturer
Institution: University of Cambridge, Faculty of Education
Contact details: 184 Hills Rd, Cambridge, CB2 8PQ
Email: cah66@cam.ac.uk

Methodological innovation paper (Fri, 15.00 - 15.30)

Keywords: qualitative research, arts based research, visual research, heuristic processes, self search

Working with images and metaphors in qualitative research: benefits and bonuses, perils and pitfalls

Background and introduction: Qualitative research seeks to develop an in-depth understanding of human experience and behaviour. This is often an exclusively word based activity. This paper explores extending the researcher's repertoire to include non-verbal methods. 

Nature of the methodological innovation/critique being proposed: This paper will provide a rationale for working with images and metaphors in qualitative research. The term image is used to cover a multiplicity of media and therefore includes paintings, sculptures, story, play, music, dance, poetry etc. Images offer a way to capture material that is non-verbal or pre-verbal and therefore beyond the reach of language. Thus, working with the arts has the potential to facilitate the collection of a richer picture of lived experience than working with words alone. There is the opportunity to gather experience and knowledge that might be otherwise excluded. This is especially important if the research participants are children, as story and play are often their preferred mode of communication. Images are closely linked to emotions, making arts informed research particularly valuable in heuristic processes and self search. This link to the inner world and to emotion kindles issues of validity and trustworthiness. It also brings into play a number of ethical issues, particularly as regards to the emotional wellbeing of participants when there is the likelihood of surfacing feelings that were previously out of awareness. Criteria for assessing the usefulness of image work in research will also be discussed. The ideas and arguments in this paper will be supported by experience of arts psychotherapy practice over nearly twenty years, and illuminated by current research examples. As part of a larger project exploring the contribution counselling and psychotherapy knowledge can make to the teacher/child relationship, interviews were conducted with teachers who had undertaken therapy training. During the interviews some of the participants created images that illustrated growth and development in their personal and professional lives. These images and what they revealed will be discussed in this session.

Conclusion and relevance to counselling and psychotherapy research practice: Counselling and psychotherapy research is often concerned with exploring lived experience, heuristic processes and self-search. Methods that enhance researching under the surface, such as working with images, are particularly relevant.

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Jane Hunt

Professional Role: Deputy Director of Counselling Psychology/Lecturer in Counselling
Institution: Keele University
Contact Details: School of Psychology, Keele University, Keele, Staffordshire, ST5 5BG
Email: j.a.hunt@psy.keele.ac.uk

Paper (Fri, 15.55 - 16.25)

Keywords: transgender, sexuality, gender, discourse, counselling                

Sex talk: male-to-female transwomen talk about the relationship between gender and sexuality

Aim/Purpose: This paper will present findings from doctoral research in which male-to-female transwomen talked extensively about their sexuality and its relationship to their gender positions. This paper will explore the various changes that participants underwent with regard to their sexualities, and consider these findings in relation to the debates in the literature regarding transwomen and sexuality. The implications of these findings for counselling transwomen clients will be considered.

Design/Methodology: This research was conducted using semi-structured in-depth interviews with six male-to-female transwomen who had undergone gender reassignment surgery, and the data analysed using a discourse analytic approach (Parker, 1992; Willig, 2001; Spong, 2010). Ethical approval was granted by the University of Manchester Ethics Committee.

Results/Findings: Two distinct discourses emerged in transwomen's talk concerning the relationship between sexuality and gender. Some participants talked about the changes in their sexuality as a result of transitioning from male to female. As men they felt attracted to women; as women they now felt attracted to men. Therefore they perceived themselves to be heterosexual in both gender positions. However, other participants spoke about how their sexual orientation had remained constant pre and post transition in that in both gender positions they remained attracted to women. This was a barrier for them with the medical profession when seeking gender reassignment surgery. As a result, for some participants gender governed their sexuality; others resisted linking their sexuality to their gender position. These findings are discussed with reference to the discourse of compulsive heterosexuality (Jagose, 1996; Butler, 1995).

Research Limitations: All participants were post-operative male-to-female transwomen and findings cannot be generalised to transwomen who have not undergone surgery or to transmen.

Conclusions/Implications: These findings suggest that the various relationships that exist between gender identity and sexual orientation may cause confusion for both transwomen and their counsellors. It is therefore important for counsellors to have an understanding of the complex dynamics between sexuality and gender when working with transgendered clients.

References available on request, please email research@bacp.co.uk

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Coleen Jones

Professional Role: Psychotherapist, Supervisor, Trainer
Institution: Cork Psychotherapy and Counselling Centre
Contact details: Suite 2, South Terrace Medical Centre, Infirmary Road, Cork, Ireland
Email: coleen@eircom.net

Paper (Sat, 13.55 - 14.25)

Keywords: transference, power, sexuality, holographic model, boundary violations

Aspects of the transference, countertransference and phenomenology as manifest in the therapeutic relationship between female psychotherapists and their clients

Aim/Purpose: This research study aims to reveal themes manifest in the transference and countertransference phenomena between female therapists - psychotherapists, counsellors and psychologists - and their clients.

Design/Methodology: Discourse analysis is selected as a suitable methodology as it parallels the dialogic, existential nature of therapy and clinical practice as themes emerge from the client's language and discourse. This study is post-modernist in its approach and is a relational-reflexive model between researcher, interviewees (or co-researchers) and the data. Data is gathered from seven experienced therapists (five female and two male) who are supervisors and trainers. They were selected as being able to offer a considered opinion about the high incidence of professional, sexual misconduct, by male therapists, and why there might be such a disparity between the sexes and why this might be the case. This questionnaire, like a projective tool is based on the research of Prof. Sue Wheeler and colleagues, which states "Of the 64 individual members complained against, 43 (67%) were female and 21 (33%) were male, in 2004, the gender split of the BACP's membership was 83% female and 17% male. Thus a disproportionate amount of complaints are being brought against men". Interviews are recorded, transcribed and the data read, re-read and compiled until the material coheres into a reduced and readable form by a process of "scholarship" and "authorship". Metaphorical thinking is significant in initiating and integrating concepts.

Results/Findings: The result is presented singularly as an amalgam, needing to be read as one, woven from seven recurrent, emerging, metaphorical, discursive themes; mothering, sexuality, culture, gender, power, transference and containment with 30 sub-themes. It points to a lack of awareness in relation to a "smothering" type of "mothering" on the part of female therapists, their need to be seen as "good", their inclination to be "too politically correct to get into the raw guts of erotic encounter".

Research Limitations: This approach resists Cartesian thinking, manualisation and formulaic approaches to psychotherapy and embraces ‘new thinking' in the field of psychotherapy, as a form of action research.

Conclusions/Implications: In conclusion what emerges highlights the need for female therapists to embrace their own sexuality. It indicates a continued need for more awareness, more containment in the form of ongoing therapy and supportive supervision.

References available on request, please email research@bacp.co.uk

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Gareth Jones

Professional Role: Counsellor (Private Practice/G.P. Practice)
Institution: Former MA Student York St. John University
Contact details: Aycliffe Village, Newton Aycliffe, Co. Durham
Email: garethglynjones@gmail.com / gareth@garethjonescounselling.co.uk

Poster (Fri, 10.00 - 10.30)

Keywords: existential isolation, surrender, journey, epiphany, growth, authenticity

From a ‘forgetfulness of being' and existential crisis, to a ‘mindfulness of being' and authenticity: a heuristic inquiry into a new life perspective out of significant losses in alcoholism and bereavement.

What are the common factors that facilitate and constitute growth?

Aim/Purpose: Willing to enter the shadow of my experiences, facing hidden and painful aspects of self, I sought clarity and integration, to enable me to sit comfortably with my chaos when facilitating anothers. In exploring growth from losses in alcoholism and bereavements, I remained open to others experience of growth, willing to embrace a co-constructed reality of the journey toward authenticity.

Design/Methodology: Heuristic (Moustakas, 1990) reflexive and narrative (Etherington, 2004; 2000) methodologies were adopted to inquire into the phenomenological experiencing of three researchers journey or quest. The heuristic process of 'immersion, incubation, illumination and explication', through personal reflection, journaling of thoughts, dreams and focusing on the ‘felt sense' (Gendlin, 2003) first facilitated understanding of my experiencing. An informal conversational interview was the main data collection tool for two co-researchers. Their narratives were transcribed and viewed by them for accuracy, no changes were requested. Analysis followed 'immersion' in the data, setting aside for 'incubation' until key themes emerged through 'illumination'. These themes were synthesised into individual depictions ('explication') using verbatim extracts of dialogue and again viewed for accuracy, no corrections were requested. Post reflection, a ‘creative synthesis' encapsulated my transformed insight into the experiencing of authenticity. Ethical approval was granted by York St. John University.

Results/Findings: Common factors included: existential isolation lead to existential crisis, to epiphany to surrender. Post surrender all heeded innate needs, commencing journeys from an external locus of evaluation to internal, becoming more authentic. All recognised authenticity's fluidity and engaged in continual self monitoring to live meaningful lives.

Research Limitations: Being a small-scale study, a larger study investigating growth from loss in other life experiences would test viability of results.

Conclusions/Implications: The aim of sitting comfortably with my 'chaos', when facilitating anothers was achieved. Today's climate which views personal therapy in counselling training as 'optional' and adherence to NICE guidelines, which perhaps favour approaches that do not view self awareness as an essential element of the therapeutic encounter, raises a question; 'Is it essential that we are willing to explore our deepest thoughts and fears, to provide safety and security for the client to do the same?'

References available on request please email research@bacp.co.uk

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Ounkar Kaur and Rebecca Midwinter

Professional Role: Researcher/Tutor
Institution: University of Bristol
Email: ounkar.kaur@bristol.ac.uk

Paper (Fri, 15.00 - 15.30)

Keywords: Black and Minority Ethnic (BME), diversity, curriculum, practice

Increasing the presence of BME students on the Diploma/MSc in counselling courses

Aim/Purpose: Despite varying from one year and one cohort to another, the Diploma/MSc in counselling has failed overall to attract a representative number of students from Black and Minority Ethnic (BME) communities, a problem faced by many such courses and within the counselling profession generally (Taylor-Muhammad, 2001; Tuckwell, 2002).

The aim and purpose of the research is to consider what the contributing factors might be as to why people from BME communities are less likely to apply for the MSc in Counselling courses and present the findings and any recommendations to the WP forum (Widening Participation) who funded the research.     

Design/Methodology: Research procedures used a qualitative research model appropriate for multicultural situations; it was important that the researcher came from a BME background which enabled her to examine which research model was most appropriate and sensitive in conducting this research. This was a pilot study where seven participants male and female were interviewed individually. Four of the participants had been in dual-roles ie tutor/student and came from various cultural and ethnic background who had been identified through various professional networks. Data was collected with the use of semi-structured interviews and analysed using thematic analysis.

Results/Findings: University of Bristol was a training institution many aspired to study at, though some reported experiences of isolation. Peer identification and issues around ethnic segregation appeared a theme as well as student experiences differing in relation to some being from non-BME backgrounds as opposed to BME backgrounds. Participants' felt it was important that issues around race, culture and ethnicity are tutor-led and for race equality training be made available to them.

Research Limitations: This was a small study and only seven people were interviewed and not necessarily from all BME communities. All interviewees had enrolled on counselling courses. There is a need to disseminate our findings to culturally relevant communities and to undertake a larger study to gain further understanding as to whether our small study is representative of a wider BME community and needs to identify people who did not enrol on the courses.

Conclusions/Implications: A number of themes emerged from the analysis which the researcher felt need to be further explored and addressed; some changes need to be implemented which may increase the numbers of students from BME backgrounds. The researchers' perspectives are not included and may have influenced the analysis.  

References available on request, please email research@bacp.co.uk

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Andrew Lansdown

Professional Role: Student
Institution: University of Newport (WALES)
Email: yakyak2005@hotmail.co.uk

Paper (Sat, 14.30 - 15.00)

Keywords: humour, clarification, identification, timing, thematic analysis

Humorous things happen in therapy (an exploration of whether humour enhances or inhibits the therapeutic relationship)

Aim/Purpose: The focus of this research study is centred on the exploration of whether humour enhances or inhibits the therapeutic relationship. The purpose was to discover whether therapists should consider humour as an intervention? There is very little empirical research on the effects of humour when introduced into therapy, although humour has been recognised since the early Greeks who considered humour to be central to a person's wellbeing.

The researcher discovered that it was very difficult to find therapists who were willing to discuss the subject of humour in therapy, as therapy is often considered as a serious process.

The researcher discovered that ‘Incongruity Theory' (Suls, 1972) seemed to fit well with clients who are having difficulty in understanding their problems from an alternative view point. This was an important discovery, as it enabled the researcher to think about how this type of humour might be used in the therapy room.

Design/Methodology: To build upon this curiosity a qualitative research format was used, involving five therapists being interviewed and the transcripts analysed using a thematic analysis which formed the structure for a semi-qualitative questionnaire. The findings from the questionnaire were analysed using a S.W.OT Analysis (McNaughton, 2006).

Results/Findings: Three main principles emerged from the findings which were: clarification, identification and timing. When linked together, these gave a strong indication that if humour is used as a therapeutic intervention, it could be beneficial for the therapist to use with a client.

The researcher used these three principles to construct a ‘humour triangle' which was central to the argument that humour should be considered if all three principles are present. Equally, if one of these principles is not present, then the argument against the use of humour should be engaged.

Research Limitations: There is very little empirical research on the effects of humour when introduced in therapy as an intervention. 

Conclusions/Implications: The researcher considered various arguments and perspectives, for and against the effects of using humour in the therapy room. Frankl (2004) states that ‘humour is an integral part of living, and to be without humour would be a major cause for concern'. The findings have left the researcher optimistic that humour can enhance the therapeutic relationship.

References available on request, please email research@bacp.co.uk

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Liz McDonnell

Other Authors: Sheila Butler and Peter Stratton

Professional Role: Research Fellow, UKCP
Institution: UKCP
Contact details: UKCP, Edward House, 2 Wakley Street, London, EC1V 7LT
Email: thomday@hotmail.com

Paper (Sat, 11.00 - 11.30)

Keywords: survey, therapists, research needs, evidence, research-informed clinicians

A survey of research priorities of UKCP members

Aim/Purpose: To gain a better understanding of therapist's research interests, research support needs and their opinions about the most important research issues.

Design/Methodology: A survey of the entire membership of UKCP to determine their attitudes to research and as a basis for planning the contribution that their organisations could make. The content of questions focused on individual members' experiences of, and activities around research as well as members' views of priority research related issues. The survey was piloted with a small group of UKCP members. An online version of the survey was located at Survey Monkey and hard copies were given out at the UKCP Research Conference (July 2010). Approximately 6,800 members received an email of the survey. Quantitative data were analysed using SPSS. Qualitative answers were subjected to a detailed thematic analysis. Relationships between qualitative and quantitative responses were explored.

Results/Findings: Five hundred and eighty eight therapists completed the survey. The strongest motivation was to know about "effectiveness/outcomes/impact/evaluation of psychotherapy". Of therapists who rated this issue, 46% were most concerned with therapeutic processes, 18% with client-based issues. Sixty seven percent put evaluation of psychotherapy as the main objective they would like UKCP to have, but there was a rich variety of reasons given for not personally becoming involved with research. The paper will present results in detail including the extremely informative qualitative responses which cannot find space in an abstract.

Research Limitations: Although a substantial sample, it was only 10% of the membership. Probably more representative of those who are research-informed (Karam & Sprenkle, 2010). Data derived from a single organisation so needs checking in the wider field of counselling and psychotherapy.

Conclusions/Implications: A substantial constituency of therapists are concerned about research and their priorities are to know more about how their practice works and what kinds of value it has. The findings fit with similar surveys but this survey should be seen as a starting point for knowing which aspects of research motivate therapists and what the implications for engaging them more with research are.

References available on request, please email research@bacp.co.uk

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John McLeod

Professional Role: Academic
Institution: University of Abertay Dundee
Contact details: Tayside Institute for Health Studies, University of Abertay Dundee, Dundee, DD1 1HG
Email: J.McLeod@abertay.ac.uk

Methodological innovation paper (Fri, 13.50 - 14.20)

Keywords: case study research, causality, generalisability, methodology, practitioner research

Improving the credibility and rigour of case study evidence: emerging principles

Background and introduction: Historically, case studies have made an essential contribution to the development of an evidence base for counselling and psychotherapy theory, practice, and training. There are, however, a number of significant methodological and epistemological issues associated with case-based research, concerning the reliability of observations, procedures for analysing data, and questions of generalisability and the establishment of causality. In recent years there has been a resurgence of interest in case study methodology within the field of counselling and psychotherapy, built around a set of emerging methodological principles for systematic case inquiry (see McLeod, 2010).

Nature of the methodological innovation/critique being proposed: This paper will use examples from the recent special issue on case study methods, of the Counselling and Psychotherapy Research journal, to examine the nature of the following methodological principles for systematic case study research:

  • assembling a rich case record
  • use of time-series analysis and critical events to establish micro-causal linkages
  • team-based data analysis
  • critical analysis of theoretical perspectives
  • standard formats for reporting case studies
  • use of client and therapist accounts
  • on-line access to supplementary data.

Conclusion and relevance to counselling and psychotherapy research practice: It is hoped that these guidelines will assist practitioners and researchers to generate case studies that are publishable and that have a capacity to influence policy decisions around the formulation of evidence-based practice. It is suggested that engagement in systematic, team-based case research can play a valuable role in therapist training and continuing professional development.

Reference: McLeod, J. (2010) Case study research in counselling and psychotherapy. London: Sage.

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Alesia Moulton-Perkins and Simon Rogoff

Other Authors: Peter Fonagy and Patrick Luyten

Professional Role: Clinical Psychologist and Honorary Post-Doctoral Researcher UCL
Institution: UCL/Sussex Partnership NHS Foundation Trust
Email: alesiaperkins@btinternet.com

Paper (Sat, 14.30 - 15.00)

Keywords: mentalisation, validity, reliability, borderline personality disorder, eating disorders

Development and validation of a new self-report measure of mentalisation: the 54-item Reflective Function Questionnaire

Aim/Purpose: This study outlines the development and psychometric testing of a new self-report measure of mentalisation, the 54-item Reflective Function Questionnaire (RFQ54). Mentalisation has traditionally been measured using the Reflective Functioning Scale (Fonagy et al., 1998) applied to data from Adult Attachment Interviews (AAI) (Main & Goldwyn, 1994), but its resource-intensive nature makes it impractical for clinical settings. Fonagy and colleagues constructed an early 46-item version of the RFQ. Perkins (2009) piloted the RFQ46 on a mixed clinical and non-clinical sample (n=401) and two conceptually coherent and internally reliable factors emerged: ‘internal-self' (α=.75), and ‘internal-other' (α =.63) (overall alpha=.77). The measure was revised and eight new theory-driven items added designed to increase the reliability of the weaker internal-other factor. A seven point rather than six point scale was utilised to maintain parity of scaling distance between polar-scored and median-scored items. In the present second phase of the research the revised RFQ54's psychometric properties are currently being re-tested on larger, more homogeneous samples.

