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Research Conference 2013  


BACP's 19th Annual Research Conference entitled 'Synergy in counselling & psychotherapy research' took place on 10-11 May 2013 at the Marriott Forest of Arden Hotel, near Birmingham.

Click here for an evaluation of this year's conference  

Abstracts

 

Pre-Conference Workshop

Presenter: Michael J Lambert

Professional Role: Professor of Psychology
Institution/Affiliation: Susa Young Gates University Professor
Contact details: 272 TLRB, Brigham Young University, Provo, Utah, 84602
Email: michael_lambert@ byu.edu

ABSTRACT: Pre-conference workshop                                                         (Thurs, 18.00 - 19.30)

Keywords: clinical support tools, problem-solving tools, negative outcomes, deterioration, psychotherapy outcome.

How to use clinical support tools to enhance counseling outcomes.

This preconference workshop highlights the nature and use of Clinical Support Tools (CST) for clients whose positive treatment outcome is in doubt. The CST intervention begins with a 40-item assessment tool (the Assessment for Signal Cases) that is administered to clients whose positive treatment outcome is in doubt (about 20-30% of clients). The subscales include items aimed at assessing the therapeutic alliance, client social supports, motivation/expectations, and untoward life events. A feedback report that is provided to clinicians includes problems with overall areas of difficulty as well as particular items that fall well below that reported for the average client. Clinicians use a decision tree to organize problem-solving, and are provided with a list of interventions that have been shown to resolve issues that are hindering a positive outcome.

Aim/Purpose: To organize problem-solving with clients predicted to have a negative outcome through the use of measuring important constructs and focussing on critical issues.

Design/Methodology:
This intervention is based on randomized clinical trials.

Results/Findings:
The workshop is focussed on what is in the intervention and how to apply it rather than research findings. The research findings are reported in my Keynote address.

Research Limitations:
We are not sure which aspects of the CST intervention are essential to further client outcomes.

Conclusions/Implications:
When the CST intervention is applied we believe that it provides counsellors with an organized method of problem solution with clients whose positive treatment outcome is in doubt.

 

Friday Keynote

Presenter: Michael J Lambert

Professional Role: Professor of Psychology
Institution/Affiliation: Susa Young Gates University Professor
Contact details: 272 TLRB, Brigham Young University, Provo, Utah, 84602
Email: michael_lambert@ byu.edu

ABSTRACT: Friday keynote presentation                                                   (Fri, 09.15 - 10.00)

Keywords:  feedback, outcome questionnaire-45, patient-focused research, quality assurance, treatment outcomes.

How to double client outcomes in 18 seconds: using mental health vital signs feedback and problem-solving tools.

Therapists are so optimistic about their effects on clients that they overlook negatively responding clients. Using a simple measure of mental health functioning along with knowledge of typical patterns of change enables therapists to focus their attention on negative treatment responders to these patients' benefit. Once negatively responding clients are identified, therapists notified, and possible reasons for failure are identified (alliance, social supports, motivation, and life events), suggestions are made for changing interventions. Such procedures take advantage of therapists' ability to problem-solve and thereby allow for a synergistic combination of clinical skill and research methods aimed at on-going treatment in real time.

Aim/Purpose: To make counselors aware of the advantages of tracking client treatment response in relation to typical response with alerts for predicted treatment failure.

Design/Methodology: The Keynote summarizes the results of nine clinical trials in which the same therapists have access to progress feedback and problem-solving tools, or practice without feedback.

Results/Findings: The results demonstrate that the number of clients who report clinically significant change doubles when feedback is provided and rates of deterioration are reduced from a baseline of 20% to 5.5%.

Research Limitations: The results are overly dependent on findings from a single research group and self-reported mental health functioning.

Conclusions/Implications: It is time to take advantage of information technology, statistical modeling, and counselor resourcefulness in routine care.

 

Saturday Keynote

Author: Roz Shafran

Professional Role: Chair of Clinical Psychology
Institution/Affiliation: University of Reading
Contact details: School of Psychology and CLS, University of Reading, Reading, RG6 6AL
Email: r.shafran@reading.ac.uk

ABSTRACT: Saturday keynote presentation                                              (Sat, 09.15 - 10.00)

Keywords: perfectionism, assessment, therapy, outcome, cognitive-behavioural.

Psychotherapy for perfectionism: research and clinical practice.

Aim/Purpose: Perfectionism can be a problem that affects clients' functioning directly and is associated with a variety of mental health problems including depression, anxiety, chronic fatigue and eating disorders. This keynote address has two aims. First, to present the latest research on the understanding and treatment of perfectionism. Second, to provide useful clinical information for counsellors and psychotherapists who come across perfectionism in their practice.

Design/Methodology: The presentation will review literature on the understanding and treatment of perfectionism, including cognitive-behavioural approaches. The findings are largely drawn from randomized controlled trials.

Results/Findings: Perfectionism can interfere with the process and outcome of therapy across the age range. It can be addressed by conceptualising perfectionism as a dysfunctional scheme for self-evaluation and by using specific therapeutic techniques.

Research Limitations: There are few large randomized controlled trials in this area, and longer term outcome studies are required.

Conclusions/Implications: While perfectionism can be functional, for some clients it can be problematic and warrant intervention. A specific cognitive behavioural model and treatment of perfectionism can be helpful.

 



Liz Ballinger

Professional Role: Lecturer in Counselling
Institution/Affiliation: University of Manchester
Contact details: Ellen Wilkinson Building, University of Manchester, Oxford Rd, Manchester M13 9PL
Email: liz.ballinger@manchester.ac.uk

ABSTRACT: Paper                                                                                          (Fri 13.50 - 14.20)

Keywords:  counsellor trainers, stress, burnout, rewards, settings.

How counsellor trainers experience their role within the current British context.

Aim/Purpose: This paper reports the findings of a research study which set out to explore how British counsellor trainers experience their role. The training sector is under increasing pressure as it tries to respond to not only a shifting climate for counselling but also to changes within the educational sector itself. The research was motivated by the researcher's own experiences as a trainer and aimed to address the lack of published research into rank-and-file trainer experiences and viewpoints.

Design/Methodology: The methodology of choice was interpretative phenomenological analysis (IPA). Sixteen trainers were recruited from across Great Britain and individually interviewed using a semi-structured interview schedule. Questions focused on what trainers understood as constituting their role and the challenges and rewards associated with its undertaking. The trainers were drawn from person-centred, integrative, psychodynamic and CBT based programmes. The majority were university-based but collectively represented experience within independent, further education, higher education and NHS settings.

Results/Findings: The findings highlighted the multifaceted and demanding nature of the training role. The role was experienced as high-stress in nature and trainers were vulnerable to burnout. Workload pressures, the emotional demands of the role, gatekeeping functions, limited autonomy and a lack of appropriate support were among the major factors cited. The context of the work carried significance, with trainers in universities and the NHS reporting a strong sense of misfit. In parallel trainers emphasised the role's rewarding nature, although some trainers were questioning their on-going commitment.

Research Limitations: The focus of the research was an in-depth exploration of individual trainer experience. The findings are not presented as generaliseable truths but as a contribution to the development of a case-based context-dependent understanding of the role.

Conclusions/Implications: The research demonstrated the level of pressure within which trainers are operating and highlighted the importance of effective preparation and support for the training role. The importance of relevant training and CPD programmes, of a revisiting of the BACP accreditation of trainers scheme were amongst the conclusions reached.

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Hope Bell et al.

Other Authors: E H Mike Robinson III, Dodie Limberg

Professional Role: Doctoral Candidate
Institution/Affiliation: University of Central Florida
Contact details: College of Education, Orlando, FL 32816,
Email: bell.c@knights.ucf.edu

ABSTRACT: Paper                                                                                          (Sat 13.50 - 14.20)

Keywords: supervisory relationship, therapeutic relationship, outcomes, person-centred, facilitative conditions.

An exploration of the relationships between supervisees' perceptions of facilitative conditions in supervision, clients' perceptions of facilitative conditions in counseling, and client outcomes.

Aim/Purpose: The purpose of this study is to examine the relationship between the perception of the facilitative conditions in the supervisory relationship, the perception of these conditions within the therapeutic relationship, and client outcomes. It is hypothesized that the supervisory relationship will impact both the therapeutic relationships of the supervisee, and client outcomes.

Design/Methodology: Instrumentation to measure relationships includes the Barrett-Leonard Relationship Inventory and the Revised Relationship Questionnaire, and client outcomes with the Outcomes Questionnaire-45. Participants were recruited through a university based Community Counseling Clinic. The goal sample size is N= 85, needed to produce a medium effect size at the .05 alpha level in multiple regression analyses with four independent variables and one dependent variable in correlational research.

Results/Findings: Preliminary results are based on a sample of size of N=42 clients and N=22 counselors-in-training. Full results with the complete sample size will be available at the conference. Preliminary results indicate a non-significant relationship between the client-counselor relationship and the counselor-supervisor relationship, with Pearson's r= -.176, p= .265.  Additionally, the counselor-client relationship nor the counselor-supervisor relationship correlate significantly with a change in client outcome scores, with Pearson r=.225, p=.175, and Pearson r=-.026, p=.877 respectively.  The first change in OQ score, taken between sessions 1 and 5, and the second OQ score change, taken between session and the final session were significantly correlated, with a Pearson r=.538, p<.01.