Design/Methodology: Using a cross-sectional questionnaire-based design, the RFQ54's reliability and validity is being tested in three separate populations: borderline personality disorder, eating disorders and nonclinical controls (target n=600). Psychotherapists and psychologists comprise a non-clinical sub-group of hypothesised ‘expert' mentalisers. Several convergently and divergently related constructs are being compared: theory of mind, mindfulness, alexithymia, and empathy. In a parallel project, cross-cultural validity is being investigated across eight other countries.

Results/Findings: Research is currently ongoing. Preliminary results for the English version of the RFQ54 are reported.

Research Limitations: The above research is limited in that criterion validity to the AAI is not demonstrated. A separate small scale study is currently comparing the RFQ54 to AAI data.

Conclusions/Implications: The establishment of a psychometrically valid self-report measure of mentalisation would allow researchers to investigate the core psychological process targeted by mentalisation based therapy (Bateman & Fonagy, 2004). Countering critiques of the current uni-dimensional RF-rated AAI (Choi-Kain & Gunderson, 2008), the RFQ54 allows for the multi-dimensional analysis of mentalisation. Mediational analyses of therapeutic processes would therefore be facilitated as well as providing an easy to administer method for quantifying therapeutic outcomes.

References available on request, please email research@bacp.co.uk

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Joanna North

Professional Role: Psychotherapist/Adoption Support Agency
Institution: Joanna North Associates. Ofsted Registered Adoption Support Agency. Private Practice
Contact details: 2 Stable Farm, Collipriest, Tiverton, Devon, EX16 4PT
Email: joanna.north@virgin.net

Paper (Fri, 15.55 - 16.25)

Keywords: attachment, practitioner researcher, secure base, trauma, narrative enquiry, researcher diary, single case study, reflexive stance

How do we care for a child with difficult behaviour?

Aim/Purpose: To explore the skills, knowledge and attitudes needed by parents and carers of children with extreme behavioural difficulty.

Design/Methodology: The methodology referenced the qualitative paradigm using the practitioner researcher model. A single case study was chosen as it was seen to be able to provide an opportunity for in depth research that could be extrapolated into the wider field and applicable to similar situations. The researcher was measuring the best possible tools for helping a child with difficult behaviour. The key research question was ‘How do we help transform the lives of children with difficult behaviour?' The research captured episodes of narrative at strategic points of the therapeutic process. In addition the researcher also used a practitioner diary to capture her own experience of the process of the therapeutic work.

Results Findings: The data were analysed by pulling out relevant commentary and feeding this back to the research subject and supporters who confirmed their acknowledgement of its relevance to the study. The research helped the practitioner and the participant find a new focus for support and therapy to help a child with complex behaviour. The key finding was that attention should focus on supporting the parent to develop skills in providing a secure base rather than trying to enforce quick behavioural changes in the child. This culminated in the development of a book for parents on ‘How to think about caring for a child with difficult behaviour' which incorporated these skills.  

Research Limitations: The research was limited to one case study. Future studies may use the findings from this one study to test applicability to a larger group of cases.

Conclusions Implications: The implications of the study supported the view that therapist's in adoption support work and work with children in care need to focus attention on helping the parent develop and hold in place a secure base so that the child can gradually learn a sense of felt security. 

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Denis O'Hara

Other Author: Fiona O'Hara

Professional Role: Programme Leader MSc Counselling
Institution: University of Abertay, Dundee, Scotland
Contact details: School of Social & Health Sciences, Kydd Building, University of Abertay, DD1 1HG, Dundee, Scotland
Email: d.ohara@abertay.ac.uk

Paper (Sat, 12.10 - 12.40)

Keywords: definitions of hope, dispositional hope, differentiation of self, epistemic style  

The relationship between counsellors' hope, self differentiation and epistemic style

Aim/Purpose: Hope has been defined as "...the sum of perceived capabilities to produce routes to desired goals, along with the perceived motivation to use those routes". While hope has consistently been identified as a central feature of therapeutic change, little research has explored the nature and influence of the therapist's hope. This study aims to explore the relationship between counsellors' hope, self differentiation (balance between cognitive and emotional processing), and epistemic style (ie rationalist, constructivist), especially how the latter two constructs influence counsellors' levels of hope.

Design/Methodology: The study used a mixed-methods design with quantitative and qualitative questionnaires with 60 participant therapists. The quantitative aspect of the study employed a within-subjects correlational design and the qualitative aspect relied on a grounded approach to the data.

Results/Findings: The results demonstrated a positive correlation between counsellors' own respective levels of hope and their levels of self differentiation. There was a more diffuse relationship between counsellors' epistemic styles and their respective levels of self differentiation and hope. Hope itself was defined in a variety of ways including: an idea, possibilities, choices, and a feeling. A variety of strategies for engendering hope through therapy were identified.

Research Limitations: The main limitation of the study at this stage of reporting is the sample size. The quantitative dimensions of the research would benefit from an increase in participant numbers. No interviews were undertaken in this study although qualitative data were gathered via a short response questionnaire. It is likely that a greater depth of analysis would have ensued from in-depth interviews.  

Conclusions/Implications: The strong relationship between counsellors' self differentiation and their levels of hope demonstrated by the study has a number of potential implications including, highlighting the importance of counsellors' own personal development and its influence on their ability to maintain their own levels of hope and possibly on how this influences their capacity to support their clients' hope. The strong positive relationship between personal growth expressed as differentiation of self, and hope suggests that greater emphasis should be placed on the personal development of counsellors. The qualitative data suggests that counsellors would benefit from a greater knowledge of more hope-specific strategies.

References available on request, please email research@bacp.co.uk

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Valerie Owen-Pugh 1 and Clare Symons 2

Other Author: Sue Wheeler

Professional Role: Lecturer in Counselling 1; Deputy Director of Counselling and Psychotherapy Programme 2
Institution: University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester, LE1 7PA
Email: vap4@le.ac.uk 1; cms49@le.ac.uk 2

Paper (Fri, 10.55 - 11.25)

Keywords: supervision, competences, supervisor training

An evaluation of Roth and Pilling's competence framework for counselling and psychotherapy supervision

Aim/Purpose: Roth and Pilling's (2009) competence framework for the supervision of psychological therapies was originally commissioned for use in the Improving Access to Psychological Therapies (IAPT) programme. However, it also has potential as a general resource, for informing research into clinical supervision and the training of supervisors. The present study sought to evaluate the framework by clarifying how well it reflects the current practice of clinical supervision, and practice on supervisor training courses. This research has been funded by BACP.

Design/Methodology: The opinions of supervisors and supervisor trainers were surveyed using an online survey, to canvas opinion of the framework as a whole, followed by an optional email survey, to elicit in-depth opinion of its individual elements. A total of 352 participants completed the online survey.

Results/Findings: Participants welcomed the fact that the framework was comprehensive in coverage and potentially applicable to a range of modalities. However, some noted that it was very much a product of its IAPT origins, with a notable emphasis being placed on the educational role of supervisors. A number of generic competence elements, such as those referring to direct observation of therapy sessions, were seen to have limited applicability across modalities.

Research Limitations: The very large number of competence elements in the framework may have discouraged participants from completing the emailed survey form. Samples of supervisor trainers were small but arguably reflected the low numbers of such trainers in the UK.

Conclusions/Implications: The framework is a useful aide-mémoire for supervising practice. However, it is arguably too detailed and unwieldy in its present form to serve as a usable checklist for personal development, or for the development of training outcomes.

References:

Roth, A. D. and Pilling, S. (2009) A Competence Framework for the Supervision of Psychological Therapies. London: University College, London. Available at: www.ucl.ac.uk/clinical-psychology/CORE/supervision_framework.htm.

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Peter Pearce and Ros Sewell

Professional Role: Head of Person Centred Dept. and Team member respectively
Institution: Metanoia Institute
Contact details: 13 North Common Road, Ealing London, W5 2QB
Email: peter.pearce@metanoia.ac.uk

Workshop (Sat, 13.55 - 14.55)

Keywords: collaborative research, internal consultation, unintended consequences, problems of success

Collaboration: ‘working together in an intellectual endeavour toward a common goal' or ‘treasonous co-operation with the enemy?'

Relevance of the workshop to counselling and psychotherapy research: This workshop will explore the benefits, limitations and unintended consequences of collaboration in the research process; in particular the experience of collaborative research within an existing workplace, detailing both the benefits and tensions of becoming internal consultants within an existing system. Although in the 'real world' the majority of research and development work occurs through collaboration and team work this is not reflected in academia where work still needs to be accredited individually. This work was undertaken as part of a Doctorate in Psychotherapy by Professional Studies which explores the role psychotherapy can have 'out of the therapy room' within education.

The aims of the workshop: This workshop aims to contribute to participants understanding of the complexity of relationship and collaboration within psychotherapy research. It will hope to illuminate some of the challenges of internal consultation to an institutional system and highlight some aspects of a possible alternative to traditional individualistic academic assessment systems for research.

How the workshop will be structured: Presentation, vignettes from practice, participant discussion in pairs and larger group sharing people's own experience.

Key points for discussion: Exploration of the benefits, limitations and unintended consequences of collaboration in the research process; benefits and dilemmas of being an insider researcher; how a more representative academic assessment system could be developed which acknowledges the reality of co-operation and team work in practice based research and development settings.  

Who will benefit from attending the workshop: It will have potential relevance both to anyone interested in collaborative research as well as for any practitioner researchers whose setting requires careful negotiation of the system and the cooperation of others.

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Sara Perren

Other Authors: Hugh MacPherson and Stewart Richmond

Professional Role: Counselling Supervisor, ACUDep Trial
Institution: University of York
Contact details: c/o ACUDep Trial, Complementary Medicine Research Group, Department of Health Sciences, Seebohm Rowntree Area 3, University of York, Heslington, York, Y10 5DD
Email: saraperren.research@gmail.com

Poster (Sat, 10.10 - 10.40)

Keywords: Depression, counselling, acupuncture, usual GP care, randomised controlled trial

Acupuncture, counselling and usual GP care for depression. A randomised controlled trial to determine clinical and cost effectiveness

Aim/Purpose: 1. To determine the clinical and cost effectiveness of short courses of acupuncture or counselling for depression when compared to usual GP care.

2. To determine which is more effective, acupuncture or counselling. To explore and compare patients' experiences of these two interventions.

Design/Methodology: Pragmatically based randomised controlled trial studying 640 moderately to severely depressed people in the North of England who have consulted their GP with depression in the last two years. Participants were randomised into the three arms of the trial: acupuncture and usual GP care; counselling and usual GP care; and usual GP care alone. Those randomised to counselling or acupuncture were offered 12 weekly sessions. Trail uses 'intention to treat' analysis - including information about everyone who takes part even if they don't attend for treatment. Main outcome measures are the Beck Depression Inventory and the PHQ9. Clients were followed up at three, six, nine and 12 months. There was also a qualitative arm of the study in which clients who wish, were interviewed in depth about their treatment.

Results/Findings: None thus far, trial still in progress.

Research Limitations: This was originally an acupuncture only trail. The researcher has worked hard to ensure that counselling - which was introduced into the trial later as a comparison arm - is represented equally in the trail. It will be important to ensure lack of bias in the analysis because of this original emphasis on acupuncture.

Conclusions/Implications: No findings as yet. Analysis will begin in Spring 2012. Both counsellors and acupuncturists in the trial are hopeful that it will demonstrate the effectiveness of both interventions. As this is an RCT, findings for the effectiveness of counselling will strengthen the position of counselling in the NICE Depression Guideline.

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Keva R Reid

Professional Role: University Lecturer in Psychology
Institution: Newman University College
Contact details: Psychology and Counselling, Genners Lane, Bartley Green, Birmingham, B32 3NT
Email: k.reid@newman.ac.uk

Poster (Fri, 10.00 - 10.30)

Keywords: conduct disorder/behaviour, Jamaica/Caribbean, parenting styles/poverty

Jamaican parenting styles and their impact on conduct disordered behaviours

Aim/Purpose: The aim of this exploratory study was to examine the influence of parenting styles on the creation of conduct disordered behaviour and the factors that mediate.

Design/Methodology: Participants for this qualitative study were Jamaican males (n=75) with a mean age of 15.7. There were 48 with conduct disordered behaviours and 27 without a diagnosis. All participants completed the Conners-Wells' Self-Report Scale, demographic questionnaire and a 24 item questionnaire which was created to assess parental styles and mediating factors. The parents and teachers of the participants completed the Conners' Parent & Teacher Rating Scale, respectively. The ethical guidelines of The University of the West Indies were followed.

Results/Findings: The analysis was based on Chi-Square and Logistic Regression. The results revealed that harsh/overly strict parenting style by single parent mothers (χ2 = 104.9, df = 1, p = .004) and residence in deprived (garrison/disorganised) communities (χ2 = 457.5, df = 1, p = .003) were some of the strong predictors in the development of conduct disordered behaviour. Logistic regression indicated that the best predictors for the development of conduct disordered behaviour were socio-economic position, parent(s)'s employment status, harsh/overly strict parenting style and the family's financial situation.

Research Limitations: The tests were not normative to the Jamaican context and as such could be biased regarding the behaviours. The dropout rate was high due to the behaviour and financial status of the participants. The generalisability can be extended outside the Jamaican context but only to deprived areas with similar family patterns and parenting styles. Cause-effect cannot be established between the variables.

Conclusions/Implications: The parenting style was often reflective of the situational factors such as lone-parenting, which was mediated and/or fostered by deprived living conditions. Scott, O'Connor & Futh (2006) explain that parenting styles does vastly improve with intervention in these areas. There are implications for understanding risk factors for adolescent behavioural problems and suggest possible interventions by counsellors, therapists and youth workers with families in deprived areas to prevent the development of conduct disordered behaviours for these communities.

References available on request, please email research@bacp.co.uk

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Ryan Roberts and Iain Khan-Gilchrist

Other Authors: Gill McCaughin, Rachel Povey, Ruairi Lynch, Beth Thomas, Siobhan McCalla and Leitha Tingle

Professional Role: Student and volunteer counsellor
Institution: LC&CTA - Lewisham Counselling and Counsellor Training Association
Contact details: LC&CTA, Broadway House 15-16 Deptford Broadway, Deptford, SE8 4PA
Email: christinebrown@lcandcta.co.uk

Poster (Fri, 10.00 - 10.30)

Keywords: disenfranchisement, isolation, gay men, drug use, acceptance

Does disenfranchisement in certain sections of the gay male community lead to increased use of legal and illegal drugs, if so, what are the implications for counselling practice?

Aim/Purpose: To investigate whether any link exists between the patterns of drug use within certain sections of the gay male community (Graham, 2009) and the levels of societal disenfranchisement (ostracised from main stream society) that many gay males experience (Herek, 2009); to inform psychotherapists/counsellors of the possible implications for their practice when working with men from this client group.   

Design/Methodology: The Duquesne Method of Empirical Phenomenology (Moustakas, 1994), was employed to collect and analyse data. Six completed questionnaires were received and two 1:1 interviews took place with counsellors/psychotherapists working with gay males. The research was carried out in London/South East England and was conducted under the BACP Ethical Guidelines for Research in Counselling and Psychotherapy, (Bond, 2004).

Results/Findings: Findings indicate that disenfranchisement is indeed a major factor in the lives of many gay males, resulting in a sense of social isolation which often began in childhood. Findings also indicate that drugs, either legal or illegal, are often used by gay men to increase feelings of acceptance and to help individuals cope with certain aspects of the gay scene/community. Therefore, there appears to be a strong link between disenfranchisement and drug use in the gay male community.

Research Limitations: The researchers were limited to collating data from counsellors/psychotherapists as ethical considerations prohibited us from approaching clients because we did not possess the resources to ensure a safe process or post interview support for clients. Our findings do not provide a national picture as the research was conducted in London/South East England; other geographical areas may evidence different findings.

Conclusions/Implications: Under investigation in this area, demonstrated by an apparent lack of published material, prompted the authors to research this topic from a psychotherapeutic view point. The results of the research will help raise awareness and understanding of the apparent correlation between societal disenfranchisement and drug use by gay males.


In order to better facilitate clients, the findings show that psychotherapists/counsellors working with gay males may need specific training in drug use, and may also need to develop a greater understanding of the connection between the use of drugs and the sense of isolation/disenfranchisement that many gay men appear to experience.

References available on request please email research@bacp.co.uk

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Maggie Robson

Professional Role: Academic, Trainer and Practitioner
Institution: Keele University
Contact details: Dr Maggie Robson, School of Psychology, Keele University, Staffordshire, ST5 5BG
Email: m.a.robson@psy.keele.ac.uk

Workshop (Fri, 11.30 - 12.30)

Keywords: research, practice, reflection

Reflective practitioners - budding researchers?

Relevance of the workshop to counselling and psychotherapy research: This workshop is relevant because it aims to break down potential practitioner resistance to engaging in research by focusing on skills that they already have and looking at what they would need to develop. It is also relevant because it explores the relevance of research to practice.

The aims of the workshop: This workshop aims to explore the idea that reflective practitioners are already researchers. The common view is that research is separate to practice and carried out by academics in institutions of learning. Research carries with it a notion of scientific exclusiveness that is sometimes not easily accessed by practitioners. However, all practitioners are engaged, either knowingly or unknowingly, in hypothesis generation and testing and meaning making which is at the heart of all scientific research. For example, in the struggle for empathic understanding of our client's world, our tentative reflections are testing our hypothesis. What we are doing is, in essence, saying 'this is how I experience what you are telling me - is it like that?'

There will be an introduction to the main themes of the workshop - connections between research and practice, what is reflexivity, the connection between research and making sense of what we do in practice. Participants will be invited to join in a series of experiential exercises aimed at helping them to deepen their understanding of the issues through their own experiences. The workshop will end with reflection on the content and experience of the workshop.