Research Limitations: Counselors-in-training are responsible for collecting their client's data, which may lead to researcher influence on the results. Additionally, the research is taking place at one university in the southeastern United States, thus is not widely generalizable.

Conclusions/Implications: While results from this study are pending, it is clear from past research that the therapeutic relationship is key to positive client outcomes.

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Natasha Carville & Joe Kelly

Other Authors: Tracey Tharme, Diane Williams

Professional Role: Trainee Counsellor
Institution/Affiliation: Lewisham Counselling and Counsellor Training Associates
Contact details: C/O Juanita Harriot, LCandCTA, 15-16 Deptford Broadway, London, SE8 4PA
Email: juanita.harriot@lcandcta.co.uk

ABSTRACT: Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: trauma, person-centred, treatment.

An exploration into the counsellor's experience of the person-centred approach as a therapeutic treatment for post-traumatic stress disorder

Aim/Purpose: Rogers' 1959 paper outlines a concept of personality that accounts for an understanding of how a person develops traumatic stress. His idea that an event significant enough to stop a person being able to accurately symbolize the experience into awareness and so cause traumatic stress, could be a way of underpinning how the person-centered approach (PCA) can account for and work with post-traumatic stress disorder (PTSD). We wanted to explore this idea in greater detail and see how practitioners of the PCA can understand and work with PTSD.

Design/Methodology: We conducted semi-structured interviews with two PCA counsellors who discussed five clients who had experienced significant trauma and exhibited symptoms of PTSD. We transcribed the interviews and applied a method of Interpretive Phenomenological Analysis (IPA) to draw out themes consistent with the experiences of their clients. We used IPA for its openness and transparency when exploring individual subjective experiences.

Results/Findings: We found that when the conditions are such that the client can openly experience the trauma in the room with the counsellor, the client can explore the trauma in a safe and manageable way. Clients being given the time they needed to explore was prominent and seemed consistent across all clients that were discussed. Working flexibly and drawing on creative aspects that suit the client were also effective in working with PTSD.   

Research Limitations: PCA counsellors who have worked with clients experiencing PTSD in a purely person centered way were very hard to find for interview in the time that had been allowed for the project. We would have liked to have had more respondents.

Conclusions/Implications: The PCA can be effective in the treatment of PTSD when certain conditions (extension of the Rogerian Core Conditions) relating to the approach are present and if the counsellor feels comfortable working in a flexible and adaptive way to suit the client. Time also needs to be allowed for a client and counsellor to develop a trusting and open relationship in which the client feels safe enough to explore the aspects of their distress.

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Gala Connell

Professional Role: Practitioner
Institution/Organisation: Leeds Counselling
Contact Details: Leeds Bridge House, Hunslet Road, Leeds LS10 1JN
Email: yourpersonaltherapy@gmail.com

ABSTRACT: Paper                                                                                          (Fri, 12.05 - 12.35)

Keywords: bilingual therapist, difference, language and identity, second language, third language.

Making meaning in a second language: a qualitative enquiry.

Aim/Purpose: The purpose of the study was to explore individual lived experiences of therapists working in English as a second language.

Design/Methodology: Ethical approval was granted by the University of Leeds School of Healthcare Research Ethics Committee. An Interpretative Phenomenological Analysis was combined with Hollway and Jefferson's (2000) approach to doing research with defended subjects. In-depth unstructured interviews were used to collect data from five practitioners, including the researcher who was interviewed by a colleague. The data contained material showing both unconscious and conscious defences employed by the research participants against anxiety related to the topic.

Results/Findings: The study highlighted issues around difference, sense of identity and opportunities to enhance the therapy process. The importance of a therapist's self-awareness was emphasised. The therapist identity is often developed in the second language (English) through training, personal therapy and client work. Therapists were found to use a ‘third language' - the language of therapy that is a result of integrating professional and language identities. This dynamic communication system can be used either defensively or purposefully in the joint meaning making with clients.

Research Limitations: All research participants were white Europeans and four of the five interviewees were women, which means limited diversity. The small sample size makes generalisation difficult.

Conclusions/Implications: The research is relevant to the growing number of second language therapists who would benefit from enhanced awareness. It may also have relevance for practitioners working in their first language who are in the process of developing a common language with their clients. Methodologically the use of another interviewer to ensure the researcher's own experience is innovative and provides a useful aid to reflexivity.

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Hannah Cooper & Clare Symons

Professional Role: Counsellor, Counselling Centre Coordinator
Institution: University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester LE17PA
Email: cooperoo@hotmail.co.uk

ABSTRACT: Paper                                                                                          (Fri, 11.30 - 12.00)

Keywords: fee, payment, voluntary sector, qualitative, practitioner research.

"Like oil and water." Investigating critical incidents in fee practice of counsellors in voluntary agencies.

Aim/Purpose: To explore how counsellors experience significant events surrounding the fee within a voluntary organisation setting when tasked with negotiating and/or sustaining fee payments without financial gain to themselves.

Design/Methodology: Qualitative study involving interviews with twelve participating counsellors, all practicing voluntarily within a counselling organisation using a range of modalities. Interviewing was semi-structured, during which participants were asked to share a significant event surrounding the fee, their response, the sense they made of it, their motivations and its lasting impact. Interview transcriptions were analysed using generic thematic analysis techniques.

Results/Findings: Analysis yielded forty-nine sub-themes across twelve themes, grouped into four main domains in which fee management had a notable impact, namely Impact from Within, Impact from Outside, Impact on Therapist and Legacy. Findings captured a rich set of experiences that roused powerful tensions involved in a therapeutic consideration of money, including its strengthening presence within the therapeutic dyad in stark conflict with the threat it posed to rupture the relationship in bringing together the intimate and commercial. Furthermore it revealed the complex dynamic of the triangular relationship fostered by the organisation, presenting a significant challenge to the counsellor's autonomous handling of the event and its potential to achieve therapeutic movement.

Research Limitations: Purposive sampling restricts the generalisability of broader observations surrounding money for therapy. The tendency for shared experiences to be more heavily focussed on the challenging presence of money as opposed to its therapeutic usefulness may have been subject to the specific interests/background of the researcher.

Conclusions/Implications: Money can be worked with creatively and therapeutically to facilitate movement within the therapy however this is most often achieved only after counsellor and client have tolerated a considerable degree of anguish. Less risk of rupture or breakdown was reported when the fee was contained within the therapeutic relationship and when responsibility was assumed by the counsellor from the outset.

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Beverley Costa

Other Author: Jean Marc Dewaele

Professional Role: Clinical Director and CEO of Charity
Institution/Affiliation: Mothertongue multi-ethnic counselling service
Email: beverley@mothertongue.org.uk

ABSTRACT: Paper                      (Fri, 11.30 - 12.00; repeated Sat, 14.25 - 14.55)                                                                                                            

Keywords: monolingual, multilingual, therapist, attunement, collusion.

Psychotherapy across languages: differences between monolingual and multilingual therapists.

Key words: monolingual, multilingual, therapist, attunement, collusion

Aim/Purpose: The purpose of this research is to explore and compare the way in which monolingual and multilingual therapists work with clients who do not have English as their native language, with the ultimate aim of improving the way in which non-native speakers of English can access and receive appropriate therapeutic help.

Design/methodology: 101 multi- and monolingual therapists from a range of modalities completed an online questionnaire. Questions covered linguistic practices with multilingual clients, perceptions and attitudes towards mono- and multilingual interactions, multilingualism and multiculturalism. Interviews with one monolingual and two multilingual therapists built upon findings from the questionnaire.

Results/Findings: 82% of the multilingual therapists tended to view their ability to share a language, or to have a facility for languages with a patient, as positive with respect to their capacity for client attunement. Monolingual therapists, on the other hand, viewed language sharing with the client as a possible source of collusive behaviour in the therapeutic relationship.  A principal component analysis yielded a four-factor solution accounting for 41% of the variance. The first dimension, which explained 17% of variance, reflects therapists' attunement towards their bilingual patients (Attunement versus collusion). Further analysis showed that the 18 monolingual therapists differed significantly from their 83 bi- or multilingual peers on this dimension. Follow up interviews confirmed this result.

Research Limitations:  There is a limit to the generalisation possible from the relatively small sample. There was no universal principle applied to classification of therapists as the therapists self-identified the modalities they align with. The interviews with participants were conducted in the style of a structured conversation rather than an identifiable scientific method of enquiry. Even though the questionnaire was anonymous there is the possibility of social desirability bias in the responses of therapists with regard to their own professional practice.

Conclusions/Implications: Recommendations based on these findings are made for psychotherapy training and supervision to attend to a range of issues including: the psychological and therapeutic functions of multi/bilingualism; practice in making formulations in different languages; the creative therapeutic potential of the language gap. A follow-on piece of research is currently being undertaken, focusing on the therapeutic experiences of multilingual clients.

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Alastair Crocket

Professional Role: Principal Academic Staff Member
Institution/Affiliation: Waikato Institute of Technology, Hamilton, New Zealand
Email: alastair.crocket@wintec.ac.nz

ABSTRACT: Paper                                                                                          (Sat, 13.50 - 14.20)

Keywords: postcolonial, positioning theory, deconstruction, cross-cultural counselling, power.

Pākehā (white) counsellor positioning in post-colonial Aotearoa New Zealand.

Aim/Purpose: This postcolonial and post-structural study explored the discursive positioning experienced by five counsellors who identify as Pākehā - the dominant  culture within postcolonial  Aotearoa New Zealand. This presentation identifies possibilities for innovative cross-cultural practice responses which become available when a counsellor is able to decline the restraints inherent in particular culturally charged position calls and take up alternative positions which offer therapeutic possibility. 

Design/Methodology: The researcher facilitated a recursive research process where the practitioner/participants initially participated in structured dialogues about their cross-cultural practice. These research conversations were transcribed and the researcher led the participants in deconstructive analyses which returned to those texts and produced accounts of changed practice. The researcher later concluded and theorised the analysis.

Results/Findings: This presentation focuses on one aspect of the findings, told through one Pākehā counsellor's account of her reflexive practice while participating in the research project.  If offers a discursive account of school counselling at the intersection of culture and gender in a challenging postcolonial context. The counsellor investigated restraints she experienced in her practice with young Māori males and opened possibilities for more effective counselling. The presentation shows the counsellor's initial naming of a problematic cross cultural context - a Pākehā woman counselling young Māori males.  It then describes her reflexive identification of discursive position calls which restricted her practice.  The final phase of this presentation is an account of the counsellor's transformed practice, and her further deconstructive analysis of that transformation.

Research Limitations: This is a qualitative study which sits in a unique postcolonial context.

Conclusions/Implications: The counsellor had been poorly positioned within postcolonial discourse in her work with young Māori males. As she participated reflexively in this project she was able to decline position calls which offered limited possibility, and to see and take up other possible, and preferred, positions. A significant outcome of this discursive repositioning was that, having recognised restraining discourses and declining the position calls they offered her, the counsellor then experienced significant developments in her practice.

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Linda Dubrow-Marshall & Rod Dubrow-Marshall

Professional Role: Lecturer in Applied Psychology (Therapies)
Institution/Affiliation: University of Salford
Contact details: University of Salford, L818 Allerton Building, Greater Manchester M6 6PU
Email: l.dubrow-marshall@salford.ac.uk; ljdmarshall@aol.com; RPDubrow-Marshall@uclan.ac.uk

ABSTRACT: Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: family of origin, family estrangement, ethical issues, undue influence, practice issues.

Ethical and practice issues when psychotherapists encounter or encourage family estrangement: lessons from case studies.

Aim/Purpose: To examine ethical issues for practitioners when considering family of origin issues with their clients including from consideration of case studies of individuals' involvement in groups where a psychotherapist has promoted and encouraged family estrangement.

Design/Methodology: Case studies are presented of individuals who felt harmed by groups and by psychotherapists within them who had persuaded them to sever ties with their families of origin. The participants approached the researchers who were known for their research in this area wanting to tell their stories and to get feedback about professional ethics. Data was collected through narrative inquiry, and a thematic analysis was conducted, as well as an examination of primary source materials relating to the groups.

Results/Findings: In both cases, the themes of undue and unethical influence were identified (cf. Aronoff, Malinoski and Lynn, 2000). In the first case study, a woman was interviewed whose psychotherapist had identified her as being "addicted to people" and persuaded her to "detach" from her family of origin and her children. In the second case study, a woman was interviewed whose son had severed ties with her after having been influenced by a self-proclaimed philosopher and his psychotherapist wife to sever ties with their families of origin to achieve true freedom and happiness, a process which they called "de-fooing". (‘foo' being a colloquial term for ‘family of origin'). In both cases the therapists were sanctioned by their respective professional bodies.

Research Limitations: The researchers interviewed people who were disturbed by their experiences and who sought help about unethical influence - this was not a representative sample. The psychotherapists were not interviewed by the researchers.

Conclusions/Implications: Long-lasting psychological harm can be caused by the use of undue or unethical influence to sever family ties. Practitioners can learn from these examples of unethical and undue influence to develop ethical, professional guidelines to help people with disturbed relationships with their families (e.g. abusive families).

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Ieva Dulinskaitė

Other Author: Gražina Gudaitė

Professional Role: Clinical Psychologist, PhD student
Institution/Affiliation: Vilnius University
Contact details: Vilnius University, Faculty of Philosophy, Universiteto str. 9/1, Vilnius, 01513
Email: ieva.dulinskaite@gmail.com

ABSTRACT: Paper                                                                                          (Fri, 16.30 - 17.00)

Keywords: psychotherapy, therapeutic alliance, psychotherapy outcome, client age, developmental goals.

The role of client age to the formation of therapeutic alliance.

Aim/Purpose: A large body of evidence points to the therapeutic alliance as one of the key factors contributing to the outcomes in psychotherapy (Orlinsky, Ronnestad, Willutzki, 2004). However, little is known about the factors that contribute to the development of a strong therapeutic alliance. The objective of this study is to explore the significance that clients age, age related specific developmental goals and the consensus of these goals between client and therapist have to the formation of therapeutic alliance and, respectively, the outcome of psychotherapy. Additionally, it will determine whether therapist or client therapeutic alliance reports are better predictors of the psychotherapy outcomes.

Design/Methodology: Three target groups of psychotherapy clients were formed according to Erikson developmental stages: adolescence, young adulthood and middle adulthood. These groups consisted of 20 participants each. Quantitative data were compiled through evidence from the therapeutic alliance questionnaire (client and therapist scales), which indicate the quality of the therapeutic alliance and the consensus of goals between the therapist and client, and the psychotherapy outcome evaluation questionnaire, which indicate the strength of client symptom reduction as an outcome of psychotherapy.

Results/Findings: Findings indicate that client age and the extent to which psychotherapist meets the expectations of the client is a valid predictor of the quality of therapeutic alliance and has significant influence to the outcome of psychotherapy. It also shows that positive alliance predicts more positive outcomes including symptom reduction and client goal attainment. The study confirmed the hypothesis that client reports of the therapeutic alliance were better predictors of psychotherapy outcomes than therapist reports.

Research Limitations: Due to the small sample of participants from a specific geographical area the findings cannot be generalised to a larger population.

Conclusions/Implications: The results of this study have significance for aspects of psychotherapy and counselling training that receive little attention at present, and will also contribute to a better understanding of client age and developmental stage as an important element of the therapeutic relationship.

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Sue Eldridge & Melanie Peake

Other Authors: Charlotte Malik, Liz Rees and Dave Webster

Professional Role: HPD in Counselling Students/Volunteer Counsellors
Institution/Affiliation: Lewisham Counselling and Counsellor Training Associates (LCandCTA)
Contact details: c/o Juanita Harriot, LCandCTA, 15 Deptford Broadway, London SE8 4PA
Email: juanita.harriot@lcandcta.co.uk

ABSTRACT: Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: autism, neurotypical, person-centred, empathy, open-ended.

How do person-centred counsellors experience working with clients on the autistic spectrum? 

Aim/Purpose: To discover to what extent Person-Centred practitioners working with clients on the autistic spectrum experience the Person-Centred Approach as effective. As current research suggests clients with a diagnosis of Autistic Spectrum Disorder are more likely to be offered counselling with a therapist from an evidence-based modality, where altering and directing behaviour is encouraged in order to make the client fit the neurotypical world, the researchers wanted to explore what happens when the Core Conditions are extended and the Person-Centred practitioner accepts the world of the person with Autistic Spectrum Disorder.

Design/Methodology: The researchers used the phenomenological approach to research and used the Empirical Phenomenology method for data analysis, in order to uncover the essence of the experience of the respondents. Our respondents were four female counsellors with clinical experience of extending the person-centred approach when working with clients with autistic spectrum disorder. Respondents took part in qualitative, semi-structured, audio taped interviews that focused on non-directiveness, empathy and the obstacles to the therapeutic alliance.    

Results/Findings: Our findings indicate that an open-ended therapeutic alliance, in which the Rogerian Core Conditions are extended, allows clients with autistic spectrum disorder to experience acceptance. The respondents reported that in their experience of this client group, the unconditional acceptance of the client and their world was key to facilitating the development of empathy within the relationship.   

Research Limitations: Due to ethical considerations, the researchers were unable to interview clients with autistic spectrum disorder so the findings of the research are limited to the experiences of the person-centred practitioners. The sample size was small; four female respondents.       

Conclusions/Implications: The results of the study suggest that the person centred counsellors' experience that the approach is a viable and effective theoretical model for practitioners working with clients on the autistic spectrum.