Key points for discussion: What is research? How does research connect to being a reflective practitioner? How can research help us understand our practice?

Who will benefit from attending the workshop: Practitioners who have an interest in developing their research and beginning researchers.

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Jeannette Roddy

Professional Role: PhD Student and Counsellor
Institution: York St John University
Contact details: Lord Mayor's Walk, York, YO3 7EX
Email: j.roddy@yorksj.ac.uk

Poster (Sat, 10.10 - 10.40)

Keywords: domestic violence, qualitative, grounded theory, narrative

Developing a client informed approach to domestic violence counselling

Aim/Purpose: One in four women and one in six men are likely to suffer from domestic violence in their life, and over 50% of women in the mental health system have suffered domestic violence (Women's Aid, 2010; Smith et al. (2010). Although many counselling clients will have experienced domestic violence, little research has been conducted into the counselling of this client group. This research investigates what works well and is effective in counselling from a client perspective, with a view to informing counselling practice.

Design/Methodology: Initially, looking at the effectiveness of counselling seemed to indicate a quantitative study. However, closer examination of the range of therapies recommended, the variety of presenting issues, and difficulty with selecting appropriate measurements suggested that this approach would be limited in scope and impact. Qualitative methodology offered an option to explore and establish what was important to the client.

Identifying an appropriate research approach involved balancing feminist philosophy with other social factors and recognising the individuality of the client whilst retaining the possibility of emerging common factors. This led to embracing a social constructionist position.

Working directly with this vulnerable client group also required care both in ethical design and implementation. A narrative/grounded theory approach has been chosen initially, to enable the client to share counselling stories which will enrich the research, whilst also providing an analytical framework to determine common process.  

Results/Findings: This is an ongoing research project and the initial pilot phase will be completed by the end of April 2011, allowing preliminary results to be shared at the conference and inform ongoing PhD research.

Research Limitations: As a small-scale pilot study, there will be questions about the generalisability of the data, philosophical concerns about trying to develop a 'standard' approach for this highly complex area and debate about appropriate interpretive frameworks.

Conclusions/Implications: This work will inform counselling practice with domestic violence survivors, building upon existing practice, and may inform appropriate measurements of effectiveness. Further research to determine the impact of improved practice could be conducted on completion of the study.

References available on request, please email research@bacp.co.uk

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Brian Rodgers

Professional Role: Researcher, Trainer, Practitioner
Institution: University of Strathclyde
Contact details: Counselling Unit, 76 Southbrae Drive, Glasgow, G13 1PP
Email: research@brianrodgers.co.uk

Paper (Sat, 15.40 - 16.10)

Keywords:  life space mapping (LSM), assisted reflexivity

Life space mapping as assisted reflexivity: a method for helping clients to reflect on change from therapy

Aim/Purpose: This paper will present the development of a visual, creative approach to exploring the outcomes of counselling and psychotherapy implemented in terms of ‘life space mapping'. The method is seen to offer clients a form of 'assisted reflexivity' allowing them to reflect on change over the duration of therapy from their own perspective.

Design/Methodology: Seventeen participants completed a life space map (LSM) prior to commencing therapy, and again at the end of therapy. Qualitative interviews were conducted with each person to explore their experience of using the LSM and how they utilised the method to reflect on any changes that had occurred. A thematic analysis of the interviews was undertaken to identify major themes of participants' experiences.

Results/Findings: The results of the study indicate that life space mapping was able to access rich, in-depth narratives of change that revealed a different ‘picture' of outcome than is usually obtained. Rather than being asked once to ‘say how it was', either in a questionnaire or a qualitative interview, the method assisted participants to recall and reflect on change by providing an explicit point of reference to refer to. Further, participants related change in terms of differences in their 'life space' rather than 'change due to therapy'.

Research Limitations: The study was undertaken as part of the initial development of life space mapping as a therapy outcome assessment tool. As such, further research needs to be undertaken into the usability of the LSM approach in different settings with different client groups.

Conclusions/Implications: The study demonstrates that the LSM provides a powerful adjunct to traditional approaches to outcome assessment which facilitates clients' reflections on change in terms of their own ‘life' and their own ‘space'. Further, it highlights the value of offering outcome data back to the clients themselves such that they can make use of it for their own growth processes. As such, the method appears to offer great potential as a more 'client centric' approach to outcome assessment.

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Anja Rutten

Professional Role: Senior Lecturer, Psychology and Counselling
Institution: Staffordshire University
Contact details: Staffordshire University, Department of Psychology and Mental Health, Faculty of Sciences, Mellor S526, College Road, Stoke-on-Trent, Staffordshire, ST4 2DE
Email: a.h.rutten@staffs.ac.uk

Paper (Sat, 15.40 - 16.10)

Keywords: Asperger syndrome, autism spectrum, therapeutic relationship, grounded theory, client experiences

How people with Asperger syndrome experience counselling

Aim/Purpose: Asperger syndrome (AS) forms part of the high-functioning end of the autism spectrum. People with AS are often isolated and socially excluded due to difficulties with imagination, communication and relationships. Mental health difficulties are common and people with AS often struggle with depression and difficulties managing anxiety. These are common presenting issues in counselling, but people with AS are underrepresented as clients and often struggle to access appropriate services. To date there has been no research into the counselling experiences of clients with AS. The purpose of this study was to seek the views of clients with AS, in particular on whether and how counselling has been beneficial or unhelpful.

Design/Methodology: Given the absence of prior research into client experiences with this group, a qualitative approach using grounded theory methodology was taken and six participants were interviewed. This ensured a bottom-up approach and maximised the impact of clients' voices. Interviews were semi-structured and supported by discussion prompts where necessary. A modified version of the open-ended Change Interview was used. Transcripts were analysed using domains and hierarchical category structure.

Results/Findings: Results show that counselling experiences of people with AS are very mixed, with a significant proportion of damaging experiences as well as some very helpful experiences. Unhelpful factors relate to lack of understanding by the therapist - both of the person and of their AS. Helpful factors relate to a large extent to the quality of the therapeutic relationship.

Research Limitations: This is a small-scale qualitative study, and research participants are not necessarily representative of all people with AS who have had counselling or other forms of psychological help.

Conclusions/Implications: People with AS value the opportunity to talk to a counsellor. A good quality, personal, therapeutic relationship with high levels of consistency is paramount. Implications for practice are substantial: this group of clients is currently not served well. Accessibility of services and lack of accommodation of client needs are major issues to be addressed. In terms of research, more needs to be done to represent client views as they may represent a fundamentally different perspective to professionals' opinions on helpfulness.

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Thomas Schröder   

Other Authors: David Orlinsky and John Davis

Professional Role: Co-Director (Academic & Research), Trent Doctoral Training Programme in Clinical Psychology
Institution: University of Nottingham
Contact details: Institute of Work, Health and Organisations, International House, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB
Email: thomas.schroder@nottingham.ac.uk

Paper (Fri, 15.55 - 16.25)

Keywords: therapeutic frame, therapeutic boundaries, process, therapist development, flexibility

Strong fences and flexible frames: therapists' perceptions of boundaries

Aim/Purpose: The need to respect therapeutic boundaries is generally accepted, serving the protection of the patient/client and - especially in the analytic/psychodynamic tradition - the maintenance of a therapeutic frame. Boundary infringements attract attention when ethical codes are breached and disciplinary procedures invoked, but little is known about where practitioners ‘draw the line' in everyday practice, which this study investigates.

Design/Methodology: Data derived from the International Study of the Development of Psychotherapists, a cross-sectional naturalistic survey. A heterogeneous sample of n= 8839 therapists from 30 countries with diverse professions and theoretical orientations completed an anonymous self-report questionnaire about their professional development, covering a wide range of variables and including up to 10 items relating to the therapeutic frame. For the latter, respondents endorsed - on a six point scale ranging from ‘never' to ‘very often' - items, following the stem "with clients in your current practice, how often do you...", such as "...agree to meet in locations other than your normal setting?"

Results/Findings: Rank orderings of means for the 10 items - largely consistent across five subgroups (four countries contributing more than 1,000 respondents each and one group encompassing all others) - show "arrange periodic additional or emergency sessions" and "initiate or receive telephone calls or letters" as most, and "sexual contact" as least frequently endorsed.

Principal component analysis (also largely consistent across subgroups) yielded two factors: ‘frame flexibility' comprising five of the most highly endorsed items, forming a reliable scale (alpha = .76), and ‘frame infringement', not forming a reliable scale.

‘Flexibility' is reliably negatively associated with analytic/psychodynamic but positively with all other theoretical influences on current practice. The ‘infringement' items are reliably negatively associated with analytic/psychodynamic, but positively, or not at all, with all other theoretical influences on current practice.

Research Limitations: Data are self-reported. Heterogeneous sample does not allow for means comparisons between subgroups.

Conclusions/Implications: Adherence to boundaries within the analytic/psychodynamic tradition protects against infringements, possibly at the expense of appropriate flexibility. Other theoretical traditions promote greater flexibility, possibly at the cost of potential boundary infringements.

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Aaron Sefi

Co-author: Terry Hanley

Professional Role: Online Counsellor and Researcher
Institution: Xenzone
Contact details: Head Office Xenzone Ltd, Lancastrian Office Centre, Talbot Road,Manchester, M32 0FP
Email: aaron@xenzone.com

Poster (Fri, 10.00 - 10.30)

Keywords: online counselling, multiple baseline, practice-based evidence, CORE-YP, effectiveness

Examining the complexities of measuring effectiveness of online counselling for young people using routine evaluation data

Aim/Purpose: Research examining online youth counselling is in its infancy and has predominantly focused upon the inner workings of online therapeutic relationships. Its effectiveness has received less attention, which can be partially attributed to the complex nature of the online environment. This project has two major aims (1) to examine the trialing of self-report questionnaires in online youth counselling, and (2) to critically reflect upon the strategy of routine evaluation adopted.

Design/Methodology: This project examines the initial routine evaluation data of an online counselling service for young people (Kooth.com). It focuses upon the experiences of young people who have had prolonged use of the therapeutic services offered over three months. The young people completed CORE-YP questionnaires at different stages - before first contact, and every month after that. The difference between the CORE-YP scores between these junctures will be analysed and considered in relation to each other and scores reported in face-to-face equivalent studies. This study adheres to the BACP's ethical framework. The data utilised within this study is anonymous routine evaluation data and permission was given by the organisation in question to use this data.

Results/Findings: This is an ongoing project which will be completed by April 2011. The change noted by the CORE-YP during the different phases of the young peoples' contact with the counselling service will be reported and the associated challenges of collecting routine evaluation data will be discussed.

Research Limitations: This is a small scale investigative project that reflects upon the generation of practice-based routine evaluation data. It trials a pragmatic methodology to provide insights into the ways online youth counselling services can best be evaluated in a naturalistic environment. As such it will inevitably encounter technical hurdles and there will be limitations to the datasets generated.

Conclusions/Implications: The data collected will provide insight into the therapeutic journeys commonly indicated by online clients. Furthermore this project will support the development of an effective systematic strategy of evaluating online youth counselling practice. It will critically reflect upon the strategy adopted by one youth counselling organisation with a view to presenting the strengths and weaknesses inherent with it.

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Allan Shaw

Professional Role: Practitioner
Institution: University of Bristol
Email: alshaw111@hotmail.com

Paper (Sat, 11.00 - 11.30)

Keywords: reflexivity, therapeutic relationships, visual impairment

More than meets the eye: a consideration of the influence of a counsellor's visual impairment upon his therapeutic relationships

Aim/Purpose: There is a lack of literature pertaining to counsellor visual impairment. Other than through personal reflection and anecdotal evidence, the researcher has had little opportunity to explore the influence of visual impairment upon therapeutic relationships.

This research aimed to address these deficiencies and to provide an opportunity for former clients and to learn more about the influence of visual impairment upon the experiences shared as counsellor and client.

Design/Methodology: With consideration of the ethical context (Hart & Crawford-Wright, 1999), research was conducted involving conversations lasting approximately two hours with three, former clients. Information provided to potential participants invited them to reflect upon the possible implications of their participation in the research. They were also required to have concluded their counselling at least one month prior to participation, so as to avoid dual-role relationships. Data were analysed using a method informed by heuristic inquiry (Moustakas, 1999). A collaborative and reflexive methodology created space for the counsellor's voice alongside the voices of former clients and allowed both to tune in to interactively produced meanings (Ellis, 2004) and co-construct new understandings.

Results/Findings: Perceived, initial client reactions to the counsellors' visual impairment included uncertainty, disappointment and relief. The potential for ‘additive' and ‘subtractive' effects previously associated with counsellor disability (Miller, 1991) was experienced, as was the perceived enhancement of ‘counsellor credibility' (Mallinckrodt & Helms, 1986). Visual impairment acted as a catalyst that facilitates therapeutic engagement. Links were also identified to clients' previous experiences of disability and role inversion within relationships.

The potential to either under-estimate or over-estimate the influence of visual impairment and the implications associated with this were also recognised.

Research Limitations: This research comprised a small number of participants, but this is compatible with the philosophical positioning of the study and the intention to work at a depth appropriate for the exploration of human experience.

Conclusions/Implications: Clients demonstrated idiosyncratic responses to the counsellor's visual impairment. These had a varied influence upon the therapeutic relationship and had the potential to interact with the counsellor's personal process. This highlights the need for continued self-awareness and the maintenance of an open and non-defensive attitude.

References available on request please email research@bacp.co.uk

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Salma Siddique 1

Other Authors: Christine Donnelly, Jen Rhind, Hugh Rooney, Kareen Hogg, Janice Deane, Peter Akyeampong and Kevin McClure

Professional Role: Lecturer and Clinical Anthropologist
Institution: Edinburgh Napier University
Contact details: School of Life, Sport and Social Sciences, Sighthill Campus, Edinburgh Napier University
Email: s.siddique@napier.ac.uk

Poster (Sat, 10.10 - 10.40)

Keywords: complementary therapy and alternative medicine (CAM), counselling and psychotherapy research, clinical anthropology, case study, ethnographical accounts, holism 

The space between things: building research for 'healing' from a holistic perspective

Aim/Purpose: This paper will explore a number of issues faced in setting up a research and clinical (teaching) Edinburgh Napier Research Initiative for Complementary Healthcare [ENRICH]. The centre's multi-clinics offer the team the opportunity to use the research stories to understand and inform the process of healing from expectations to outcomes.

Design/Methodology: Clinical anthropology offers a thread to hold together a number of physiological and psychosocial disciplines to better understand the naming of, making meaning from illness, disease and disorder. There is a need for the research at the centre to develop and evidence the links of findings to observations and experience beyond tautological labels. The researchers intend to develop new ideas from old methodological approaches for building integrative theories. In working with an integrative approach of multiple disciplines there is a need for a "specification of constructs, triangulation of multiple investigators, within case and cross- case analyses" (Eisenhardt, 1989). The strengths and weaknesses of building theories across therapies from the case study approach will be examined; from grounded theory to ethnographical monographs. This will be achieved through the research design reflecting the process, contexts, effects and outcomes of the treatment sessions. Data will be collected and analysed using Comprehensive Process Analysis (CPA; Elliott, 1989). A number of post-session instruments will be used to identify the event and analyse the data, used in various combinations: Measure Yourself Concerns and Wellbeing (MYCAW) (Polley et al., 2007) Measure Yourself Medical Outcome Profile (MYMOP) (Paterson, 1996), the Interpersonal Process Recall (IPR) interview (Elliott, 1984); the Helpful Aspects of Therapy (HAT) form (Llewellyn, 1988), and the Change Interview (Elliot et al., 2001)

Results/Findings: The clients will access the service through self and GP referral and will receive a combination of counselling and body therapies. The centre is currently being set up and it is hoped that the research strategy and reflexive account will be ready for discussion and debate by May 2011.

Research Limitations: The limitation could be the relevance of the existing research methodology in integrative therapies in its application to the physio-psychological outcomes of complementary therapies.

Conclusion/Implications: To evidence CAM, counselling and psychotherapy in promoting health and well being using valid and reliable research methodology. It is hoped that an integrative research model is developed which is applicable to this holistic approach.

References available on request please email research@bacp.co.uk

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Salma Siddique 2

Professional Role: Lecturer and Clinical Anthropologist
Institution: Edinburgh Napier University
Contact details: School of Life, Sport and Social Sciences, Sighthill Campus, Edinburgh Napier University  
Email: s.siddique@napier.ac.uk

Poster (Fri, 10.00 - 10.30)

Keywords: proximity, distance, relationship of exchange, metaphor, contact, transactional analysis

Ostrich in the room: early attachment patterns and how they shape the client's capacity to engage with the therapeutic process

Aim/Purpose: The paper considers proximity and distance within attachment patterns and the relevance of these to the therapeutic relationship. The paper explores how the patterns of attachment create the internal working model, which regulates the infant's thoughts, feelings, expectations and responsiveness in the form of adaptive responses through reciprocity between adults wants of spontaneity, autonomy and awareness from the infant's need for protection, potency and permission (Crossman, 1966).

Design/Methodology: The research paper is based on a clinical case study and including a literature review of ethnographical accounts examining the concept of how attachment is negotiated within the context of a relationship over time.

Results/Findings: There is a growing body of research evidence which tracks the phenomena of client's patterns of attachments shifting through the course of the development of a working therapeutic alliance over time.

Research Limitations: The Eurocentric model of attachment to understanding and relating to the other has failed to consider the fluidity of social identity and dynamics of invisibility.

Conclusions/Implications: Attachment patterns are fluid and contextualised, and can influence the relationship between the therapist and client which should be constantly negotiated to inform strategies of relating. Attachment and trust are key to the relational approach in bringing proximity, autonomy and intimacy issues into the therapy session and result in a new attachment being experienced and articulated.

References available on request please email research@bacp.co.uk

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Janette Simmonds

Professional Role: Senior Lecturer/Psychologist
Institution: Monash University
Contact details: Blg 6, Clayton, Vic 3800, Australia
Email: janette.simmonds@monash.edu

Paper (Sat, 15.05 - 15.35)

Keywords: training, experiences, supervision, self care, responsibility

First sessions: anxieties and insights of counselling psychology students on beginning field work

Aim/Purpose: The experience of students training or recently graduated in counselling psychology was researched. Participants were asked about their professional contact with clients and the aspects of training that they drew on. Their experience of supervision and use of other resources was also explored. The aim was to further understand students' and graduates' experiences of field practice, how they used their training, what additional resources they drew on, and their needs.  