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Bradley T. Erford & David Kaplan

Institution/Affiliation: American Counseling Association
Email: dkaplan@counseling.org

Dr Erford is the 2012-13 President of the American Counseling Association (ACA) and a professor in the school counseling program at Loyola University, Maryland (USA). Dr Kaplan is the Chief Professional Officer for the American Counseling Association and directs the professional activities that support ACA's 51,000 members

ABSTRACT: Paper                                                                                          (Fri, 10.55 - 11.25)

Keywords: counseling, counseling profession, counseling definition, Delphi method, United States.

The development of the consensus definition of counseling in the United States.

Aim/Purpose: To develop a definition of counseling endorsed by the profession of counseling in the United States.

Design/Methodology: A two-round Delphi study was utilized to identify conceptual elements of a definition of counseling through gathering and organizing the opinions of delegates from 30 identified organizations representing the counseling profession in the United States. For round one of the Delphi, the organizational delegates were divided into seven workgroups. Each workgroup was tasked with constructing a concise definition of counseling specifically geared for the public and legislators. The resulting definitions were then rated by each delegate using a Likert scale across seven dimensions. Delegates were also asked to list the most common terms that occurred across the definitions. In the second Delphi round, each workgroup was asked to create a completely new definition of counseling utilizing the most highly ranked definitions and the most frequently cited common terms from round one. Delegates then rated the second round definitions.  

Results/Findings: After the second round ratings, one definition stood out as the most highly rated. The delegates made minor modifications and then approved: Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. This definition was subsequently endorsed by 29 of the participating organizations.

Research Limitations: A Delphi assumes that all participants are experts at the chosen task. It is possible that an organizational delegate could have been chosen because of leadership experience rather than the necessary knowledge base for constructing a definition of counseling.

Conclusions/Implications: Having 29 major organizations in the United States agree on one definition of counseling is historic. For the first time ever, diverse counseling organizations have come to a consensus about what it means to engage in professional counseling. From reading the consensus definition of counseling, consumers as well as professionals can get a good sense that counseling is a professional relationship that is meant to empower diverse individuals throughout the lifespan to live meaningful and healthy lives. 

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Finian Fallon

Professional Role: Accredited Psychotherapist in Ireland, completing a Doctorate in Psychotherapy.
Institution: Dublin City University
Contact details: 33 Kildare Street, Dublin 2, Ireland.    
Email: finian.fallon3@mail.dcu.ie

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: psychotherapy regulation, psychotherapy training, psychotherapy policy, psychotherapy accreditation, private sector psychotherapy.

What issues are relevant to the future of private sector psychotherapy in Ireland? A literature review and discussion

Aim/Purpose: Government policy related to private sector psychotherapy in Ireland assumes a Primary Care model. General Practitioners (GPs) are the first point of contact for many with mental distress. There is little statutory regulation of private sector therapy in Ireland. Accrediting bodies provide training and ethical frameworks without government recognition. Terms such as psychotherapist and counsellor are not legally protected. It may be of benefit to consider what issues and dynamics relate to policy and the future impact of these.

Design/Methodology: The study was by way of discussion with experts in the field. A literature review was also completed by carrying out online searches of academic databases using terms such as "psychotherapy policy Ireland", "mental health policy Ireland", "psychotherapy statutory regulation" and "psychotherapy in Ireland". European models of psychotherapy were reviewed and financial figures for the Irish private sector were extrapolated.

Results/Findings: Many factors are at play the developing sector. Differences exist in professional standing between psychiatry, medical doctors, regulated psychologists and unregulated psychotherapy professionals. GPs are the main entry points for mental distress presentations. This position is unquestioned in policy. Difficulties in GPs referring patients to private sector psychotherapy practitioners exist. Training organisations compete with accredited practitioners through the provision of therapy services by trainees.

Research Limitations: The research is small scale and is by way of literature review. There is a lack of research in this area in Ireland.

Conclusions/Implications: Policy may need to evolve based on research and what is best for service users rather than sustaining current structures which are based on historic dynamics rather than a strategic rationale. More research is needed. The benefit of providing trainee services to clients needs review. A lack of statutory regulation is detrimental to the future private sector psychotherapy.

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Merih Fidan

Professional Role: Part-time Doctoral student and part-time counsellor
Institution/Affiliation: Lifelong Learning Institution of Leicester University
Email: merih@fidan.co.uk

ABSTRACT: Paper                                                                                          (Sat, 15.55 - 16.25)

Keywords: interpreters, counsellors, non-English speaking clients, counselling.

A comparative investigation of experiences of interpreters and counsellors in a triadic psychotherapeutic relationship.

Aim/Purpose: To explore interpreters' and counsellors' experiences of counselling and interpreting process in working with non-English speaking clients.

Design/Methodology: Focus groups were used. Data were collected from five interpreters and five counsellors, and was analysed using Thematic Analysis. Ethical approval was obtained from University of Leicester. 

Results/Findings: The themes of ‘Helping Relationship', ‘Third Person in the Room', ‘Uncaring Sector' and ‘Support and Train Me' from the Interpreters data revealed that the interpreters describe their job as a helping and humane relationship with difficulties in dealing with traumatic cases. Common role conflicts included clients making unexpected disclosure and service providers making unnecessary remarks. Significant obstacles for establishing trust were conduit interpreting where only word-for-word translation is offered, and staff's attitudes. Interpreters' needs were training on safeguarding, desensitizing and boundary issues, doing through role plays; also organizational support and supervision.

The themes of ‘Blind Process', ‘Eureka Moment', ‘Learning Process' and ‘Good Practice Issues' were developed for the Counselors data. They described their job as working with risks, highly sensitive issues, cultures, narratives and metaphors. They observed clients as suffering from health and mental health issues and being anxious about the confidentiality. Although they recognized interpreters as gatekeepers into the clients' world, their experiences of three- way relationship indicated broken rhythms and lacking ‘Eureka Moments'! Counsellors' lack of experience, interpreters' background and the specific community issues unpicked learning difficulties were mentioned as the most affecting factors in establishing the trust. Finally, they suggested developing more effective cultural courses and also debates for policy development, and using intercultural models and non-talking therapies.

Research Limitations: This paper reports the findings of the focus groups of the researcher's PhD study only. Generalisation cannot be made due to small number of participants.   

Conclusions/Implications: The data showed diverse concerns and needs for the interpreters and the counsellors. Further qualitative research is therefore needed.

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Julie Folkes-Skinner

Professional Role: Academic and Practitioner
Institution/Affiliation: University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester, LE1 7PA
Email: jafs1@le.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 10.55 - 11.25)

Keywords: trainee, assimilation model, change, counsellor.

The assimilation of problematic experiences during counsellor training: the case of Mandy.

Aim/Purpose: To describe the changes experienced by one, trainee counsellor during professional training.

Design/Methodology: The assimilation model theory proposes that psychological distress is caused by difficulty in assimilating problematic experiences and that these are expressed by clients through specific voices. It provides both a method for investigating client change and an evolving theory that explains that process of change (Elliott, 2010).  Five semi-structured interviews, using the Change Interview Schedule (Trainee Version), (Folkes-Skinner, Elliott, and Wheeler, 2010) were conducted between the author and a trainee enrolled on a postgraduate programme at a British university, over the course of her training. The transcripts of interviews were analysed and the trainee's dominant and problematic voices identified (Honos-Webb and Stiles, 1998). The Assimilation of Problematic Experience Sequence (APES), (Brinegar, Salvi, and Stiles, 2008), was used too.

Results/Findings: The trainee had problematic emotional experiences that emerged in response to the demands of training. The emotional problems that emerged were expressed through two problematic voices Rejected Little Girl and Idealistic Learner. The pattern of assimilation was similar to that of other studies of successful outcome client cases. The inter-relationship between these voices, in particular the use of one problematic voice to conceal a more vulnerable aspect of the self was also identified.  

Research Limitations: Unlike other assimilation model studies interviews were not weekly and important aspects of trainee change may have been missed. This study did not use quantitative measures of distress or function to track trainee change over time and findings are limited by the use of one research method. This study concerned one trainee who successfully completed training.

Conclusions/Implications: These findings may help trainers and trainees to understand the process of change that occurs during training. How trainees assimilate problematic experiences may be a useful indicator of successful training outcome. This study demonstrates how the assimilation model method can be used to study change in non-clients and further informs the development of the assimilation model.

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Jesse Fox 1

Professional Role: Doctoral Student
Institution/Affiliation: University of Central Florida
Contact details: University of Central Florida, College of Education, Orlando, FL 32816
Email: jessefox@knights.ucf.edu

ABSTRACT: Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: Dissociative identity disorder, narratology, qualitative research, therapeutic outcomes, chronology of DID.

Recovering identity: a qualitative investigation of a survivor of dissociative identity disorder (DID).

Aim/Purpose: This poster reports the findings of the subjective experience of a female survivor of Dissociative Identity Disorder (DID). The study used narratology, detailing the participant's lived experience with DID. This poster explains narratological methodology and reports the findings of the study that included three themes: (a) outcomes, (b) chronology of DID, and (c) misperceptions of DID. Lastly, the poster discusses the implications of using narratology to inform counseling research and practice.

Design/Methodology: This study used a narratological method to extract meaning from the participant's story (Hays and Wood, 2011). Narratology consists of "gathering data through collecting their [the participants] stories, reporting individual experiences, and chronologically ordering the meaning of those experiences" (Creswell et al., 2007, p. 240). Furthermore, narrative research has promising potential to inform counseling given its similarity to the therapeutic process-counselors help their clients by hearing and understanding their story (Hays and Wood, 2011; Creswell et al., 2007). After obtaining Institution Review Board (IRB) approval, a participant with a history of DID was interviewed three times using Sideman (2006) three-part, phenomenologically based interviewing strategy. The interviews were analyzed using a three-step process that consisted of developing codes, categories, and themes derived from the transcribed interviews, an analysis strategy common to qualitative inquiry (see Creswell, 2007).

Results/Findings: The results of the interviews suggested three primary themes that comprized the participant's story: (a) outcomes, (b) chronology of DID, and (c) misperceptions of DID. Each theme was composed of several sub-categories: therapeutic outcomes included sub-categories (a) positive outcomes, (a) negative outcomes, and (c) undefined spirituality; chronology of DID included sub-categories (a) abuse history, (b) characteristics, (c) therapeutic implications, and (d) critical incidents; misperceptions of DID was strong enough of a category to be considered a theme in its own right.

Research Limitations: There were two limitations to the study. The one form of data collection and the findings are therefore limited to the self-disclosure of the participant. Also, the results of the investigation cannot be generalized to other individuals who currently have DID.

Conclusions/Implications: There were several consistencies between the participant's story and prior research of DID, suggesting the importance of finding a knowledgeable and empathic professional for later recovery from the disorder.

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Jesse Fox 2

Professional Role: Doctoral Student
Institution/Affiliation: University of Central Florida
Contact details: College of Education, Orlando, FL 32816,
Email: jessefox@knights.ucf.edu

ABSTRACT: Paper                                                                                          (Fri, 12.05 - 12.35)

Keywords: counselor intuition, instrument development, thin slice data, q-methdology, generalizability theory.

The development of the counselor intuition scale (CIS).

Aim/Purpose: The purposed of this presentation is to report the methodology and initial reliability and validity of the Counselor Intuition Scale (CIS), an instrument developed to measure the intuitive ability of counselors based upon pattern recognition theory of intuitive expertise (see Kahneman and Klein, 2009). The theoretical foundation of the instrument and the methodology of item selection and analysis will be discussed.

Design/Methodology: The CIS is a measure of counselor intuition based upon pattern recognition theory (see Kahneman and Klein, 2009), namely that intuitive moments are the result of rapidly recognizing patterns of stored patterns of past experience that are triggered by one's present context. The CIS adapted the methodology of the Profile of Non-Verbal Sensitivity (PONS; Bänziger, Scherer, Hall, and Rosenthal, 2011) using video based items comprising the scale.  Reviewers are encouraged to view the shortened version of the PONS (called the Mini PONS) at http://www.affective-sciences.org/webexperimentation. Furthermore, the CIS was created using the established stages of instrument development (see Allen and Yen, 2002; Crocker and Algina, 2008; DeVellis, 2003). After receiving Institutional Review Board approval, each item depicted a two to five minute segment where a client self-disclosed about a presenting problem. Identified experts were then asked to analyze each item and Q-Methodology factor analysis was used to analyze correlational consensus amongst experts' viewpoints (Dziopa and Ahern's, 2011). Generalizability theory (see Crocker and Algina, 2008) was later used to establish the initial reliability and validity of the CIS.

Results/Findings: A total of 13 clients (12 female and 1 male) volunteered to be counseled on video tape. Each session was then analyzed and 39 segments were identified meeting three criteria: (a) the segment is at least two minutes long but no longer than five minutes, (b) the counselor is not speaking (or is only using minimal encouragers), and (c) the segment has potential to elicit an intuitive response. A total of six experts were identified who provided their intuitive response to each segment. Each then rated by approximately 40 experts for their accuracy. The analysis of the expert review is still in process. However, the findings will be presented at the time of the conference.

Research Limitations: There are various anticipated limitations to the study. All the stages of instrument development will not be completed by the conclusion of the current study. Also, determining how much data is needed for a counselor to trigger his/her intuition in a video clip is somewhat arbitrary and may pose an insurmountable difficulty in gathering expert consensus on the individual items of the CIS.

Conclusions/Implications: The CIS was created to measure the intuitive ability of counselors. The scale is based upon pattern recognition theory of intuitive expertise and is therefore a measure of professional mastery of counselors.

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Isabel Gibbard

Other Author: Terry Hanley

Professional Role: Counsellor
Institution/Affiliation: Lancashire Care Foundation trust
Contact details: West Lancashire Primary Mental Health Team, Bickerstaffe House, Ormskirk Hospital, Wigan Road, Ormskirk, L39 2JW
Email: Isabel.gibbard2@lancashirecare.nhs.uk

ABSTRACT: Paper                                                                                          (Fri, 14.25 - 14.55)

Keywords: grounded theory, client experience, responsiveness.

Responsiveness: a predictor of positive therapeutic outcome.

Aim/Purpose: This paper investigates clients' experiences of Cognitive Behavioural Therapy (CBT) and Person Centred Therapy (PCT) in primary care. The aim was to inform the assessment process whereby prospective clients are assigned to the two different therapies.

Design/Methodology: A total of 16 clients responded to unstructured interviews (PCT = 9; CBT = 7) to talk about their experiences of therapy. The resulting transcripts were analysed using grounded theory methodology. Transcripts were broken down into meaning units and assigned to categories, using the constant comparison method. The categories were integrated, a core category conceptualised and a theory generated. 

Results/Findings: A comparison of the accounts revealed similar and contrasting experiences. The main categories (e.g. accessing therapy, engaging with the therapy) corresponded to the client's journey through therapy. All participants entered therapy with a particular view of reality. In successful therapy this view changed and they went on to manage their lives in a more constructive way.  Participants attributed this change to different elements of the therapy (categorised as the trick) which brought about a new understanding (the key). Where therapy was unsuccessful this did not occur. The mechanism of change was personal to the individual and not specific to either therapy. Some were to be expected (e.g. carrying out tasks in the CBT group). Others appeared counterintuitive (e.g. putting me straight in the PCT group). The differences and similarities appeared to be due to the client's capacity to respond to the therapy offered or to the therapist's capacity to respond to the individual needs of the client. The core category reciprocal responsiveness was chosen to explain this. 

Research Limitations: The study is limited to two therapies within primary care. Future studies may consider clients experiences within other settings and with other therapeutic approaches.  

Conclusions/Implications: The findings suggest that the ability of the therapist and client to respond to each other will affect the outcome of therapy. This has implications for the assessment process, in determining the prospective needs of the client in addition to a diagnosis. It also contributes to the growing body of literature emphasising the importance of therapist responsiveness rather than strict adherence to one therapeutic approach.

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Jayne Godward

Professional Role: Senior Lecturer
Institution/Affiliation: Leeds Metropolitan University
Email: j.godward@leedsmet.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 12.05 - 12.35)

Keywords: conflict management, tutors, trainee counsellors, grounded theory, embedded approach.

How do tutors manage conflict which occurs in their relationships with students on counsellor training courses? 

Aim/Purpose: Conflict is a common feature in counsellor training between students and tutors.  There has been very little research into this area. The aim of this study was to find out how lecturers in counselling managed conflict in the relationships between themselves and their trainee counsellor students.

Design/Methodology: Nine participants were recruited mainly through convenience and snowball sampling. Seven participants answered questionnaires with open ended questions and four participants took part in a focus group, two taking part in both. Data collected was analysed using grounded theory methods.

Results/Findings: The core category, ‘An Embedded Approach to Conflict Management' was identified. This was made up of two sub-categories: ‘Learning and Teaching' and the ‘Supporting Framework'. Successful resolution was seen as a process which involves reflection by both student and tutor, student development and resulting progression in their training. The ‘Supporting Framework' emerged as a major theme involving contracted communication between different parties involved in the student's training, the co-tutor, the organisational context and management, as well as team supervision. All parties involved in the student's training need to co-operate and work together to support the tutor and to help the student succeed in his/her training.

Research Limitations: Small sample size and lack of diversity in participants may mean that it is difficult to generalise the findings of this study to counsellor training across the UK and in all types of educational establishments. More time was needed to reflect upon data and develop the grounded theory.

Conclusions/Implications: From the findings of this limited study, it appears that effective conflict management should not be seen as a mere strategy or something separate from the teaching and learning on counselling training programmes, instead a model is proposed whereby conflict management is embedded into the curriculum and course structure and the tutor is supported by a framework made up of different parties working together towards the same end. Future research could involve a wider sample from different types of educational institution. It would also be useful to look at the student perspective on student-tutor conflict to see if this supports what has been found in this study.

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Rebecca Gray

Professional Role: Research Associate
Institution/Affiliation: National Centre in HIV Social Research (University of New South Wales, Australia)
Contact details: National Centre in HIV Social Research (UNSW) John Goodsell Building, Sydney, NSW 2052, Australia
Email: rebeccagrayresearch@gmail.com

ABSTRACT: Paper                                                                                          (Fri, 12.05 - 12.35)

Keywords: shame, stigma, addiction, silence, coercion.