Design/Methodology: This qualitative study had three components in an evolving research design. Participation of first year masters students and graduates supplemented the range of experience of students willing to be interviewed during their first field placement. A total of 32 students and recent graduates participated in interviews, emailed questionnaires (using the same questions as in the face-to-face interviews), and a focus group. The research was conducted following guidelines from the university human research ethics committee and ethical approval was sought and gained from the committee.

Results/Findings: Students and recent graduates vividly recalled their first experiences of seeing ‘real' clients in a field setting, and their own anxieties, excitement, and insights. Systematic thematic analysis indicated that participants experienced supervision in a range of ways from immensely supportive and encouraging, to bullying and burdening. Personal self care emerged as an important issue, in that students felt they had been taught about it and knew it was important, but under pressure to ‘be professional', at first found it difficult to allow themselves sufficient time for it.

Research Limitations: Although there was considerable diversity in experiences reported by those participating, the number of participants was quite small.

Conclusions/Implications: Postgraduate counselling psychology students and graduates who had ‘tried out' some of their training contributed fresh and interesting reflections on their experiences with clients, including on topics such as balancing professionalism and self care, and appropriate levels of responsibility and self determination. They also discussed what they found useful in their pre-practicum training and practicum experience and what they thought should be revisited.

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Gail Simon

Professional Role: Systemic Therapist, Supervisor and Lecturer in Counselling Research
Institution: The Relate Institute and the Pink Practice
Email: gail.simon@don.ac.uk

Workshop (Sat, 11.35 - 12.35)

Keywords: relational, social constructionism, systemic, qualitative inquiry, paradigm

A relational turn for qualitative research in counselling and psychotherapy?

Relevance of the workshop to counselling and psychotherapy research: To invite practitioner-researchers to situate stories of 'self' in a relational context and explore ways of extending these stories into a research model which emphasises a relational context. To encourage practitioner researchers to foreground relationality in exploring inner and outer dialogue in counselling, supervision and training.

How the workshop will be structured: The workshop starts with a short introduction to situate this question in a philosophical and practice context. Then delegates will break into three groups and look at three brief but detailed examples of researching relationships in a practice context. Transcripts will be provided. There will be an overarching PowerPoint presentation in the background with some key quotes and points and this will be available as a handout.

Key points for discussion: Why researching relationality is important and how we can extend our research questions to include a relational focus.

Who will benefit from attending the workshop: Practitioners, practitioner-researchers, tutors, academics.

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Ian C Smith

Professional Role: Clinical Psychologist / Lecturer in Research Methods
Institution: Lancaster University
Contact details: Division of Health Research, Lancaster University, Lancaster, LA1 4YT
Email: i.smith@lancaster.ac.uk

Paper (Fri, 14.25 - 14.55)

Keywords: training, brief therapy, social work, community workers, learning disabilities

The effects of brief therapy training with community team workers

Aim/Purpose: Although much training for non-therapists in therapy approaches is very brief, the evidence of such training affecting clinical practice is mixed. This study used a qualitative approach to explore the effects of a two-day training for social workers in solution focused therapy.

Design/Methodology: In-depth semi-structured interviews took places with seven participants, nine months after they had received brief training in therapy techniques. Interviews were transcribed and thematic analysis was used to identify key themes.

Results/Findings: Whilst participants reported that they hadn't systematically made use of the therapy techniques taught, they did report making other changes in their practice which they linked to better communication with clients, a more even distribution of power in client interactions, greater efficiency in working and increased feelings of control. Barriers and facilitators to making use of the training were also identified, which included how trainees understand their work role and fit of the skills taught with the expectations of the employer.

Research Limitations: The relatively small sample size and time-scale of the research are identified as limitations. It is noted that this research aimed to identify possibilities rather than generalisable principles.

Conclusions/Implications: The research suggests that it may be fruitful for therapy trainers to target brief training for non-therapists on teaching changes to interaction style rather than on performance of particular talking therapy techniques per se.  

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Vicki Smith

Professional Role: Senior Lecturer in Counselling Studies
Institution: University of Huddersfield
Contact details: Department of Behavioural and Social Sciences University of Huddersfield, Queensgate, Huddersfield, HD1 3DH
Email: v.smith@hud.ac.uk

Paper (Sat, 15.40 - 16.10)

Keywords: student/tutor relationship, relational features, safe, learning, support

It's the relationship that matters: a qualitative analysis of the role of the student/tutor relationship in counselling training

Aim/Purpose: The purpose of this study was twofold. Firstly to investigate which particular features of their relationships with tutors counselling trainees valued, and secondly to ascertain the extent to which students perceived a connection between the quality of their relationships with tutors and the quality of the learning experience.

Design/Methodology: This study comprised a qualitative analysis of the role of student / tutor relationships in counselling training. Two focus groups comprising of between eight and 10 students on a UK postgraduate diploma in counselling were undertaken and the findings were analysed using template analysis. Ethical approval was obtained via the University Ethics Committee.

Results/Findings: The findings indicated that these relationships have a strong impact on the effectiveness of the learning experience. Students identified a number of valued relational features, with the creation of a safe, supportive learning environment being regarded as of crucial importance. The results suggested that students needed to feel sufficiently comfortable with, and trusting of, tutors if they were to take the kind of interpersonal risks that are necessary in this type of experiential, skills- based training. Students experienced higher levels of negative affect and, by implication, stress if tutors were unsuccessful in providing sufficient levels of safety and support, particularly in the latter stages of training. Strong links were found between the relational concepts students valued in tutors and those previously identified as important in client/therapist and supervisory relationships (Rogers, 1957; Jones et al., 2008).

Research Limitations: This study focused on students from one institution, so its findings may not be applicable to other institutions. All participants were women, a fact which excludes a male perspective about an issue on which men may place less emphasis, although the number of men undertaking counselling training courses is invariably small. Finally, all students were volunteers, so may have chosen to participate due to having particularly strong views or grievances regarding the issues discussed. This could have had an effect on the findings.

Conclusions/Implications: This study's findings suggest that for tutors to maximise students' learning on this type of training course, specific opportunities to focus on relational issues, including the resolution of difficulties, need to be provided. Provision of a safe learning environment and minimising the power imbalance (Mehr et al., 2010) between students and tutors both appear to aid learning.

References available on request please email research@bacp.co.uk

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Lesley Spencer

Professional Role: Senior Lecturer in Counselling
Institution: University of Wales, Newport
Contact details: School of Health & Social Sciences, University of Wales, Newport, Allt-yr-yn Campus, Newport, NP20 5DA
Email: lesley.spencer@newport.ac.uk

Methodological innovation paper (Fri, 14.25 - 14.55)

Keywords: family interview, narrative analysis, IPR, performance, pluralistic model

Focusing a lens: developing a personal, pluralist model of narrative analysis to explore the relational aspects of a family interview

Background and Introduction: This paper reflects on a narrative research student's journey in evolving a personal, pluralist approach to narrative analysis through the process of analysing an interview with a mother and daughter, about the mother's traumatic experience of nearly dying from heart failure. The interview in question is part of a doctoral study exploring the lived experiences of families who have been referred for genetic counselling because they are at risk of sudden arrhythmic death syndrome (SADs).

Nature of the methodological innovation/critique being proposed: Originally the researcher tried out eight different methods of analysis with a view to ‘learning techniques' and eliminating unsuitable approaches. However what gradually emerged was a personal pluralistic model that combined and adapted aspects from five different models of analysis into a personal synthesis that could be used to analyse all the family interviews in the study.

As the foci were linked one method of analysis naturally led to the next; making the process involved cumulative and sequential, but not linear. Clandinin et al.'s (2000, 2006) ‘three dimensional narrative inquiry space' was used to understand the impact of context and time and that began the process of ‘focusing in' on social interaction. The researcher reflexively examined her inner processes through writing a parallel chart (Clandinin & Cave, 2008) that served the function of Intelllectual Property Rights (IPR) (Kagan, 1980) helping the investigator understand her researcher ‘plotline' (Clandinin, 2006) in relation to the mother and daughter's plotlines. The role of counselling skills was examined in relation to ‘bumping places' (Clandinin, 2006) and in ‘tuning-in' for the co-creation of new meaning. Performance analysis (Reissman, 2008) was used to understand the changing inter-relationship between the roles of narrator and audience. Finally Andrews' (2002) work on dominant and counter narratives was used to understand the relationship between the mother's and daughter's narratives.

Conclusion and relevance to counselling and psychotherapy research practice: This process has been potentially useful for counselling research because it illustrates how using a pluralist approach to narrative analysis enables the complexities of the relationship between time and context; researcher and family; narrator and audience; mother and daughter and the ethics of counsellor's role and researcher's role to be more fully explored and understood. The potential richness of this interpretation of the data would have been arguably less likely with a purist approach to analysis (Frost, 2009).

References available on request please email research@bacp.co.uk

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Sheila Spong

Professional Role: Senior Lecturer in Counselling
Institution: University of Wales Newport
Contact details: School of Health and Social Sciences, Edward Anwyl Buildng, Caerleon Campus, Caerleon, Newport, NP18 3QT
Email: sheila.spong@newport.ac.uk

Poster (Sat, 10.10 - 10.40)

Keywords: influence, co-construction, meaning

Influence, autonomy and the co-construction of meaning in therapeutic practice

Aim/Purpose: This paper considers the implications of the notion of co-construction of meaning on our understanding of client autonomy. Contemporary trends in therapy - and particularly in some integrative, humanistic and psychodynamic therapies influenced by post-modern and post-structuralist ideas - emphasise the relational impact of the therapist's self in client change processes. This, however, raises particular challenges to how we understand client autonomy in therapy. Individual autonomy as an ethical principle and as an aim of therapy have been subject to various critiques; here the focus is on understanding ways in which client autonomy and co-construction of meaning are jointly constructed in therapist writings and in descriptions of practice.      

Design/Methodology: The paper offers a theoretical consideration of the co-construction of meaning in relation to the client's capacity to exercise agency, and in terms of the therapist's capacity to contain or facilitate her/his influence on the client. A critical discussion of these concepts as used in the literature is augmented with findings from interviews with three therapists who place emphasis in their practice on the co-construction of meaning between client and therapist. These interviews are analysed through a discourse analytic lens, exploring how the interviewees weave together talk of autonomy, agency, co-construction and influence.

Results/Findings: There is relatively little material that directly addresses the interface of the co-construction of meaning between therapist and client and the influence of the therapist. These perspectives, stemming as they do from different paradigms of the subject/self, cannot easily translate into a mutual language in which issues of agency and autonomy can be addressed. Multi-layered usage of these concepts will be presented, focussing on how they are used in relation to each other and in relation to other theoretical elements. In particular, focus will be on aspects of conflict and coherence in the participants' descriptions of their practice.

Research Limitations: The philosophical bases for the arguments discussed here cannot be fully explored in this short paper and so the focus is on the application of these to the practice of counselling. The small interview study provides indicators of how these concepts can be utilised in therapy talk but it cannot be assumed that the findings are generalisable.

Conclusions/Implications: This paper presents an approach to the development of a pluralist stance through which a commitment to autonomy/agency can be honoured alongside an understanding of the process of co-construction of meaning.

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Nele Stinckens and Dave Smits

Professional Role: Professor, Dr
Institution: KULeuven, Belgium
Contact details: Tiensestraat 102, 3000 Leuven
Email: nele.stinckens@psy.kuleuven.be; dave.smits@psy.kuleuven.be

Paper (Sat, 15.05 - 15.35)

Keywords: multi-spectrum monitoring, client feedback, helping and hindering in-therapy processes

What is the weather inside? Using client feedback to measure temperature, pressure and turbulence in therapy

Aim/Purpose: Therapists differ in their effectiveness to affect change. An extensive body of evidence shows that feedback generated by routine process and outcome monitoring has a large potential to increase therapeutic efficiency and efficacy. Many available monitoring-systems focus on quantifying therapy outcome, thereby missing the potential to gain insight on what makes therapy work. At the KU Leuven (Belgium), we've developed a multi-spectrum and multimodal monitoring protocol that supplies therapists with rich and idiosyncratic data about ongoing therapeutic processes. In our presentation we'll focus on how this feedback supports therapists' interventions in a clinically relevant fashion.

Design/Methodology: An in-depth content analysis of 16 interviews, taken from therapists after six months of implementing the monitoring instrument, has been done to identify helpful and hindering processes that are initiated in clients, therapists and their ongoing interactions. The results of this analysis will be presented and discussed.

Results/Findings: The majority of therapists considered the feedback as supportive, clinically relevant and beneficial for daily practice. A broad variety of helpful relational and task-oriented processes could be discerned: increase of self-reflective processes, more meta-communicative behaviour, gain of insight in the therapeutic processes, stronger anchoring of therapeutic results, increase of engagement in the therapeutic process. Identified hindering processes were: disengagement because of extra workload, disappointment because of poor quality of feedback and uncertainty in case of failure.

Research Limitations: Only a small number of therapists (16), mostly working in an out-patient setting, volunteered for this research. The majority of these therapists (12/16) had an initial positive attitude towards monitoring. The interviews took place six months after first use. A prolonged and more extensive use of the system could lead to a more detailed view on the initiated processes.

Conclusions/Implications: Implementing a multi-spectrum monitoring instrument has strong potential as a supportive and helpful therapeutic tool, resulting in a better alignment on tasks and goals in therapy. Hindering processes challenge us to rethink the way we design and implement monitoring systems. User friendliness of instruments, clinical relevancy of feedback, extensive and ongoing support and positive (non-evaluative) working atmosphere seem to be critical to realise the full potential of any monitoring system.

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Peter Stratton

Other Author: Julia Bland

Professional Role: AFT Academic and Research Development Officer
Institution: University of Leeds
Contact details: 12 The Drive, Leeds, LS8 1JF
Email: p.m.stratton@ntlworld.com

Paper (Sat, 15.40 - 16.10)

Keywords: effectiveness, self-report, outcomes, family process, NICE, SCORE

Researching the effects of counselling and psychotherapy through changes in relationship processes

Aim/Purpose: Current developments make it essential that therapists demonstrate the value of their work. But existing methodologies favoured by NICE and IAPT such as RCTs are not fit for this purpose. A novel approach is needed for therapeutic practice which helps clients with a wide variety of difficulties which are often not clearly defined diagnostically. The SCORE is a new self-report measure designed to meet these challenges, based on a claim that much of the value of therapy relates to improved personal relationships.

Design/Methodology: A brief account of the development of a measure designed to enable clients to describe the current state of their families using items that have therapeutic significance. After piloting earlier versions, the "SCORE 40" was given to all clients over 11 who came for family or couples therapy. Statistical and clinical judgements of the data from 500 clients identified the stable dimensions of the quantitative data and showed how these scores related to the qualitative accounts supplied by the same people. Further analyses and comparison with 126 non-clinical participants enabled the creation of a short but effective version, the SCORE 15.

Results/Findings: The SCORE 40 has good psychometric properties with high internal consistency, split half reliability and every item correlating with the average score. Three dimensions emerged: strengths and adaptability; overwhelmed by difficulties; disrupted communication. Scores from the quantitative scale are used to structure an exploration of the qualitative accounts. The researcher presents verbatim descriptions of close relationships and of the clients' description of the problems they want help with, grouped according to the quantification of the kind of relationship difficulty. Then the descriptive accounts are used to identify salient items in the quantitative record. The 10 minute SCORE 15 is presented.

Research Limitations: The SCORE is an effective indicator of close relationships but is not yet proven as sensitive to therapeutic change.  

Conclusion/Implications: We can now measure the quality of relationships in couples and families. A further study is needed to monitor change during therapy and this is under way. Meanwhile there are many clinical as well as research uses for the SCORE that will be discussed in the paper.

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Clare Symons

Other Authors: Andrew Reeves and Sue Wheeler

Professional Role: Deputy Director of Counselling and Psychotherapy Programme
Institution: University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester, LE1 7PA
Email: cms49@le.ac.uk

Paper (Sat, 11.35 - 12.05)

Keywords: complaints, malpractice, ethical practice, professional conduct, client accounts

Under-informed vs over-identified: differences between lay people and therapists who have not complained about poor or harmful therapy experiences

Aim/Purpose: This project aims to investigate the reasons why people who have experienced poor or harmful therapy might not bring a formal complaint to a professional body, and to explore similarities and differences in reasons for not complaining between lay people and practitioners who have been clients. The project has been part-funded by BACP.

Design/Methodology: An online survey was constructed using quantitative and qualitative approaches to explore reasons for not complaining. The survey was publicised widely, using a snowballing approach in order to reach as many people as possible who were invited to self-select as respondents. No prescribed definition of ‘poor or harmful' therapy was given, allowing participants to choose whether they felt that they had had an experience that might have warranted a complaint.

Results/Findings: Lay people and therapists broadly agreed that feelings of powerlessness and a lack of confidence were factors in not bringing a formal complaint. Participants who were lay people were more likely to agree that they did not know they could complain or how to bring a complaint. Participants who were therapists were more likely to agree that feelings of allegiance towards their therapist were a factor in not bringing a complaint. Additional reasons identified in comments made by participants who were trainees or therapists at the time of their therapy relate to fears of the impact on their own professional career if they were to complain.

Research Limitations: Leaving the definition of poor or harmful therapy open to participants who self-select opens this research up to criticisms regarding the validity of the respondents' issues with their therapy.  

Conclusions/Implications: The research has implications for therapists regarding the information that they make available to clients and how they work with power differences in the therapy room. In addition, the findings can also contribute to the development of complaints procedures in counselling and psychotherapy.

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Sandra Taylor

Professional Role: Director of Relationship Counselling
Institution: University of Manchester
Contact details: Marriage Care, Clitherow House, 1 Blythe Mews, Blythe Road, London, W14 0NW
Email: sandra@marriagecare.org.uk

Paper (Fri, 16.30 - 17.00)

Keywords: favouritism, preferences, counselling training, perceptions, ideals

Favourites and favouritism in counselling training - exploring people's perceptions, experiences and ideals and their impact

Aim/Purpose: Within the small amount of counselling training literature favouritism and preferences between trainers and students has rarely been considered, though Rogers & Freiberg (1994) did note that the lecturer, ‘realises that if she lets herself fully interact with her students, she will come to like some of them very much and feel real dislike for others' (p. 42). This paper aims to share research results concerning favourites and favouritism in counselling training and to explore their potential implications.

Design/Methodology: Dyad Interviews with six pairs of former counselling and psychotherapy trainers and students, followed by eight discussion interviews between counsellor and former students, were part of wider research on the reciprocal relationship between counselling trainers and students. These non-traditional methods of interviewing enabled the researcher to explore with relational immediacy. Issues of favourites and favouritism initially emerged organically and were prompted in later interviews as a growing area of interest. References to favourites and favouritism were collated and divided into subthemes.

Results/Findings: The findings provide evidence of: trainers' unease concerning 'favouritism' and greater ease in discussing 'more connection' with some students than others; students' greater ease with having favourites or preferred trainers but disliking favouritism by trainers; students often interpreting trainers as favouring students they spend more time with, even when instigated by the students. Both students and trainers were, at times, impacted in significant ways.

Research Limitations: The sample is small and so it is not possible to make generalisations. Favourites and favouritism emerged as a small part of a larger piece of research rather than being a subject in its own right.

Conclusions/Implications: This small study reveals the previously unknown richness of former students and trainers experiences, assumptions, and preferences about favourites and favouritism in counselling and psychotherapy training and the impact of these. The implications of this for counselling and psychotherapy training, include the importance of exploring these issues as far as possible, within training team supervision and within training groups. The research methods themselves stimulated the emergence of this theme and revealed the amount that had not been previously shared between student and trainer and so highlighted the potential of these research methods.

Reference:

Rogers, C., & Freiberg, H. J. (1994). Freedom to Learn (3rd ed.). New York: Macmillan College Publishing Company.

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Valerie Thomas

Professional Role: Senior Lecturer in Counselling
Institution: Anglia Ruskin University
Contact details: Faculty of Health and Social Care, 3rd Floor William Harvey Building, Bishop Hall Lane, Chelmsford, CM1 1SQ
Email: valerie.thomas@anglia.ac.uk

Workshop (Sat, 13.55 - 14.55)

Keywords: imagery, imagination, tacit, heuristic, process

Using mental imagery to illuminate the process of research

Relevance of the workshop to counselling and psychotherapy research: Helping researchers understand the role of imagination as a neglected resource in disclosing the unconscious and tacit dimensions of the research process.

The aims of the workshop: Introduce participants to using mental imagery procedures to illuminate and monitor their research processes.

How the workshop will be structured: It will be presented in following form:

How the workshop will be structured: It will be presented in following form:

  • Five minute introduction to workshop including aims and presenter's research interests in mental imagery
  • Ten minute presentation on the background, theory and practice of using mental imagery as a means of disclosing implicit and tacit dimensions of research process
  • Ten minute experiential exercise that guides participants through procedure of translating their current research process into a mental image
  • Ten minute recording imagery exercise and in pairs making sense of image in relation to their research process
  • Fifteen minute discussion of experiences, making links between practice and theory. Clarifying how image can be used as an ongoing monitoring tool in research process.
  • Five minute completion of workshop including recommendations for further exploration and reading (including handouts).

Key points for discussion: The imagination as a trustworthy source of information regarding the research process. How do we interpret mental imagery in relation to research? What is the relationship between conscious and unconscious processes in research?

Who will benefit from attending the workshop: Participants who would like to explore the use of mental imagery as a heuristic research method. Participants who would like to expand their range of creative strategies with relation to research. Participants with a current interest in unconscious processes and the tacit dimensions of research.

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Kamilah Tomlinson and Natasha Boxill

Other Authors: Liene Paulauska, Henry Sycamore, Nema Adams and Kimberley Clarke-Gilgeous

Professional Role: Student / volunteer counsellor
Institution: LC&CTA; Lewisham Counselling and Counsellor Associates
Contact details: c/o Chris Brown, LC&CTA Broadway House, 15-16 Deptford Broadway, London, SE8 4PA
Email: c/o christine.brown@lcandcta.co.uk

Poster (Fri, 10.00 - 10.30)

Keywords: dieting, eating disorders, society, psychological, phenomenology

Is dieting a socially accepted form of eating disorder, if so, how does this effect counselling practice?

Aim/Purpose: To explore if any significant correlation between eating disorders and dieting exists and what impact this might have on psychotherapeutic practice.

Design/Methodology: A series of 1:1 semi-structured interviews with a number of professionals were audio recorded then transcribed; these professionals had/do work with clients who had/have presented weight loss as an issue. Phenomenological analysis of data (Moustakas, 1994) ensued and the common strands/themes inherent in our data were used to define/describe our findings. This research was conducted following the BACP Research Guidelines (Bond, 2004).

Results/Findings: Results, garnered from counsellors' views of their clients diets and dieting, indicate that many clients who do/have dieted solely to lose weight have low self-esteem, and that once dieting starts the clients' psychological issues become more profoundly associated with their physical appearance. Empathises then become increasingly centred on losing weight rather than addressing the underlying self-esteem issues and a definitive correlation between such clients' low self-esteem/confidence and body image emerges; it also seems that many such clients primarily tend to use dieting in an attempt to control/improve their lives. These features are also dysfunctional characteristics seen in anorexia, bulimia/binge eating. Results also indicate that once such clients reach their idealised weight they suddenly, often rapidly begin to regain weight; many individuals become heavier than before. Dieting exclusively for appearance sake manifests in the research as a socially accepted Westocentric phenomenon fuelled by the media and our increasingly celebrity obsessed culture.

Research Limitations: With restricted resources post interview support to respondents could not be provided, therefore, the results are gathered only from data generated from interviewing counsellor/psychotherapists' in the field in relation to their experiences and views on their clients' diets and dieting.

Conclusion/Implications: Whilst further investigation is recommended, the research suggests that counsellor/psychotherapists need to be more aware of the apparent correlation between dieting/low self-esteem and eating disorders. Additionally, dieting maybe an early indicator of (1) the potentiality to develop an eating disorder, and (2) strongly emerges as a sign of low self-esteem/confidence; attentiveness to this may better facilitate practitioners in identifying their clients' underlying self-esteem issues.

References available on request please email research@bacp.co.uk

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Andreas Vossler and Naomi Moller

Professional Role: Lecturer in Psychology (AV)
Institution: The Open University
Contact details: Faculty of Social Science, Department of Psychology, Walton Hall, Milton Keynes, MK7 6AA
Email: a.vossler@open.ac.uk

Paper (Sat, 13.55 - 14.25)

Keywords: evaluation, psychotherapy research, family counselling, systemic therapy, Relate

Research in practice: evaluation of Relate family counselling

Aim/Purpose: The aim of this presentation is to present the results of a pilot study investigating the process and outcome of Relate family counselling in one local Relate centre. Relate family counselling aims to support family functioning and relationships and prevent the negative impact of family crises and breakdown on the wellbeing of children and adolescents. While it can be assumed that this model of family counselling is likely to be clinically as well as cost effective for a variety of adult and child presenting issues, further research is needed to clearly evidence this.

Design/Methodology: The pilot trails a quantitative study design with data collected through three questionnaires assessing family functioning and child psychological functioning: the new British ‘Systemic Clinical Outcome and Routine Evaluation' Scale (SCORE-15; Stratton et al., 2010), the American-developed ‘Family Adaptability and Cohesion Evaluation Scale III' (FACES-III; Olson, 1986) and the ‘Strengths and Difficulties Questionnaire' (SDQ, Goodman, 2001). Data is gathered from parents and children aged 11 and older before counselling, at session four and at the last session or session 12 (which ever is first). Data collection is still in process with the aim to include 50-60 families in the pilot. Statistical analysis will be used to examine changes across time and factors impacting on outcomes. Data collection and analysis for this study will be completed by March 2011.

Results/Findings: First preliminary analysis indicate moderate to high levels of distress reported by families when seeking Relate family counselling.

Research Limitations: The pilot illustrates a range of practical issues and concerns that need to be considered when implementing a ‘practice-based evidence' design (Levant, 2005). These include incomplete participant data and high levels of family counselling drop-out.

Conclusions/Implications: The pilot is a useful process to evaluate the suitability of the selected instruments for this sample and contributes crucial information that will inform the procedures around data collection in the planned multi-site evaluation of Relate's family counselling services. More broadly, the proposed paper will provide useful information for practitioners looking to understand how to engage in service evaluation, in particular in a family setting.

References available on request please email research@bacp.co.uk

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Sue Wheeler and Julie Folkes-Skinner

Professional Role: Director of Counselling Programme (SW)
Institution: Institute of Lifelong Learning, University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester, LE17PA
Email: sw103@le.ac.uk

Poster (Sat, 10.10 - 10.40)

Keywords: supervision, practice research network, research clinic

Supervision and clinical practice: does supervision make a difference

Aim/Purpose: The aim of this paper is to present the first results from the University of Leicester counselling and psychotherapy research clinic, related to supervision of clinical practice.

Design/Methodology: In 2010, the University of Leicester initiated their research clinic that offers free counselling and psychotherapy. The clinic routinely collects data on all clients, counsellors and supervisors, before, during and after therapy. The data is stored using the CORE Net system; the unique feature of this data collection protocol is the involvement of supervisors.

Data is collected on every supervision session: this includes details of clients and other matters discussed. Measures of the working alliance between supervisor and supervisee are routinely collected every session. All therapy sessions and all supervision sessions are digitally recorded. Biographical information about supervisors and counsellors is collected and the supervisor completes a questionnaire about the progress of the counsellor every six months.

Results/Findings: This paper will provide details of the clinic and the data that is routinely collected. It will present some preliminary data related to the use of supervision and its effect on the progress of therapy and outcome. The data presented will be descriptive at this stage providing information about the agreement on the working alliance between supervisor and supervisee, the amount of time each client is discussed, client progress and outcome.

Research Limitations: The collection of supervision data began in July 2010. By April 2011 the clinic will have seen approximately 50 clients and data on supervision will be available for about half of those clients. Nonetheless there will be a rich data set including the tape recordings and transcripts.

Conclusions/Implications: The clinic is a test of concept of a research practice network and the focus of this paper is on supervision. The research could provide information that has the potential to influence the practice of supervision in the UK for years to come.

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Kevin Wright

Professional Role: Chartered Counselling Psychologist
Institution: University of Abertay Dundee, South London & Maudsley MH Trust (SLaM)
Email: kevin_wright_k@yahoo.com

Paper (Fri, 16.30 - 17.00)

Keywords: Brief therapy, EAP, gender differences, coping strategies, work stress

The effectiveness of brief therapy provided through an Employee Assistance Programme (EAP) in the UK: gender differences in changing coping strategies for managing stress

Aim/Purpose: To examine the change in coping strategies for managing stress as a result of brief therapy with particular reference to gender differences in responses.

Design/Methodology: The study was in two stages. The first stage was to find the baseline scores for the measures going to be used for the counselling sample. The second stage gained the pre-treatment, post-treatment and six month follow-up scores for subjects coming for counselling in coping strategies for managing stress. At the first stage a ‘well-being' questionnaire was randomly distributed to the 17,500 workforce (ie 5,295 questionnaires were sent out). Over 2,300 responses were received. During the second stage similar questionnaires were distributed to subjects (241) who came for brief therapy to 22 therapists.

Results/Findings: This report focuses on gender differences. The mean scores at the pre-treatment stage were matched against responses at the post-treatment stage and again at a six month follow-up stage, and these were compared with the baseline normative means obtained in the first stage of the study. The study looked at whether the change produced means that were still significantly different from the baseline norm and whether the change was clinically significant and reliable. It was seen that the counselling process was effective in producing change in some of the coping strategies examined. However, there were significant differences between the male and female mean responses.

Research Limitations: As this research was carried out in the commercial field, where an organisation had bought a counselling service for their employees, then it would not have been seen as acceptable or ethical to carry out a random control trial so the counselling subjects' means for the different variables were compared with baseline norms obtained from the same population from which the subjects came.

Conclusions/Implications: The finding that there were significant differences in the pattern of responses between the genders may have relevance or implications with respect to research and practice. The findings suggest that it may be important to consider examining the therapeutic methods as used in brief therapy in order to adapt them so that they may be more gender specific/sensitive.

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SYMPOSIA

Symposium A

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Mick Cooper, Joanne Pybis and Katherine McArthur

Professional Role: Professor of Counselling (MC)
Institution: University of Strathclyde
Contact details: University of Strathclyde, 76 Soutbrae Drive, Glasgow, G13 1PP
Email: mick.cooper@strath.ac.uk

Symposium A overview (Fri, 10.55 - 12.25)

Keywords: school-based counselling, children and young people, Wales, humanistic therapy, randomised controlled trials

School-based counselling: developing research

The aims of the symposium: To present new research on school-based counselling in the UK, to explore its implications for practice, and to consider further developments in the field.

Contribution of each symposium paper to the overall theme: Pybis begins the symposium with a presentation of data from a recently commissioned, large scale evaluation of school-based counselling in Wales. This is one of the largest evaluations of its type conducted, and provides a unique opportunity to gather a wealth of data on the process and outcomes of school-based counselling. Cooper's presentation then focused down on the outcomes of school-based counselling when a highly representative, low drop-out sample is used. Finally, McArthur presents latest findings from one of the most rigorous studies of school-based counselling to date: a randomised controlled trial of the intervention which now has over 20 participants.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: At a time of severe financial challenges, school-based counselling must demonstrate its effectiveness to be considered a valid form of mental health intervention. These papers present a series of increasingly rigorous evaluations of school-based counselling, as a means of developing the database for this profession.

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Joanne Pybis

Lead Author: Andy Hill

Other Authors: Mick Cooper, Karen Cromarty, Kate Smith and Sue Pattison

Professional Role: Research Facilitator
Institution: BACP
Contact details: 15 St John's Business Park, Lutterworth, Leicestershire, LE17 4HB
Email: jo.pybis@bacpc.co.uk

Symposium A paper 1 (Fri, 10.55 - 12.25)

Keywords: schools, counselling, evaluation, Welsh

Evaluation of the implementation of the Welsh Assembly Government's national school-based counselling strategy

Aim/Purpose: BACP and Professor Mick Cooper (University of Strathclyde) together with Ipsos MORI successfully won a bid for tender to evaluate the effectiveness of schools counselling in Wales commissioned by the Welsh Assembly Government. Here the findings from the first stage of the evaluation project are presented, specifically reporting on the perceptions and attitudes of school counsellors, local authority leads/service managers, head teachers and school link people on the perceived effectiveness of and the actual impact and effectiveness of the strategy; standardised outcome measures are used to assess the success of the strategy. The results of this evaluation will be used to develop a standardised counselling service across Wales.

Design/Methodology: Various methodologies were used. Questionnaires were designed for completion by school counsellors across Wales (n=106) and local authority leads and service managers (n=36), in addition a telephone based structured interview was designed for school link people and/or head teachers (n=264); further retrospective analysis of outcome data (eg YP CORE) was conducted and finally desk research was conducted with annual reports and minutes of meetings relevant to the strategy also being analysed.

Results/Findings: Preliminary results from the questionnaires indicate the attitudes towards and perceived effectiveness of the strategy are overall very positive. The majority of participants reported the strategy to work collaboratively with other services and initiatives and to be recognised and valued by school staff, pupils and parents. Further results are to follow.

Research Limitations: A limitation of this research is the use of subjective methods of data collection based on attitudes and opinions, however this will be addressed in the second stage of the evaluation.

Conclusions/Implications: Will follow once results finalised. It is expected the results of this evaluation will be used to develop a standardised counselling service across Wales.

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Mick Cooper 1

Other Authors: Elizabeth Freire, Susan McGinnis and Lorna Carrick

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: University of Strathclyde, 76 Soutbrae Drive, Glasgow, G13 1PP
Email: mick.cooper@strath.ac.uk

Symposium A paper 2 (Fri, 10.55 - 12.25)

Keywords: school counselling, children and young people, effectiveness, humanistic therapy

Evaluation of school-based counselling using a sample with a high response rate

Aim/Purpose: Recent research does suggest school counselling is associated with large improvements in wellbeing, but response rates in many of these datasets are unacceptably low, making the evidence of effectiveness unreliable. The aim of the present study, therefore, was to evaluate pre- and post-counselling outcomes for all young people who attended school counselling, including those that may subsequently go on to drop out of counselling. It was also an opportunity to consider moderators of outcomes in school-based counselling.

Design/Methodology: To obtain this maximum response rate, young people who attended the Glasgow school counselling services during the 2009-10 academic year were invited to complete Young People's CORE forms (YP-CORE, a measure of general psychological distress) on a weekly basis. This was to ensure that an ‘end of therapy' form was available for every client who consented to participate in the evaluation.

Results/Findings: Pre- and post-counselling data was available on 259 young people, 86% of all young people who had attended one or more session of counselling. The overall effect size from pre- to post-counselling was 1.35, substantially greater than previous effect sizes obtained. The only factor associated with size of effect was rate of attendance, with more regular attenders showing improved outcomes.

Research Limitations: The results are uncontrolled, meaning that it is impossible to rule out the possibility that the young people may have simply improved over time.

Conclusions/Implications: These findings suggest that the large pre- to post-therapy effect size for school counselling is robust, and representative of the full cohort of young people attending the service.

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Katherine McArthur

Other Authors: Mick Cooper and Lucia Berdondini

Professional Role: PhD Student
Institution: University of Strathclyde
Contact details: Counselling Unit, 76 Southbrae Drive, Glasgow, G13 1PP
Email: katherine.mcarthur@strath.ac.uk

Symposium A paper 3 (Fri, 10.55 - 12.25)

Keywords: school-based counselling, children and young people, randomised controlled trial, person-centred therapy, humanistic therapy

A pilot randomised controlled trial to assess the impact of school-based counselling on young people's wellbeing, using pastoral care referral

Aim/Purpose: The previous pilot tested the feasibility of a procedure for conducting a randomised controlled trial of school counselling for emotional distress. The current pilot aims to both build on the findings and address the limitations of the previous study by testing an alternative procedure. The screening process used to recruit participants was replaced by a pastoral care referral system, which is more closely aligned to usual practice. The six-week intervention period was extended to one school term to allow a longer period of counselling and fit more neatly into the school calendar.