Professional accounts of client shame and silence when counselling in alcohol and other drug settings.

Aim/Purpose: Shame and its connection to problematic alcohol and other drug (AOD) use has been widely theorized, however, less is known about the effect of treatment settings when counselling clients presenting with shame. This study sought to explore the effect of AOD treatment settings on shame in counselling.

Design/Methodology: Seventeen qualitative interviews were gathered from frontline workers in Australia. The principles of grounded theory informed the analysis which prioritized an inductive approach. The in-depth, semi-structured interviews were designed to elicit responses about participants' perceptions of shame, AOD use, treatment settings, and developing a therapeutic relationship.

Results/Findings: Three major insights were developed through this study. First, shame is entangled with the stigmatisation of problematic AOD use, and, second, the labels ‘addiction' and ‘dependence' are value laden and not clearly defined. The third insight is that clients are positioned in complex ways to their treatment, which was described as having the potential to significantly disrupt the counselling process. Participants provided insights about the collision between the multifactorial determinism of problematic AOD use and social edicts, which define certain drugs as illicit and certain behaviours as pathological. This collision appeared to lead to a series of inherent contradictions in treatment goals. As such, when developing a therapeutic relationship it is possible that client-silence is attributed to their mortification, when in fact it could be a reaction to the treatment setting.

Research Limitations: Professionals only provide one perspective from which to understand the dynamics of shame in AOD counselling. While this study cannot contradict established research, the interview material is able to problematise the underlying assumptions and practices associated with AOD counselling.

Conclusions/Implications: Research to date has not fully accounted for the effect of directive treatment settings on AOD counseling. This presentation provides professional insights about the complexity of shame in talking therapy and raises awareness about the impact of the setting on the clinical encounter, particularly, how professionals interpret silence in counseling sessions.

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Suzy Hansford

Professional role: Psychotherapist/counsellor / University of Leeds
Institution/Affiliation: University of Leeds Student Counselling and private practitioner
Contact details: 49 Great George Street, Leeds, LS1 3BB
Email: suzy@suzyhansfordcounselling.co.uk

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: autoethnography, narrative research, reflexivity, use of self, transformation.

Emerging from the resistance - using autoethnography as a research method to understand resistance.

Aim/Purpose: To describe the process of carrying out a transformational research study using autoethnography to understand the writer's emotional relationship with food. The aim of this poster is to explore the use of self as a psychotherapist and researcher and the ways in which this can transform and inform practice, as a less traditional method of research.

Design/Methodology: The poster describes the writing of a narrative study using autoethnography. The method was a systematic collection of journal entries and then carrying out a reflexive analysis of the material. The narrative derives from using a number of different tools to explore a very personal struggle for the researcher, which reflect issues brought by clients - that of an emotional relationship to food and disordered eating behaviours. The methodology used brought difficulties which reflect the socio-cultural context of the study and give a useful insight for practice. For example the meanings given to food and the impact these have. The research design evolved constantly, as the insight of the researcher became increasingly reflexive.

Results/Findings: The findings are methodological.

  • 1. They show that autoethnography as a research method can be transformational, both in terms of the researcher's personal insight and developing deeper empathy with clients, by using herself as the researcher and researched.
  • 2. The resistance to the process of writing the study mirrors resistance experienced by clients to make changes, and gave the researcher the opportunity to find creative ways to work with resistance. This benefits psychotherapy practice by increasing attunement to a resistant client and working with them to find ways through this.
  • 3. The identification of resistance to acknowledging disordered eating and to carrying out the research run in parallel.

Research Limitations: This research is limited by the fact that it is one person's experiences and cannot be used as a generalisation, although it may have some resonance with other therapists.

Conclusions/Implications: Research in psychotherapy and counselling could benefit from using methods which are reflective of the ways in which therapists work. This study demonstrates that this type of research is directly accessible and relevant to practitioners. It also highlights the socio-cultural context to understanding personal experience.

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Jane Hunt   

Professional Role: Lecturer in Counselling     
Institution: Keele University    
Contact details:  School of Psychology, Dorothy Hodgkins Building, Keele University, ST5 5BG.    
Email: j.a.hunt@keele.ac.uk    

ABSTRACT: Paper                           (Fri, 15.55 - 16.25; repeated Sat, 15.20 - 15.50)                                                                                                       

Keywords: transgender, counselling, psychotherapy, survey, interviews.

An exploration of transgender people's experiences of seeking and receiving counselling or psychotherapy within the United Kingdom.

Aim/Purpose: There is a significant gap in the literature regarding transgender people's experiences of seeking and receiving counselling or psychotherapy within the UK outside of gender identity clinics.  A recent systematic review identified that, excluding research relating to gender identity clinics or successful gender transition, there were only two papers relating to transgender clients' experiences of counselling, both of which report research conducted in America which is not directly transferable to the UK (King et al. 2007). We therefore know little about when transgender clients seek therapeutic help, whom they seek help from, and what their experiences of counselling or psychotherapy are.

This paper will present findings from a research project investigating transgender people's experiences of seeking and receiving counselling in the UK. The research has been funded by a BACP Seedcorn grant.

Design/Methodology:  Data was collated via an online survey circulated to transgender support organisations and through six semi-structured follow up interviews. Survey data was analysed using descriptive statistics and thematic analysis (Braun and Clark, 2006).

Results/Findings: The majority of participants sought counselling on two or more occasions and received from 2 to 12 sessions. Counselling was sought prior to transition or whilst coming out. The NHS or the private sector were the main source of counselling support. Participants sought counselling for a variety of reasons, but anxiety and depression, gender confusion, suicidal ideations, low self-worth, and isolation were significant factors. There are a range of issues participants perceive to have helped or hindered their experience of seeking and receiving counselling, but a therapeutic relationship in which they felt cared for and respected was key to a good therapeutic experience.

Research Limitations: This was a small scale study and findings cannot be generalised to the UK transgender population.

Conclusions/Implications: This research provides empirical evidence regarding transgender clients' experiences of seeking and receiving counselling or psychotherapy within the UK. It should be of significant value to counselling practitioners working with this client population, and those involved in counselling training.

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Jindy Johal

Other Author: Clare Symons

Professional Role: Counsellor and Psychotherapist  
Institution/Affiliation: University of Leicester
Email: jindyjohal@hotmail.com

ABSTRACT: Paper                                                                                          (Fri, 10.55 - 1125)

Keywords: language, therapists, unspoken, multilingual therapy, qualitative research.

"No one ever speaks about it." A qualitative investigation exploring the experiences of multi-lingual therapists in practice.

Aim/Purpose: Multilingual counselling has seldom been researched, and the experiences of therapists working in more than one language has received scant attention. The aim of this project was to explore and understand the experiences of counsellors trained in English, when counselling clients using another language.                                                                                                              

Design/Methodology: This research adopted a qualitative methodology, which involved interviewing 11 participants trained in different modalities, counselling in different languages with varied levels of experience. Interviews were audio-recorded, transcribed in full and analysed using thematic analysis. Ethical approval was granted by the University of Leicester and written consent was obtained from all participants.

Results/Findings: The analysis generated 49 subcategories and 15 categories that were structured into four domains. The overarching theme was of experiences not being voiced. Discussion around counselling in a language other than English had not taken place during training, in the workplace, in supervision or with peers. Therapists described a number of difficulties which impacted on client work and themselves, such as feeling isolated, tired, and bearing full responsibility for the work. Participants reported that the differences in their work in other languages often resulted in less effective therapy than with English speaking clients.

Research Limitations: This was a small-scale study. The geographical area and number of agencies offering multilingual therapy is limited, which meant many participants worked for the same agency, and the majority were from London. Different experiences may be reported in other agencies and cities.

Conclusions/Implications: This research suggests that therapists may feel unprepared, unsupported and unsure of the effectiveness of therapy in a language in which they did not train. Additional support and a discussion on multilingual therapy is called for in the workplace, along with specialist training.

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Mohammed Abbas Khan

Professional Role : Associate Psychotherapist  
Institution/Affiliation: Liverpool John Moores University
Email: A.Khan@ljmu.ac.uk      

ABSTRACT:  Paper                                                                                         (Sat, 15.20 - 15.50)

Keywords: South Asian men, therapeutic services, stigma, thematic analysis, access, black magic.

Seeking therapeutic help: comparing British South Asian men's attitudes towards counselling between the first and second generation.

Aim/Purpose: The aim of the research was to investigate South Asian men's attitudes and the barriers they face when considering counselling. Research into the attitudes of men and some of the barriers they face when considering accessing therapeutic services (Good et al 1998, Panganamala and Plummer, 1998) has provided a rich insight for the counsellor; however this insight is missing regarding South Asian men's attitudes when considering counselling. 

Design/Methodology: A qualitative approach has been adopted in this study. Two focus groups of South Asian male participants from the first and second generation were recruited. A sample of 12 men aged between 35 and 65 and all of British South Asian descent were recruited utilising a purposive sampling method (Marchel and Owen, 2007). The data was analysed using a thematic analysis method (Braun and Clarke, 2006). Ethical approval was granted by Newman University College.  