Design/Methodology: This small pilot study in secondary schools with no existing counselling service uses pastoral care referrals to identify young people aged 13-18 suffering emotional distress. The cut-off point for emotional distress scores will be set higher than the previous pilot to reflect the finding that counselling may be more helpful to more severely distressed young people. Participants were randomised to either school counselling or waiting list for one school term (approximately 10 - 12 weeks), with outcome assessments at midpoint and endpoint. The primary outcome is change in psychological wellbeing as measured by YP-CORE, and among the secondary outcomes is change on a personalised goal-based measure.  

Results/Findings: So far 34 participants have been randomised (approximately 50% of those assessed), an adequate number for a pilot RCT, suggesting that the new recruitment procedure is highly feasible. Preliminary data show no significant differences on outcomes between counselling and waiting list participants though the observed effect size for counselling is medium to large. Those in the counselling condition showed significantly more self-reported improvement than those on the waiting list. However, qualitative data suggested that participants tended to experience both conditions (counselling and waiting list) as helpful.

Research Limitations: The small sample size means that clinical implications cannot be drawn from the findings, since a small-scale pilot is not a suitable test for efficacy.

Conclusions/Implications: This study suggests that pastoral care referral is an efficient way of recruiting participants. Given the small sample size, the results can be seen as interim findings with a view to extending the protocol. However, the observed effect size for counselling together with qualitative data paints a promising picture for school counselling.

Symposium B

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Jane Balmforth, Robert Elliott, Sue Wiggins and Sarah Shaffner

Discussant: Ladislav Timulak

Professional Role: Course Director, Doctorate in Counselling Psychology
Institution: Trinity College Dublin
Contact details: School of Psychology, Trinity College Dublin, Dublin 2, Ireland
Email: janebalmforth@googlemail.com

Symposium B overview (Fri, 10.55 - 12.25)

Keywords: significant events, clients, relational depth, client disclosure

Significant events in person-centred-experiential psychotherapy

The aims of the symposium: To illustrate how the study of significant events in therapy is closely linked to practice and may help therapists' awareness of two types of helpful events.

Contribution of each symposium paper to the overall theme: Elliott will open the panel by providing a brief overview and history of significant events research. In her paper, Wiggins will illustrate the use of quantitative methods for measuring an important feature of significant event, the degree to which they are characterised by relational depth. Shaffner will then describe her use of Wiggins' measure as part of a process of identifying and describing the process features of relational depth events. Balmforth will use comprehensive process analysis to take us deeper into the unfolding nature of a related kind of significant event, in which clients disclose important content to their therapist.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: The study of significant events provides in-depth data from clients about aspects of the therapy that helped or hindered them in the process of change. This in turn provides concrete examples of practice for therapists to consider. The symposium illustrates a range of different qualitative and quantitative methods that can be used to study such events, providing examples of advantages and challenges of researching them.  

Role of the symposium discussant: Timulak, a significant events researcher who has recently published reviews of the significant events literature, will act as discussant of this set of papers, reviewing their strengths and limitations and locating the research presented within the broad range of significant events research.

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Robert Elliott 1

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: Counselling Unit, 72 Southbrae Drive, Glasgow, G13 1PP
Email: fac0029@gmail.com

Symposium B paper 1 (Fri, 10.55 - 12.25)

Keywords: significant events, research methods, change process research

An introduction to significant events research

Aim/Purpose: To provide a context for the other presentations by presenting a brief history of research on significant events in psychotherapy, along with its rationale and main approaches.

Design/Methodology: Significant events research focuses on important moments in therapy as a way of understanding how therapeutic change comes about. Significant events can be studied using either discovery-oriented, hypothesis-testing, or rational-empirical research strategies. Events can be identified by asking clients, therapists or observers. Once identified, they can be described using qualitative or quantitative data collection procedures, or a combination. They are then analysed using a variety of methods, both qualitative and quantitative.  

Results/Findings: Over the past 30 years, common types of significant events have been identified (eg insight, alliance ruptures; see reviews by Timulak, 2007; 2010), and models of different kinds of events have been constructed (eg conflict splits, misunderstandings).

Research Limitations: It is not clear how significant therapy events relate to outcome. Research has focused on widely varying types of events, making it difficult to develop cumulative knowledge.  

Conclusions/Implications: Significant events research provides a useful complement to process-outcome, and sequential analysis approaches to psychotherapy change process studies.

References available on request please email research@bacp.co.uk

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Sue Wiggins 1

Professional Role: Researcher
Institution: University of Strathclyde
Email: spwiggins@gmail.com

Symposium B paper 2 (Fri, 10.55 - 12.25)

Keywords: significant events, relational depth, item response theory, measurement

Presence of relational depth during significant events in therapy

Aim/Purpose: The aim of this study was to explore if there were differing levels of relational depth presence during significant events in therapy. It also investigated how well the current Relational Depth Inventory-Revised (RDI-R) successfully targeted a range of individuals experiencing varying levels of relational depth presence.

Design/Methodology: A total of 163 clients first described a significant event then rated it on the revised 24-item Relational Depth Inventory (RDI-R). Of these, 43 were recruited from the research clinic of the University of Strathclyde and 120 were recruited online where the RDI-R was presented on a website. Resultant data were subjected to statistical analyses using Rasch analysis, a form of item response theory. This study was approved by University of Strathclyde and NHS ethics committees.

Results/Findings: Lower levels of relational depth in significant events in therapy were typically characterised by therapist empathy, respect and genuineness, as items assessing these characteristics were easiest to endorse. Beyond these characteristics, higher levels of relational depth presence were additionally characterised by more difficult to endorse magical and spiritual experiences. However, results also suggested that there are some persons experiencing very high levels of relational depth presence that is not currently adequately assessed by the RDI-R.

Research Limitations: As with any quantitative research, the main limitation of this study is that it lacked the rich data possible with qualitative methods.

Conclusions/Implications: The finding that there appear to be multiple levels of relational depth during significant events suggests that it is not an all or nothing occurrence. The finding that some individuals appear to be experiencing relational depth presence at a higher level than the current RDI can assess, may indicate that there may be some significant events that are perhaps beyond language.

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Sarah Shaffner

Other Author: Jane Balmforth and Robert Elliott

Professional Role: Researcher
Institution: University of Strathclyde
Email: sarah.shaffner@strath.ac.uk

Symposium B paper 3 (Fri, 10.55 - 12.25)

Keywords: significant events, relational depth

Process characteristics of relational depth events

Aim/Purpose: The purpose of this study was to describe the process characteristics of client-identified relational depth events in person-centred psychotherapy.

Design/Methodology: We used the Relational Depth Inventory-Revised (RDI-R) to identify sets of possible relational depth events, first making short lists of possible events based either on the client open-ended event descriptions with the highest ratings for relational depth content, or on the RDI-R's with the highest client ratings. Next, the Helpful Aspects of Therapy (HAT) forms and therapist process notes were used to locate six of these relational depth events on the session recordings. These six events were then analysed for basic quantitative and qualitative descriptive features (eg how long the event lasted, therapist and client response modes) by three raters. The study received ethical approval from the University of Strathclyde.  

Results/Findings: The six relational depth events appeared typically to be quite brief, to involve client self-revelation and close tracking by the counsellor, and to be emotionally powerful. Clients did most of the talking, with therapist utterances serving to show that the tracking was occurring. In most cases clients were describing emerging realisations.

Research Limitations: The biggest limitation of the study is that it was done with an existing data set that did not allow the researcher to verify the event identification with the client and had to rely on consensus among raters. The small sample size and restriction to person-centred therapy also limits generalisability.

Conclusions/Implications: The moments of high relational depth in this sample seem to be quite short and to occur without the therapist doing more than empathising with the client and tracking the client's process though their emerging realisations. More research on the process characteristics of relational depth events is needed.

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Jane Balmforth

Professional Role: Counselling PhD student
Institution: University of Strathclyde, Glasgow
Contact details: Counselling Unit, University of Strathclyde, Glasgow, G12 1PP
Email: janebalmforth@gmail.com

Symposium B paper 4 (Fri, 10.55 - 12.25)

Keywords: significant events, client disclosure, comprehensive process analysis.

Significant client disclosure events in therapy: process, effects and context

Aim/Purpose: To explore important client-identified disclosures in therapy and identify how these events were significant for the client; how the event occurred and whether it had lasting significance.

Design/Methodology: This presentation is based on data from six clients. The research study used the Helpful Aspects of Therapy (HAT) form to identify important events. Participants attended brief structured recall interviews to discuss the disclosure event. The analysis was carried out using comprehensive process analysis (CPA), a systematic qualitative method for analysing significant therapy events, developed by Robert Elliott (Elliott, 1989, 1993). CPA attempts to identify the features of key client and therapist responses, the sequence of effects arising from the event through to the end of therapy and beyond to follow-up interviews, and the context, or background, which encompasses everything that led up to the event. The study has received ethical approval from the University of Strathclyde.  

Results/Findings: Initial findings indicate that the client is the agent in deciding when and what to disclose, rather than the disclosure resulting from a particular therapist intervention. Participants generally reported that the significance of the disclosure lasted beyond the end of therapy.

Research Limitations: Participants were aware that the researcher was investigating significant disclosures; the interviews did not take place immediately after the identified disclosure event - there was a gap of one to three days.  

Conclusions/Implications: Clients may attend counselling with specific tasks to accomplish that the therapist needs to be alert to; eg clients may consider disclosing significant material for some time before it is revealed and may first test the therapist with less important disclosures.  

References available on request please email research@bacp.co.uk

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Symposium C

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Chloe Randal, Sam Tucker, Jeremy Halstead and Chris Leach

Discussant: Michael Barkham

Professional Role: Professor (MB)
Institution: Centre for Psychological Services Research, Sheffield University
Email: m.barkham@sheffield.ac.uk

Symposium C overview (Fri, 10.55 - 12.25)

Keywords: early change, prediction, outcome, feedback, psychotherapy

When things are not going well in psychotherapy: Can we predict it? Yes we can

The aims of the symposium: This symposium presents the theoretical practical and empirical background to the introduction of a feasibility study of the introduction of a monitoring and feedback system to routine secondary care psychological therapies.

Contribution of each symposium paper to the overall theme: In the first paper, a literature review, Chloe Randal sets the scene by offering the history and rationale for developing feedback systems in psychotherapy services along with a summary of research findings.

In the second paper Sam Tucker describes the practicalities and pitfalls of introducing client monitoring and feedback into a busy NHS setting.

In the third paper Jeremy Halstead presents an analysis of the relationship between outcome and demographic data collected prior to therapy and significant early change in therapy. This helps to establish to what extent later change in therapy is best predicted from early change or pre therapy variables.

In the fourth paper Chris Leach examines the relationship between early gains and later improvement in therapy. As well as indicating the strong predictive value of early change in therapy, this also provides a benchmark against which the currently undertaken study of feedback in routine settings can be compared.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: Outcome measurement in psychotherapy and counselling has evolved through stages of: measuring effectiveness (pre and post measures), measuring the shape of change (session by session measures) to using the shape of change to inform feedback and improve therapy. This symposium addresses the issues of implementing such a system in a routine psychological therapy setting in the UK. The combination of a logical research based approach and opening up another channel of communication between client and therapist offers new opportunities for all psychological therapies to help more people more of the time.

Role of the symposium discussant: Michael Barkham is a leading psychotherapy researcher on the national and international scene. He will offer contextual wisdom in the areas of theory practice and policy.

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Chloe Randal

Other Authors: Jeremy Halstead, Sam Tucker, Chris Leach and Mike Lucock

Professional Role: Assistant Psychologist
Institution: South West Yorkshire Partnership Foundation Trust
Email: chloe.randal@swyt.nhs.uk

Symposium C paper 1 (Fri, 10.55 - 12.25)

Keywords: case tracking, feedback, outcome measures, early stages, psychological therapies

Theoretical background and rationale of case tracking and feedback in psychological therapies

Aim/Purpose: To summarise past research that provides an overview of the rationale for providing feedback to therapists regarding clients who are not improving in the early stages of therapy, as a means of improving overall outcome.

Design/Methodology: Several studies, mainly in the United States, have detected treatment failure early in the course of therapy by collecting data from session-by-session outcome measures and comparing an individual's actual trajectory of change with their predicted trajectory using complex statistical methods. Where failing treatments have been detected feedback has been provided to therapists as an alert that their client is not on track.

Results/Findings: Research has shown that there is a significant minority of clients who stagnate or even deteriorate during psychological therapy. These clients have been referred to as "not on track" (NOT) cases. Lambert et al. (eg 2007), in the US, demonstrated that providing feedback to therapists about clients who are not on track in the early stages of therapy can improve therapeutic outcome for these clients.

Research Limitations: Most of these studies have been carried out in the United States, mainly in university counselling centres, where routine completion of outcome measures has been established for some time. Further research in other settings is needed in order to generalise these findings and assess the feasibility of managing a case tracking and feedback system.

Conclusions/Implications: Case tracking and feedback is a promising development in modern psychotherapy practice. The use of case tracking can result in an increased sensitivity to the progress of clients; therapists can then use this information to direct and guide their care plan to improve overall outcome. Further research is needed to establish whether the effectiveness of a system of routine, sessional outcome measures together with feedback to therapists will transfer to a NHS secondary care setting.

References available on request please email research@bacp.co.uk

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Sam Tucker

Other Authors: Jeremy Halstead, Chloe Randal, Chris Leach and Mike Lucock

Professional Role: Assistant Psychologist
Institution: South West Yorkshire Partnership Foundation Trust
Email: samantha.tucker@swyt.nhs.uk

Symposium C paper 2 (Fri, 10.55 - 12.25)

Keywords: monitoring and feedback system, feasibility, acceptability, logistics, compliance

The triumphs and tribulations of creating a monitoring and feedback system in a standard UK NHS secondary care setting

Aim/Purpose: In the UK, routine monitoring and feedback to therapists regarding client progress represents a promising but neglected opportunity to improve therapeutic outcome...until now. This paper describes the first UK implementation of a monitoring and feedback system (MFS) in routine clinical practice, gives direct insight into encountered barriers and recommends solutions, to inspire and inform future adoption of similar systems.

Design/Methodology: A methodology for the development and application of an MFS in an adult psychological therapies service is presented. The service offers various therapies for clients defined as severe and complex. The backbone of the present MFS was two brief distress measures, which consenting clients completed before each therapy session, and one post session measure assessing helpfulness, alliance and stage of therapy. Therapists received feedback after each client's fourth session. A three month pilot phase preceded official implementation, representing an opportunity to hone a functional, transportable protocol with minimal disruption to routine practise. Qualitative and quantitative data on compliance, user acceptability and logistics is presented. The study was approved by the REC.

Results/Findings: Feedback from therapists and clients shaped the eventual protocol and the pilot was punctuated by numerous interventions to enhance utilisation. Consequently, early establishment of structured, reflexive communication opportunities for therapists and clients is recommended. Ease of administration predicted utilisation, which was factored into recruitment and data collection. Client feedback identified social desirability issues, which further influenced data collection. Training and communication initiatives included a therapist manual and a weekly web based communication forum. Feasibility issues including confidentiality, case tracking and feedback mechanisms are discussed.

Research Limitations: Limitations based on the generalisability of findings and the feasibility status of the study are discussed.

Conclusions/Implications: Although continuous systematic quality control is necessary, our experiences suggest it is feasible to implement an MFS in standard UK secondary care. A pilot phase in which protocols can be reconfigured according to the idiosyncratic realities of the site, therapists and clients is advocated. Continued development may lead to improved client outcomes, a fresh proactive approach to treatment outcome and ultimately alterations to routine service delivery, building a crucial bridge between research and practise.

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Jeremy Halstead 2

Other Authors: Sam Tucker, Chloe Randal, Chris Leach and Mike Lucock

Professional Role: Consultant Clinical Psychologist, Honorary Lecturer
Institution: South West Yorkshire Partnership Foundation Trust, Leeds University
Email: spruksec@gmail.com

Symposium C paper 3 (Fri, 10.55 - 12.25)

Keywords: predicting, early change, psychotherapy

Can we predict who will make early gains in routine psychological therapy?

Aim/Purpose: Early gains in psychotherapy are of value in themselves and as a sign that therapy is likely to be effective. In this study we look at the relationships between data gathered at screening (six months to two years before therapy), pre therapy (two to eight weeks before therapy) and early gains defined as change over the first four sessions to see whether we can distinguish early gainers (EG) from non early gainers (NEG) using screening and pre therapy measures.

Design/Methodology: n=200 routine referrals to a secondary care psychological therapies service have had their symptom levels monitored prior to each therapy session. Early gainers (five points or greater decrease at the fourth session) are classed as EG. Those showing less change, no change or increase are classed as NEG. Screening measures of symptoms (including CORE-OM, sPaCE, BAI, IIP), personality (SAPAS-SR) and demographic data are analysed to see which best predict EG versus NEG individuals.

Results/Findings: Preliminary analysis of the data suggests that the ratio of early gainers (EG) to non early gainers (NEG) is 5:6. That is slightly more are not attaining a five point increase than are. The two groups are very similar in terms of age and measures of depression and general distress. There are some indications of a weak association between reported anxiety and positive early response to therapy.

Research Limitations: This research is conducted with a particular client population (severe and complex) in a particular setting (NHS secondary care) with people who have mainly waited for nine to 18 months for therapy. They may not generalise to other populations. The numbers may not be sufficient, at this stage, to detect small but statistically significant influences on early change.

Conclusions/Implications: The main finding is that on a wide range of measures early gainers and early non gainers are indistinguishable. This contrasts with the finding that early gains predict good outcomes. It supports the idea that we need to know what is going on in therapy rather than prior to therapy to predict therapy outcomes and plan feedback interventions.  

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Chris Leach

Other Authors: Jeremy Halstead, Sam Tucker, Mike Lucock and Chloe Randal

Professional Role: Consultant Clinical Psychologist, Honorary Professor of Psychology
Institution: South West Yorkshire Partnership Foundation Trust
Email: chris.leach@swyt.nhs.uk

Symposium C paper 4 (Fri, 10.55 - 12.25)

Keywords: early gains, prediction, outcome

The prediction of therapy outcomes from change at session four

Aim/Purpose: The collection of session by session outcome data in psychological therapy is gaining increasing acceptance, eg as part of the monitoring in IAPT services. It is less common in secondary psychological therapy services. Such data supports efforts to investigate how early response to therapy may predict final outcome which will then support feedback systems aimed at improving therapy outcome.