Results/Findings: There were some similarities and differences in both group's results, as both identified that the understanding of western services, stigma, black magic and power would all be issues for men when considering accessing help. The first generation did not identify that being male would prevent them from accessing help, which has been identified in the previous literature (Good., Dell and Mintz, 1989). This group considers ignorance amongst religious leaders, family pressure and a complete lack of understanding as having an impact on them when accessing therapeutic help. In contrast, the second generation expressed that being male would be an issue, as men are seen as being the head of the family within the South Asian community.

Research Limitation: This study was conducted using a small sample of participants, so its findings cannot be claimed to reflect universally all men from the South Asian community. Larger, more representative samples should enhance the external validity in order to gain a further understanding of the problem of stigma in the help-seeking process. 

Conclusion/Implication: There appears to be distinct differences amongst both groups of participants in terms of accessing therapeutic services. The findings of this study added knowledge to the existing literature/professionals in the area of religion, and identified specific barriers which have an impact on individuals accessing counselling.

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Billy Lee

Professional Role: Lecturer
Institution: University of Edinburgh
Contact details: Psychology, 7 George Square, Edinburgh, EH8 9JZ
Email: b.lee@ed.ac.uk

ABSTRACT: Paper                                                                                          (Fri, 15.00 - 15.30)

Keywords: counseling education, listening, talking, lived experience, phenomenology.

Developing understandings of therapeutic listening and talking.

Aim/Purpose: The research purpose was to explore student counsellors' developing understandings of therapeutic listening and talking. Six student counsellors reflected on their listening practices that they had undertaken as part of a postgraduate certificate in counselling skills.

Design/Methodology: Phenomenological interviewing principles were employed to attempt to elicit concrete, experience-near, accounts. Researchers attended to bodily self-awareness, bodily empathy, and intercorporeality, while communicating with the participants. The transcripts were analysed using the method of Interpretative Phenomenological Analysis (Smith and Osborne, 2003). The present study builds on prior work with these interviews concerning a theme of developing therapeutic reflexivity (Lee and Prior, 2012).

Results/Findings: Three themes and associated subthemes captured significant qualities in the students' understandings of the processes of talking and listening: 1. Openness: "I do have to hear them before I hear myself"; 2. Hearing past the speaker: "There's something about now things lingering with me"; 3. Engaging in the moment: "It's meaningful for you both engaged in that moment". Subthemes included: silence, self-scrutiny, agency, otherness, "observing the broader picture", "becoming aware of when the story affects me", mutuality, availability, and the present moment.

Research Limitations: Limitations include that generalization is difficult with a relatively small sample, as phenomenological methods aim to explicate the concrete and particular rather than the universal. Also the study will have been inevitably influenced by the researchers' own interpretative engagement with the data. Reflexivity is integral to this method, namely, attention to the researchers' own fore-understandings and potential impacts on the knowledge generated.

Conclusion/Implications: The findings connect with broader themes of research into both clients' and therapists' understandings of what they are doing together in the consulting room. We draw on hermeneutic, phenomenological and psychotherapeutic concepts to offer new ways to theorize the processes of talking and listening. One practice implication is that by being aware of implicit models of talking and listening, counsellors may bracket or address their own and clients' expectations of the session. We also show that concrete, lived experiences have something to contribute to theory development in hermeneutics, phenomenology and counselling.

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Ruth Levesley

Other Authors: Mick Cooper, Karen Cromarty, Andy Hill, Jamie Murdoch, Jo Pybis, Nick Turner

Professional Role: Chief Executive
Institution/Affiliation: Relate, Birmingham
Email: Ruth.Levesley@relatebirmingham.co.uk

ABSTRACT: Paper                                                                                          (Sat, 15.20 - 15.50)

Keywords: counselling young people, schools, Relate, randomised controlled trial.

Piloting a pragmatic randomised controlled trial for school-based counselling: lessons learned.

Aim/Purpose: The aim of this paper is to present some of the key lessons learned when conducting a pragmatic RCT in the counselling field.  This is a trial which attempts to replicate the real world context in which the therapy is delivered.  In addition, we report on the outcomes of this small-scale RCT of school-based counselling and the implications of these findings.

Design/Methodology: Forty-two young people, across four secondary schools, were randomised to receive either school-based Humanistic counselling or to go on a waiting list for one school term. The primary outcome was change in psychological distress as measured by the Young Person's CORE (YP-CORE). Additonal measures including the SDQ and a goal based outcome measure were completed at all assessment points. Outcomes were assessed, for participants scoring 5 or more on the emoptional symptoms subscale of the SDQ prior to randomisation at baseline and then at 6-week midpoint and 12-week endpoint.

Results/Findings: We were able to recruit an average of about 6-8 participants per school per recruitment phase: approximately 50% of participants assessed being eligible for participation.  The researchers within this trial received one full day's training however, as the trial progressed, it became apparent that some issues that the trainers had taken for granted as being understood by the researchers were not as clear as first thought. There was an issue of counsellor adherence to the intervention. Outcomes indicated trends towards reductions in psychological distress for the counselling group as compared to the waiting list, with effect sizes on the primary outcome measure of 0.39 at endpoint, and 0.59 at midpoint.

Research Limitations: This is a small scale pilot. However, it is hoped it will be able to be extended further and combined with other similiar studies in order for a meta-analysis to be conducted.

Conclusions/Implications: A pragmatic RCT, developed as a collaboration between a service provider, an academic institution and a professional body is feasible, however key lessons have been learned about the practicalities of conducting such a study. This study provides support for the effectiveness of school-based counselling, however further, large scale studies are required.

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Dodie Limberg et al. 1

Other presenters: E H Mike Robinson III, Jesse Fox, Hope Bell, Sandra Robinson, Grant Hayes

Professional Role: Doctoral Candidate
Institution/Affiliation: University of Central Florida
Contact details: College of Education Orlando Florida, USA
Email: dlimberg@knights.ucf.ed

ABSTRACT: Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: altruism, practicing counselors, phenomenological research, model development, culture.

A phenomenological investigation of practicing counselors living in Scotland, experiences of altruistic caring.

Aim/Purpose: This phenomenological investigation sought to describe the lived experience of counselors (n= 9), residing in Scotland, experiences of altruistic caring in their personal and professional lives.  This study is an extension of a research line of qualitative studies focused on a model of altruism development.  The purpose of this study is to focus on practicing counselors common experiences as they relate to altruistic caring, and to describe the phenomenon that occurs within the context of the Altruism Development Model.

Design/Methodology: This study is a phenomenological research design. The research team obtained permission from the institutional review board (IRB) to conduct in depth interviews and record observations. A diverse group of practicing counselors, living in Scotland, were interviewed. Moustaka's (1994) transcendental approach was used to analyze the data in order to provide a new perspective from previous studies. More specifically, the research team conducted horizonalization and developed structural and textural descriptions in order to describe the phenomenon.

Results/Findings: The findings of this study describe the phenomenon experienced by practicing counselors living in Scotland. The textural description of the participants experiences is supported by what altruistic experiences they have had (e.g. everyday acts of kindness), and the structural description is supported by how they experienced altruism (e.g. choosing a career in the helping field). Additionally, the findings provide support for the Altruism Development Model. Participants reported a perceived relationship between altruism and the impact it has on their professional practice.  

Research Limitations: The limitations for this study include the presence of the interviewer may have impacted the participants responses, and the participants may not be able to equally articulate their responses. Additionally, the biases of the researchers may influence the findings.

Conclusions/Implications: The findings have implications for the counseling profession. The findings supports future research aimed at investigating practicing counselor's experiences in other cultures.

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Dodie Limberg et al. 2

Other presenters: E.H. Mike Robinson III, Sandra Robinson, Grant Hayes

Professional Role: Doctoral Candidate
Institution/Affiliation: University of Central Florida
Contact details: College of Education Orlando Florida
Email: dlimberg@knights.ucf.ed

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: structural equation modeling, quantitative research, confirmatory factor analysis, correlational research design.

Applying structural equation modeling (SEM) to the counseling field.

Aim/Purpose: The purpose of this poster is to describe the foundational components of structural equation modeling and how it can be applied to research in the counseling field. More specifically, an actual research study focused on counselors' levels of altruism and burnout will be used to exemplify the procedure of applying structural equation modeling.

Design/Methodology: Structural Equation Modeling (SEM) is a confirmatory procedure that is a combination of multiple regression, path analysis, and confirmatory factor analysis (Ullman, 2007).  SEM allows an investigator to test proposed theoretical model that is supported by the literature and provides directionality of relationships, as opposed to multiple regression, in a causal framework (Lambie, 2007; Ullman, 2007; Graziano and Raulin, 2004). The results generated from SEM can only be applied to the sample used to test the model; additionally, SEM can be used in experimental and non-experimental designs but is most often used in correlational studies (Ullman, 2007). The foundational components of SEM will be exemplified in correlational research design study that was completed to investigate the directional relationship between practicing school counselors' altruistic motivation and behaviors to their degree of burnout. Specifically, this investigation tested the theoretical model that practicing school counselors scoring at higher levels of altruism (as measured by the Heintzelman Inventory; Kuch and Robinson, 2008; and the Self-Report Altruism Scale, SRA-scale; Rushton, Christjohn, and Fekken, 1981) would have lower levels of burnout (as measured by the three factors [emotional exhaustion, depersonalization, personal accomplishment] of the Maslach Burnout Inventory-Educator Survey; MBI-ES; Maslach, Jackson, and Leiter, 1996).