Design/Methodology: This paper presents data for the first therapy contracts (completed and in progress) collected as part of a study looking at the possibility of replicating Lambert's (1) therapist feedback protocols to enhance outcomes. n=200 clients routinely referred for secondary care psychological therapy were given a pre therapy outcome symptom measure (sPaCE) prior to each session. Data were collected for: change prior to the fourth session and at the last point or completion of therapy. Early change was categorised into three groups corresponding to: a significant increase in symptoms (increase of five or more), no change (+4 to -4) and early gains (EG) -5 or more.

Results/Findings: The data were analysed using categorical and continuous methods. Both approaches showed a very strong association between early gains (EG) and improvement of 12 points (ES=0.75) at the last measured point in therapy. It was found that the results were similar for clients who had completed and those still in therapy.

Research Limitations: The data is based on clients mostly with severe and complex symptoms referred to a secondary psychological therapy service. The ratio of clients demonstrating different patterns of change may be different in other services.

Conclusions/Implications: These findings offer overwhelming support for the idea that early response to therapy is a significant predictor of therapeutic outcome. This means that it should be possible to tailor interventions for individuals according to their early change pattern. In particular, providing feedback on progress and suggestions for enhanced interventions may improve outcomes for clients who are not doing well at the fourth session.

This study in a naturalistic setting without therapist feedback also provides a benchmark for future studies, where monitoring is combined with feedback.

References available on request, please email research@bacp.co.uk

Symposium D

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Sue Wiggins, Rosanne Knox, David Murphy and Mick Cooper

Discussant: Rosanne Knox

Professional Role: Professor of Counselling (MC)
Institution: University of Strathclyde
Contact details: University of Strathclyde, 76 Soutbrae Drive, Glasgow, G13 1PP
Email: mick.cooper@strath.ac.uk

Symposium D overview (Fri, 13.50 - 15.20)

Keywords: relational depth, therapeutic alliance, client experiences, therapist experiences, person-centred therapy, working alliance, mutuality, Rogers' therapeutic conditions, outcome

Relational depth: new research findings

The aims of the symposium: To present findings from a range of new studies exploring the phenomenon of relational depth.

Contribution of each symposium paper to the overall theme: Wiggins opens the symposium by presenting the first robust set of quantitative data to suggest that the experience of relational depth is strongly associated with outcomes. Her presentation is followed, and supported, by a qualitative interview study by Knox, which explores clients' experiences, and perceptions, of relational depth. Murphy's findings provide further support for the concept of relational depth, showing how its therapeutic impact is related to the bi-directional encounter between therapist and client. Exploring this at a more micro-level, Cooper also presents evidence to support the hypothesis that relational depth is, indeed, an inter-subjective experience. 

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: This symposium provides some of the strongest evidence yet that relational depth is a real, two-person phenomenon within the therapeutic encounter, and that its presence is predictive of good outcomes. Such findings are important in supporting relational forms of therapeutic practice, and for developing theory and research around the therapeutic relationship.  

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Sue Wiggins 2

Professional Role: Researcher
Institution: University of Strathclyde
Email: spwiggins@gmail.com

Symposium D paper 1 (Fri, 13.50 - 15.20)

Keywords: relational depth, outcome, working alliance, quantitative

Relational depth and outcome

Aim/Purpose: To investigate whether relational depth, as assessed by the newly developed Relational Depth Inventory (RDI), is related to outcome.

Design/Methodology: Forty clients completed outcome measures including CORE, the Strathclyde Inventory, and the Personal Questionnaire at both pre and post therapy (post therapy was either at the end of therapy or after eight or more sessions). At post therapy they also completed the Relational Depth Inventory (RDI) which asks clients to describe a helpful event in therapy and then rate it on the 24-item version of the RDI. Clients also completed the Working Alliance Inventory (WAI) at regular intervals. Results were quantitatively analysed using a correlational design to predict post therapy client improvement from the RDI.

Results/Findings: Results suggest that relational depth ratings of helpful events are significantly associated with overall post-therapy improvement when controlling for pre-therapy and working alliance.

Research Limitations: RDIs were completed alongside outcome measures and WAIs completed at session three, five, 10, 15 and then every fifth session. RDIs were completed at either session eight or 10 and then at 20, 30 etc. Therefore RDIs and WAIs were not always completed at exactly the same time.

Conclusions/Implications: Results imply that relational depth (as assessed by the RDI) is a significant indicator of therapeutic improvement when controlling for pre-therapy and working alliance.

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Rosanne Knox

Professional Role: Children's Charity Manager; PhD Student
Institution: University of Strathclyde
Contact details: Counselling Unit, H76 Southbrae Drive, Glasgow G13 1PP
Email: rosanneknox@aol.com

Symposium D paper 2 (Fri, 13.50 - 15.20)

Keywords: relational depth, qualitative research, client experiences, person-centred, therapeutic relationship

The proactive client: what ‘conventional' clients think about relational depth

Aim/Purpose: In recent years evidence has begun to emerge suggesting that specific, identifiable moments of relational depth between client and therapist can have a significant positive impact on the progress and outcome of therapy. However research into clients' experiences of relational depth has to date primarily involved participants who are also therapists or trainee therapists themselves. The question of whether ‘conventional' clients also experience such moments has remained largely unanswered. This study addresses that question.

Design/Methodology: In-depth qualitative interviews were conducted with 11 participants whose only experience of counselling was as a client. The study was phenomenological in nature and interviews were semi-structured using a person-centred approach. Data were analysed using a grounded theory methodology.

Results/Findings: Most participants were able to identify one or more moments of relational depth with their therapist, seeing them as important events within the overall process. Participants also highlighted their own commitment and perseverance, and growing feelings of care and compassion for their therapist, as factors facilitating the described meeting at relational depth. During the moment itself participants spoke of opening their heart both to their therapist and to previously hidden parts of themselves. They also highlighted the empowering effect of their therapist's positive affirmation and hopeful attitude.

Research Limitations: Due to the small number of participants these findings cannot be generalised to any great extent, but can give an indication of how some clients perceive and experience relational depth.

Conclusions/Implications: This study provides evidence that an experience of a moment of relational depth can be identified by conventional, non-therapist clients, and that such moments can also be seen by these clients as significant moments in their therapy with a positive impact on the ongoing therapeutic process and beyond. These findings would point to the value of therapists being ready and willing to meet their client at relational depth, rather than it being something they should be purposefully aiming to achieve.

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David Murphy

Other Author: Duncan Cramer

Professional Role: Lecturer in Trauma Studies and Counselling
Institution: University of Nottingham
Contact details: Dearing Building, School of Education, Jubilee Campus, Wollaton Road, Nottingham, NG3 1BB
Email: david.murphy@nottingham.ac.uk

Symposium D paper 3 (Fri, 13.50 - 15.20)

Keywords: relational depth, mutuality, reciprocity, Rogers' therapeutic conditions, outcome

Mutual experiencing of Rogers' therapeutic conditions: some evidence of relational depth and positive outcome

Aim/Purpose: Rogers' (1957; 1959) claim that the client's minimal perception of therapist empathy, unconditional positive regard and congruence as necessary and sufficient conditions for constructive personality change has been supported equivocally. In contrast to the view of the therapeutic relationship as unilaterally therapist created, recent research from the psychotherapy literature has pointed towards the role of reciprocal positive interaction between client and therapist. Rogers (1959) also referred to the reciprocal nature of the therapeutic conditions, therefore suggesting the therapeutic relationship is a bidirectional process. Relational depth as a therapeutic concept has also referred to the co-experiencing of client and therapist (Mearns and Cooper, 2005). The current study aimed to explore the reciprocal and mutual experiencing of the therapeutic conditions, their development over the early stages of the therapeutic relationship and subsequent association with an objective measure of outcome.

Design/Methodology: The study collected data relating to the quality of the mutual affective therapeutic environment from 72 counselling/psychotherapy dyads in a naturalistic design. Levels of provided and perceived therapeutic conditions by both clients and therapists were assessed using a shortened version of the Barrett-Lennard Relationship Inventory after the first and third session and clients also completed the CORE-OM after the first and third session.

Results/Findings: Using hierarchical linear multiple regression the moderating effect of client perception on therapist held conditions provided a significant interaction effect. Plotting the interactions showed that client perception of high levels of therapist conditions is more strongly associated with outcome when client levels of empathy and unconditional positive regard (UPR) for the therapist are also high. This finding supports the view of the therapeutic relationship as a mutual, bi-directional and co-constructed phenomena and provides evidence in support relational depth as having positive therapeutic impact.  

Research Limitations: Small sample (n=72), correlations within findings were small, naturalistic study meaning that controlling extraneous variables was not possible.

Conclusions/Implications: This study lends support to Rogers' theoretical suggestion that the therapeutic conditions are bidirectional and co-constructed. The findings suggest that when there is perceived mutuality experiencing of the therapeutic conditions then outcomes are better. The implication is that practitioners are called to tend their inter-subjective awareness within the therapeutic encounter.

References available on request please email research@bacp.co.uk

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Mick Cooper 2

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: University of Strathclyde, 76 Soutbrae Drive, Glasgow, G13 1PP
Email: mick.cooper@strath.ac.uk

Symposium D paper 4 (Fri, 13.50 - 15.20)

Keywords: relational depth, therapeutic relationship, client experiences, therapist experiences

Therapists' and clients' experiences of relational depth: are they synchronous or asynchronous?

Aim/Purpose: In assessing the validity of the concept of relational depth, a key question is whether relational depth is something that both therapist and client experience it at the same time, or whether it might be quite possible for one person to experience it but not the other. The aims of this study, therefore, are: 1. to examine the degree of synchrony between clients' and therapists' experience of depth of relatedness; 2. to examine moderators of the degrees of synchrony; 3. to examine other factors that may predict the depth of relatedness.

Design/Methodology: An analogue design was used. Pairs of trainee and practising counsellors, predominantly of a humanistic orientation, were asked to conduct a brief therapy session, and to rate the degree of connectedness at one minute intervals. Correlational analysis and multi-level modelling was used to identify the overall degree of synchrony across pairs of participants, and to assess moderating variables and other predictors of level of depth.

Results/Findings: Therapists' and clients' ratings of the degree of connectedness showed a high level of association. This association was significant even when the general effect of deepening over time was controlled for. Depth of relating appears to be significantly greater with female therapists, as compared with male therapists.

Research Limitations: Limitations of the study are its analogue design, ceiling effects, the brevity of the session, and possible demand characteristics on both clients and therapists.

Conclusions/Implications: This study suggests that the experiencing of a depth of connection is, as hypothesised, an inter-subjective phenomenon, and therefore a real experiencing within the therapeutic relationship.  

Symposium E

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Robert Elliott, Elizabeth Freire and Graham Westwell

Professional Role: Professor of Counselling (RE)
Institution: University of Strathclyde
Email: fac0029@gmail.com

Symposium E overview (Fri, 13.50 - 15.20)

Keywords: person-centred/experiential therapies, therapy adherence/competence, therapist facilitative conditions, therapeutic relationship

The Person Centred and Experiential Psychotherapy Scale (PCEPS)

The aims of the symposium: To introduce and explore the Person Centred and Experiential Psychotherapy Scale (PCEPS) by describing its development and initial reliability and generalisability data, and to provide an opportunity for discussion of the issues and controversies that such an instrument raises for counsellors and researchers.

Contribution of each symposium paper to the overall theme: Westwell's presentation will introduce the PCEPS by providing an account of its development via a heuristic research process and by describing the characteristics of the current version of the instrument. In his presentation, Elliott reports the results of the current reliability trial, including generalisability analyses that will provide information about optimal sampling strategies. Finally, Elliott will introduce an open discussion, by summarising some of the issues and controversies inherent in attempting to define practice within the scope of a measurement instrument such as the PCEPS.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: The PCEPS represents an attempt to operationalise person-centred-experiential counselling/psychotherapy, making it a potentially useful tool for assessing treatment adherence/competence in RCTs and other forms of psychotherapy research. Beyond this, however, it has significant potential for testing theory, for facilitating training and practitioner self-reflection, and for evaluating professional practice. 

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Graham Westwell

Lead Author: Robert Elliott

Other Author: Elizabeth Freire

Professional Role: Lecturer in Counselling
Institution: University of Strathclyde
Email: gramw@tiscali.co.uk

Symposium E paper 1 (Fri, 13.50 - 15.20)

Keywords: heuristic inquiry, person-centred/experiential therapy, therapy adherence/competence, therapist facilitative conditions, therapeutic relationship

Developing the Person Centred and Experiential Psychotherapy Scale (PCEPS) - a heuristic collaborative process

Aim/Purpose: The assessment of ‘treatment integrity' is an essential component of psychotherapy trials (Waltz, Addis, Coerner, & Jacobson, 1993) and is concerned with adherence and competence. Currently, there are no well-constructed, appropriate adherence/competence measures of person-centred and experiential therapies. Such measures are critical for the development of efficacy trials on person-centred/experiential therapies; therefore, the researchers developed the PCEPS to aid in carrying out the systematic research needed to influence policy and promote best practice.

Design/Methodology: The development of the PCEPS followed a heuristic inquiry process. This involved systematically playing 10-15 minute audio segments of therapy from the archive of the Strathclyde Therapy Research Centre, using the instrument to rate the segments, and then analysing results. This was the 'discovery-orientated' and 'theory-building' phase (Stiles, 1993). The research team group process followed these stages of heuristic enquiry: engagement, immersion, incubation, illumination, explication and creative synthesis (Braud and Anderson, 1998), in order to refine and evolve the instrument.

Results/Findings: Repeated testing of the instrument scrutinised its theoretical validity and usefulness (Cronbach & Meer, 1955). The current version of the PCEPS consists of 15 items within two subscales: (a) person centred process, and (b) experiential process. Each item has an introductory descriptive summary and six anchor points with examples of practice to assist the rater.

Research Limitations: The 'theory-building' phase was quite time consuming and potentially endless. Because of the very nature of the heuristic process, the researchers' previous experience and training may have resulted in bias towards particular item constructs. Heuristic inquiry arguably has the potential to encourage 'self indulgent, narcissism and solipsism' (Etherington, 2004).

Conclusions/Implications: The researchers have developed a competence/adherence measure for person centred/experiential therapies, which can be used to clarify and specify therapeutic processes for practitioners. The measure may be useful for training in person-centred/experiential approaches and as an aid to self-reflection and in the supervision of clinical practice.

References available on request, please email research@bacp.co.uk

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Elizabeth Freire

Professional Role: Lecturer in Counselling Psychology
Institution: University of Strathclyde
Email: elizabeth.freire@strath.ac.uk

Symposium E paper 2 (Fri, 13.50 - 15.20)

Keywords: person-centred/experiential therapies, therapy adherence/competence, therapist facilitative conditions, therapeutic relationship

Reliability and generalisability of the Person Centred and Experiential Psychotherapy Scale (PCEPS)

Aim/Purpose: This study aimed to assess the reliability of the Person Centred and Experiential Psychotherapy Scale (PCEPS), a new adherence/competence measure of person-centred and experiential psychotherapies.

Design/Methodology: One hundred and twenty audio-recorded segments of therapy sessions selected from the archive of taped therapy sessions of the Strathclyde Therapy Research Centre were rated independently by six raters using the PCEPS. Six segments were systematically selected from 20 clients seen by 10 therapists (two clients per therapist); in the first, middle, and last third of therapy; and in the first and second half of therapy sessions. Three raters were qualified and experienced person-centred therapists and three raters were person-centred counselling trainees in their first year of training. Inter-item and inter-rater reliability of the scores across raters, segments, therapists, and clients will be reported using Inter-Class Correlation (ICC) and Cronbach's alpha, followed by exploratory factor analysis and generalisability theory analysis (Cronbach, Gleser, Nanda, & Najaratnam, 1972), using ANOVA and MANOVA analyses to measure the key components of variation in PCEPS ratings.

Results/Findings: Results will be presented at the conference as by the time of this submission the analysis was not completed. Interrater reliability is expected to be .7 or higher for most of the 15 items of the PCEPS, and high inter-item reliabilities are also expected.

Research Limitations: Therapy process measures in general and therapist adherence/competence measures in particular can be criticised for ignoring context and participant internal experiences, while attempting to generalise from relative brief segments of therapy to therapist performance in general. The present study would also be strengthened by comparison to non person-centred-experiential therapies.

Conclusions/Implications: The PCEPS has potential for use in RCT research as well as in counselling training and supervision, but will require further testing and validation.

References available on request please email research@bacp.co.uk

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Robert Elliott 2

Professional Role: Professor of Counselling
Institution: University of Strathclyde
Contact details: Counselling Unit, 76 Southbrae Drive, Glasgow G13 1PP
Email: fac0029@gmail.com

Symposium E paper 3 (Fri, 13.50 - 15.20)

Keywords: humanistic therapies, person-centred-experiential therapies, scientific evidence, politics and science, adherence-competence measures

The PCEPS as a case study in the intersection of politics and research

Aim/Purpose: To highlight some of the controversial issues surrounding the origins and development of the Person Centred and Experiential Psychotherapy Scale (PCEPS), and to stimulate discussion with the audience.

Design/Methodology: This is not an empirically-based presentation. Instead, it will provide a brief historical account of how the PCEPS came about, focusing on the conflicts and controversies involved. Audience members will be invited to react and comment on the issues raised.

Results/Findings: 1) Although the PCEPS began as an attempt to develop an adherence/competence measure for planned RCTs, it later became entangled with the Skills for Health Humanistic Psychotherapy competency project led by Hill, Roth, Pilling and others. This was a highly controversial process involving conflicts over: (a) standardisation of counselling/psychotherapy, (b) definition of humanistic therapy, (c) what constitutes scientific evidence. (2) The PCEPS replicates the division between nondirective or "classical" person-centred therapy and its experiential off-shoots (eg emotion-focused therapy) and attempts to measure and compare the actual practice of both versions of person-centred-experiential therapy, raising concerns about whether such a thing is, possible, wise or fair. (3) A version of the PCEPS is to be used to evaluate the competence of counsellors receiving additional training in humanistic counselling competencies in order to be able to work in IAPT settings, raising further issues along similar lines.

Research Limitations: Other versions of this history no doubt exist, perhaps highlighting different issues and downplaying its focus on controversy.

Conclusions/Implications: The PCEPS is not a neutral, "objective" instrument. It is important to talk about the controversial issues raised by the PCEPS, and to highlight the particular understandings embedded in it. The evidence presented in the previous presentation may help clarify some of the issues but is unlikely to eliminate them.

References available on request, please email research@bacp.co.uk

Symposium F

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Linda Dubrow-Marshall, Pamela Savic-Jabrow and Susan Cousins

Discussant: Rod Dubrow-Marshall

Professional Role: Manager, Counselling and Wellbeing Service and Lecturer; Visiting Fellow
Institution: University of Salford; University of Glamorgan
Email: l.dubrow-marshall@salford.ac.uk; ljdmarshall@aol.com

Symposium F overview (Sat, 11.00 - 12.30)

Keywords: self-care, ethics, BME issues, supervision, reflective practice

Self-care for practitioners: recommendations from research and practice

The aims of the symposium: To learn about research on self-care practices of practitioners, to understand recommendations from the literature about best practice, and to consider challenges to self-care for BME and other isolated practitioners.

Contribution of each symposium paper to the overall theme: The paper on current self-care practices of counsellors/psychotherapists and challenges to self-care will review recommendations from the literature about self-care and will present results of a survey of current self-care practices and a survey of sources of stress for counsellors working in university counselling services and independent practitioners. The paper on where do counsellors in private practice receive their support will present an analysis of a survey of independent practitioners. The paper on self-care for BME and other isolated practitioners will present ethnographic research on special issues in self-care for these practitioners, along with suggestions for how to address these challenges through fostering a sense of belonging and other strategies.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: Self-care is an ethical imperative according to the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy. These papers will present findings from current research and practice about self-care of psychotherapists/counsellors, consider relevant literature, and offer suggestions for self-care strategies for practitioners as a way of enhancing good practice.

Role of the symposium discussant: To tie together implications from the presented studies and to examine the presentations drawing on phenomenological, existential and cognitive perspectives and systems approaches. This will allow for a brief exposition of how wider social, cultural and economic factors might interact with self-care and personal and professional identity issues for practitioners and the potential benefits of self-care in the context of positive psychology approaches (Seligman, 1990) will also be explored.

References available on request please email research@bacp.co.uk

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Linda Dubrow-Marshall

Professional Role: Manager, Counselling and Wellbeing Service and Lecturer; Visiting Fellow
Institution: University of Salford; University of Glamorgan
Email: l.dubrow-marshall@salford.ac.uk; ljdmarshall@aol.com

Symposium F paper 1 (Sat, 11.00 - 12.30)

Keywords: ethics, self-care, stress, reflective practice, practitioner

Current self-care practices of counsellors/psychotherapists and challenges to self-care

Aim/Purpose: To examine current self-care practices of counsellors/psychotherapists, to examine sources of stress for counsellors, and to make recommendations for effective practitioner self-care.

Design/Methodology: A sample of counsellors working at a university counselling service, as well as a sample of independent practitioners were interviewed in order to identify common themes of sources of stress. A survey of current self-care practices was developed and administered to approximately 100 practitioners. Findings were qualitatively and quantitatively analysed to identify themes that may indicate requirements for self-care for practitioners and which can be mapped against the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy and other research findings on self-care.

Results/Findings: Themes emerged which indicate that counsellors experience a number of significant sources of stress, ranging from difficult clients, compassion fatigue, unrealistic pressures from services to deliver a high quality of care to a large number of diverse and demanding clients, lack of personal support, harassment, and transference and countertransference issues. Counsellors may be unrealistic when evaluating their own self-care practices in that they may be hesitant to think of themselves in negative terms. They experience some sources of anxiety and tension and may face difficulties in finding supportive colleagues and others to whom they can meaningfully discuss their work-related anxieties without feeling judged. The development of relationships independent of work is a potential source of self-care for practitioners, as well as feelings of connection and effectiveness both inside and outside the professional arena. Finding time and being motivated to exercise is a harder challenge for practitioners than to care for their bodies by eating nutritious food or getting sleep.

Research Limitations: These are preliminary findings based on a non-random selection of participants and with the need to reflexively acknowledge the subjectivity of the data analyst.

Conclusions/Implications: It may be helpful for practitioners to become more thoughtful about their self-care practices and sources of stress which threaten their self-care. Preliminary surveys highlight that practitioners are generally attending to self-care, as is required by the BACP Ethical Framework, but have room for improvement such as increasing exercise and being able to confide anxieties and concerns to supportive colleagues.

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Pamela Savic-Jabrow

Lead Author: Linda Dubrow-Marshall

Professional Role: Counsellor
Institution: Private practice based in Merseyside, UK
Email: Psavicjabrow@aol.com

Symposium F paper 2 (Sat, 11.00 - 12.30)

Keywords: support, independent practitioner, self-care, supervision, reflective practice

Where do counsellors in private practice receive their support?

Aim/Purpose: The purpose of the study was to discover if counsellors in private practice feel the need for support.

Design/Methodology: The purpose of this pilot study was to make contact with counsellors in private practice to determine whether/how they received support; if so, from which sources. The sample included counsellors who were listed as independent practitioners on the British Association for Counselling and Psychotherapy (BACP) website at the time of the study. Ethical approval for the research was obtained from the University Ethics Committee. The method of an email interview questionnaire was chosen for the study with the understanding that respondents would feel under no obligation to partake in the study. A cover sheet with information about the study was provided and those who requested a copy of the results were sent the information. A survey questionnaire asking 29 structured questions (a mixture of open and closed) was sent to 525 recipients, and from this, 31 questionnaires were completed.

Results/Findings: A total of 30 respondents (97%) believed that support was an important feature of being a counsellor in private practice. Several support options were determined by practitioners including the supervisor - 31 participants (100%); the self - 25 (80%); a counsellor - 11 (35%) and other sources, for example massage - 16 (52%), implying that in order to practice, all counsellors felt the need for/benefit of supervision.

Research Limitations: The pilot study attracted a disappointingly low response rate possibly due to a lack of awareness or perhaps interest in this area.

Conclusions/Implications: From the study although the response rate was low, it can be determined that supervision is a key factor in maintaining the well-being of practitioners. Moreover, the actual felt need for support by practitioners in terms of supervision in addition to the issues which could arise if this is not received is worthy of further investigation.

A short report on the above research entitled, "Where do counsellors in private practice receive their support?" was recently published in Counselling & Psychotherapy Research, (September 2010; 10 (3): 229-232).

References available on request, please email research@bacp.co.uk

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Susan Cousins

Lead Author: Linda Dubrow-Marshall

Professional Role: Counsellor
Institution: Cardiff University
Email: CousinsS@cardiff.ac.uk

Symposium F paper 3 (Sat, 11.00 - 12.30)

Keywords: BME, self-care, self-esteem, isolation, lone worker

Self-care for BME and other isolated practitioners

Aim/Purpose: To examine issues for BME and other lone and isolated workers that challenge self-care and self-esteem.

Design/Methodology: Data were collected through semi-structured interviews with colleagues at the Black and Asian Therapist Network conference, Black and Minority Ethnic Support Network, and self-esteem workshops and cultural awareness training. Auto-ethnographic research was also conducted in this context. Responses to the author's article on isolation in the workplace were analysed.

Results/Findings: Thematic analysis indicates that many BME practitioners work in isolation in environments where their colleagues are predominantly white. This isolation can result in individuals modifying aspects of their behaviour in an attempt to fit in, and they may need support in order to not need to appropriate or identify with something outside themselves in order to feel okay. Other practitioners also work in isolation and experience possible threats to their self-esteem while being deprived of supportive networks and other opportunities to increase their sense of belonging. Recommendations are made to help isolated practitioners to maintain self-care and self-respect, as required by the ethical code, such as developing supportive networks of other BME and isolated practitioners and becoming role models to others, enhancing acceptance, respect, trust for and belief in themselves.  

Research Limitations: This is a preliminary study based on interviews and limited samples.

Conclusions/Implications: BME and other isolated practitioners might consider their circumstances and look for ways to increase their sense of themselves and their sense of belonging by seeking out and attending BME forums, supervision groups, staff networks, and by finding mentors. Through these means, practitioners might find safe spaces to explore their particular experiences, express themselves and speak candidly, therefore increasing their sense of self and their self-esteem, the cornerstones to being able to effectively practice self-care. BME and other isolated practitioners have a right and indeed a responsibility to take care of themselves and of their needs and to not unconsciously expect someone else to take up this role. Good informal social relations and networks of informal ties are needed to increase a sense of belonging and ability to become fully integrated practitioners.

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Symposium G

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John Mellor-Clark

Discussant: Michael Barkham

Professional Role: Managing Director
Institution: CORE IMS
Email: john@coreims.co.uk

Symposium G overview (Sat, 11.00 - 12.30)

Keywords: CORE System, outcome measures, outcome methodology, practice-based evidence, IT feedback systems

Developing new CORE tools, methods and feedback technologies

The aims of the symposium: The symposium aims to present examples of how measurement tools, methods and technologies are evolving to bridge the typical gap between routine outcome measurement, clinical practice and research. This opening contextual paper takes an international perspective drawing on how the empirical yield from published work by Mike Lambert (US); Scott Miller and Barry Duncan (US); IAPT (UK) and the CORE Group (UK) collectively adds to the new paradigm of practice-based evidence that seeks to reduce the research-practice gap.

Contribution of each symposium paper to the overall theme: Each of the two papers on tool development focus on how bottom-up measurement development initiatives contrast with theory-led measurement design by placing a premium on accessibility and clinical utility. The methodology paper continues the clinical utility theme to explore practitioners' preferences for methodology design that facilitates and values integrated perspectives to synthesise clients outcomes from a broad breadth of domains. The final technology paper combines information technology and mathematical technology to describe an approach to the delivery of methodological pluralism for routine outcome measurement in family therapy.    

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: Implications for theory, research and practice will be drawn out in the conclusion to each paper designed to draw the symposium audience into discussion via the informed position of the discussant.

Role of the symposium discussant: The discussant's role in the symposium will be to offer a constructive critique of the symposium as a whole and raise questions that help to promote discussion and reflection on the application of the profiled tools, methods and technologies on the interface between research and practice in line with the conference theme. 

References available on request please email research@bacp.co.uk

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Michelle Brooks and Stephanie Davies

Other Authors: The Collaborative Research Group

Institution: Nottinghamshire NHS Trust; Nottingham University
Contact details: c/o NPDDNet, Mandala Centre, Gregory Boulevard, Nottingham, NG7 6LG
Email: chris@psyctc.org

Symposium G paper 1 (Sat, 11.00 - 12.30)

Keywords: learning disability, CORE system, questionnaire, LD-CORE, psychometrics

CORE-LD - an outcome measure for psychological therapies for people with learning disabilities

Aim/Purpose: 1) To develop an outcome measure for psychological therapy for people with learning disabilities (PwLD) that is accessible and reflects the particular experience of living with a LD. 2) To test the psychometric properties, reliability, acceptability and sensitivity to change of CORE-LD.

Design/Methodology: Seventeen potential items tested in a multi-site study involving NHS secure and non-secure, third sector and non-clinical samples. NHS Ethical approval. Explored internal reliability, test-retest reliability, discriminant (clinical/non-clinical) validity, sensitivity to change and early estimates clinically significant and reliable change criteria.

Results/Findings: n=324 participants, 52 non-clinical, 17 third sector, 14 high secure NHS and 241 other NHS. Three items dropped to create 14 item CORE-LD. Eighty nine percent complete items, 97% portable. Cronbach alpha .83, test-retest stability .64. Strong gender difference in non-clinical sample, may be age effects but not clear. Clinical/non-clinical difference highly significant, d = .5. Strong improvement with therapy.

Research Limitations: Heterogeneous sample reflects reality of great differences between different services for PwLD. Larger samples of both clinical and non-clinical data are needed to get a better picture of distributions of scores.

Conclusions/Implications: A 14 item CORE-LD is a usable tool to support routine assessment of change in psychological therapies for PwLD.

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Elspeth Twigg

Other Authors: Michael Barkham, Bridgette Bewick, Janice Connell, Mick Cooper, Chris Evans, Elizabeth Freire, John Mellor-Clark and Brendan Mulhern

Professional Role: Research Lead
Institution: CORE IMS
Email: elspeth.twigg@coreims.co.uk

Symposium G paper 2 (Sat, 11.00 - 12.30)

Keywords: school counselling, CORE system, outcome measurement, YP-CORE, psychometrics

YP-CORE - an outcome measurement system for young people aged 11-16 years

Aim/Purpose: 1) To develop a version of the CORE-OM appropriate for use with younger people; 2) to test the psychometric properties, reliability, acceptability and sensitivity to change of YP-CORE and refine as necessary; 3) To develop therapist Assessment (TAF) and End of Therapy (EoT) forms to use alongside YP-CORE.

Design/Methodology: Thirty four items of the CORE outcome measure (CORE-OM) translated where appropriate to be more comprehensible to young people (11-16). 33 practitioners and 43 young people rated items for inclusion/exclusion and suggested alternative wording if appropriate. YP-CORE v1 (18 items) piloted at three services. Subsequent analysis yielded final, 10-item version.

Ten items tested in a multi-site study to obtain clinical data. NHS ethical approval. Internal reliability, validity, sensitivity to change, initial estimates of reliable change obtained. Non-clinical sample obtained from one school.

Ongoing larger, multi-site study (10 sites) to collect clinical data across age-groups and concurrent non-clinical data collection across age groups in education setting (six sites). University of Strathclyde ethical approval.

Modification of CORE TAF and EoT for young people.

Results/Findings: YP-COREv1: n=343 participants from two schools counselling and one voluntary counselling site. Several items frequently missed and increasing numbers towards end of measure. Some items not sensitive to change.

YP-CORE: n=324 participants, 46 non-clinical, 163 school counselling, 80 voluntary and youth counselling. Ninety three percent complete items. Cronbach alpha .85, Age/gender differences in clinical sample. Strong improvement with therapy. Positive practitioner feedback.

Research Limitations: Priority to establish age and/or gender-specific cut-offs as appropriate to enable clinician assessment of recovery/improvement. Test-retest stability required.

Conclusions/Implications: A 10- item YP-CORE is a valid and usable tool to support routine assessment of change in psychological therapies for young people.

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Nick Turner

Lead Author: John Mellor-Clark

Other Authors: Michael Barkham, Peter Bell, Richard Evans, Corinna Furse, Andy Haxell and Rose Mary Owen

Professional Role: Director
Institution: Relate Institute
Email: Nick.Turner@relate.org.uk

Symposium G paper 3 (Sat, 11.00 - 12.30)

Keywords: CORE system, outcome measures, practice-based evidence, PST CORE, psychosexual therapy

PST CORE - developing an outcomes methodology for psychosexual therapy

Aim/Purpose: 1) To develop and pilot a standardised outcome measurement methodology for practitioners of psychosexual therapy to assess the effectiveness of PST on clients' symptom reduction, goal attainment, psychological well-being and relationship quality, 2) to test the clinical face validity of the methodology with volunteer participant members of Relate and/or BASRT and assess the empirical yield from a sample of 200 client outcomes.

Design/Methodology: Two focus groups involving a total of over 30 volunteer participants helped provide contextual data to profile (a) personal approaches to outcome evaluation; (b) severity definitions for common presentations; (c) generic and problem-specific client goals; and (d) appraisals of existing measurement methodologies for their clinical and empirical contribution to routine outcome measurement. Subsequent face validity data were secured through per groups review, and personal experiential testimony.

Results/Findings: Data collection is scheduled to commence January through to June 2011. Qualitative findings underpinning the methodology will be presented, along with the tools, and quantitative feedback data and assessment data from the first three months client throughout. Initial outcomes for early completers will also be presented.   

Research Limitations: As a pilot study there will be an obvious need for larger samples of clinical data to get a better picture of the overall distributions of scores across the range of tools being applied. Likewise, face validity data from volunteer practitioners is unlikely to be representative of the wider professional body.

Conclusions/Implications: Conclusions drawn from data gathered in the design process suggest that the measurement of outcomes in psychosexual therapy is complex and multi-facetted. Simple measurement of sexual or relational functioning is insufficient and must equally take account of individual and couple psychosocial distress alongside goals in seeking therapeutic help.

References available on request please email research@bacp.co.uk

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Célia M D Sales

Other Authors: Paula Gomes Alves, Robert Elliott, Chris Evans, Alex Curtis Jenkins, John Mellor-Clark and Peter Wakker

Professional Role: Professor
Institution: UAL, CIS/ISCTE IUL
Email: celiasales@universidade-autonoma.pt

Symposium G paper 4 (Sat, 11.00 - 12.30)

Keywords: family therapy, CORE-OM, simplified personal questionnaire, MF calculator,  methodological pluralism

Technological innovation in family therapy: the individualised patient progress (IPP) web system

Aim/Purpose: The researchers present a pilot technology for monitoring and measuring psychological change (IPP) applied to family therapy. IPP uses a double metric of idiographic measures focused on change in the patients' unique problems, alongside the evaluation of patient change on standardised, traditional nomothetic measures. Applied to family therapy, the IPP offers clinician the possibility of profiling family complaints, based on complaints similarities (MF Similarity, Sales & Wakker, 2009). IPP major features and initial results on its use in naturalist family therapy settings are presented.  

Design/Methodology: The project has a patient sample comprising 100 individual patients and 20 families. Each participating patient completes a battery of measures comprising the Simplified Personal Questionnaire (PQ; Elliott, Shapiro & Mack, 1999), the CORE-OM (Evans, et al., 1999), the PHQ9 (Kroenke, Spitzer & Williams, 2001) and the Helpful Aspects of Therapy Questionnaire (Elliott, 1993). Therapists will collate the outcomes data through a web-based system offering real time session-by-session feedback to help inform clinical management and supervision. Standard ethical approval considerations will be discussed.

Results/Findings: Data collection is from January through to December 2011. Qualitative findings focusing on the patient and therapists experiences of the innovative integration of idiographic and nomothetic tools will supplement qualitative data profiling case mix for the first three months. Initial outcomes for early completers will also be presented.

Research Limitations: As a pilot study there will be an obvious need for larger samples of clinical data to get a better picture of the overall distributions of scores across the range of tools being applied. Likewise, face validity data from patients and practitioners will have limited generalisability to the wider professional body.

Conclusions/Implications: Few published studies to date have attempted to deploy a pluralistic methodology combing nomothetic and idiographic tools through a routine outcome measurement technology, and there are limited statistic display technologies for synthesising the complex individual and systemic goals of family therapy. The technical viability, clinical utility and empirical value are anticipated to have a wide range of implications.

References available on request please email research@bacp.co.uk

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