Results/Findings: The results of the study support that school counselors with higher levels of altruism have lower levels of burnout. The findings of this study show two dimensions of altruistic motivation: (1) positive future expectations and (2) self-efficacy contribute significantly to all dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment). Additionally, a significant relationship was found between altruism and burnout and self-reported wellness.

Research Limitations: The limitations for this study include threats to construct, internal, and external validity within a descriptive correlational research study.

Conclusions/Implications: Applying Structural Equation Modeling to counseling research provides researchers an opportunity to describe theoretical models of constructs that are not directly measurable (e.g., altruism, burnout).

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Katherine McArthur

Other Authors: Mick Cooper, Lucia Berdondini

Professional Role: PhD student
Institution/Affiliation: University of Strathclyde
Contact details: Counselling Unit, School of Psychological Sciences and Health, Graham Hills Building, 50 George Street, Glasgow G1 1QE
Email: katherine.mcarthur@strath.ac.uk

ABSTRACT: Paper                                                                                          (Fri, 15.50 - 16.25)

Keywords: school-based counselling, Humanistic counselling, change processes, children and young people, qualitative analysis.

Change processes in school-based humanistic counselling: a qualitative interview study.

Aim/Purpose: Despite a recent increase in research into school-based counselling, very little is known about the processes by which it can bring about change in young people. This paper aims to use qualitative data to test and develop a model of change.

Design/Methodology: Interview data from Adapted Change Interviews with 20 young people who have participated in Humanistic school-based counselling will be thematically analysed.  Drawing on Stiles's theory-building case study methodology, this paper will test - and develop - the Humanistic model of therapeutic change.

Results/Findings: Evidence in support of the Humanistic model of personality change is present in the data, but the model of change emerging from these interviews suggests a more pluralistic process, whereby change follows distinctive pathways for each individual, and may include following advice and learning specific skills as well as extra-therapeutic factors such as self-help and relational support.

Research Limitations: This study was devised after data was collected as part of a randomised controlled trial, therefore interviews were not conducted with this purpose in mind. In addition, since the participants were recruited specifically for the purposes of a randomised controlled trial, they may not be representative of young people in school-based counselling services. 

Conclusions/Implications: Change in school-based Humanistic counselling follows a model of change which is similar to that anticipated by Humanistic theory. However, external factors influencing change point to a more pluralistic process.

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Julia McLeod

Other Author: John McLeod

Professional Role: Lecturer in Counselling
Institution/Affiliation: University of Abertay
Contact details: Division of Nursing and Counselling, University of Abertay, Dundee, DD1 1HG
Email: julia.mcleod@abertay.ac.uk

ABSTRACT: Paper                                                                                          (Fri, 11.30 - 12.00)

Keywords: counselling skills, embedded counselling, organisational context, outcome,  process.

Research on counselling skills and embedded counselling: review of methods and findings.

Aim/Purpose: A significant proportion of the counselling that people receive is embedded within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. The present paper has the following aims:

  • to review the different methodological strategies that have been used in research on embedded counselling,
  • to present an overview of research findings in this area.

Design/Methodology: A thematic scoping review was carried out to generate categories of research themes/questions and methodologies associated with this area of practice. Articles were identified by searching on-line databases and contents lists of relevant journals.

Results/Findings: The main research questions within this literature include: evaluating the impact of counselling skills training; the process and experience of counselling skills training; the experience of using counselling skills; the process of seeking help; service user experiences of being recipients of counselling skills; the process of responding to empathic opportunities; organisational factors that constrain the use of counselling skills; qualities of helpful and unhelpful embedded counselling conversations. The main research strategies and methodologies that have been employed are (i) self-report measures; (ii) interviews, and (iii) analysis of conversational and interactional patterns based on recordings of meetings between service users and practitioners. The key findings highlight challenges that practitioners report in relation to acquiring and using counselling skills, the high level of value that service users attribute to effective use of counselling skills by practitioners, and specific difficulties around responding to emotional material. There is a lack of research around the significance of organisational factors in relation to support for practitioners of counselling skills.

Research Limitations: The literature search spanned several professional domains (counselling, nursing, medicine, social work and education) and it is likely that some relevant articles may have been missed. The number of published studies within each topic area was too small to allow confidence in any implications for practice that might be derived.

Conclusions/Implications: A range of robust methodologies have been developed to analyse the process and outcome of embedded counselling. Further research will enhance the quality of training and service delivery.

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Naomi Moller & Andreas Vossler

Professional Role: Associate Head of the Department of Psychology
Institution/Affiliation: University of the West of England
Contact details: Department of Psychology, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY
Email: Naomi.Moller@uwe.ac.uk

ABSTRACT: Paper                    (Fri, 13.50 - 14.20; repeated Fri, 16.30 - 17.00)                                                                                                             

Keywords: perceptions, body weight, fat, qualitative, story-stem.

Assumptions about fat counsellors: findings from a story-completion task.

Aim/Purpose: Fatness is widely accepted as a basis for assuming social and personal qualities of an individual and, due to ‘fat stigma,' the connotations of fatness are very negative (Brewis et al., 2011). It is known that fat bias operates in the work environment (Fikkan and Rothblum, 2012), and it can be hypothesized that therapist fatness will impact not only perceptions of counsellors but also the therapeutic alliance, which has been shown to be a robust predictor of outcome in counselling (Norcross et al., 2011). The scant research base suggests therapist body weight does matter to clients (Vocks, Legenbauer and Peters, 2007) yet this is an under-researched area. This study therefore explores attitudes to and assumptions about fat counselors in three groups: teenagers, university undergraduates and trainee counsellors.

Design/Methodology: The 168 participants, consisting of 75 young adults (16-18 years), 63 university undergraduate students (age 18-33) and 30 trainee counsellors (age 28-46), participated in a story-completion task either online or as a paper-based task. Data was analysed qualitatively using thematic analysis within a social constructionist lens which sought to identify the cultural narratives which the participants drew on to tell their stories.

Results/Findings: The analysis found three themes. The first outlines the strongly negative associations with fat expressed by a majority of participants, who linked fatness to unfashionable dress, dishevelled appearance, lack of personal hygiene and a propensity for junk food. The second theme describes how many participants read fatness as a sign of professional incompetence as a counsellor, for example as an indicator of poor mental health. The third theme explores anomalous responses, both stories which appeared to refuse the task and those telling fantastical tales, and suggests that these responses can be conceptualized as different ways for fat-anxious participants to manage internalised fat stigma.

Research Limitations: The use of story-completion tasks as a qualitative method of data collection is relatively new; this means that there are remaining questions about how to conceptualise and analyse story-stem data.

Conclusions/Implications: The results of this study suggest that fat stigma operates at  a wide range of weights and that perceiving a counsellor as fat may have significant and potentially highly negative meaning for clients. This has implications for counsellors of any body weight and suggests the lack of research in the area is problematic.

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Heather Moore

Professional Role: Practitioner and Masters Student
Institution/Affiliation: Dublin Business School
Email: heddymoore@gmail.com

ABSTRACT: Poster                                                                                         (Sat, 10.00 - 10.30)

Keywords: suicide, vicarious trauma, resilience, burnout, melancholia.

"ALL CHANGED, CHANGED UTTERLY, A TERRIBLE BEAUTY IS BORN." An exploration on the impact of suicide prevention on the experienced clinician.

Aim/Purpose: This research seeks to explore and examine in-depth the impact of suicide prevention work on seven accredited Irish psychotherapists.

Design/Methodology: Semi-structured, qualitative interviews were conducted with seven Irish psychotherapists working exclusively in suicide prevention. The process of interpretative phenomenological analysis (IPA) was applied to the seven narratives. Three from the Humanistic tradition, three Person-Centred therapists and one practitioner from a rational-emotive orientation. A psychoanalytic illumination of the process of suicide was deemed necessary to interpret phenomena and data.

Results/Findings: Three salient superordinate themes emerged from the data: 1) Overworking; 2) Identity Disruption; 3) A Spiritual Practice. Most striking across all seven transcripts was the mix of the corrosive nature of suicide prevention on the self of the therapist, combined with unparalleled opportunities for personal growth and spiritual reformulation. Humanistic practitioners, who were acutely aware of their own sublimation of melancholia, could deeply empathise and journey with their clients. An overarching theme drawn from the findings is the restorative nature of client engagement in the life of the therapist. Alongside this, the egregious effects of meeting the suicide risk surfaced, and participants were "profoundly changed". Dissociation, depersonalisation, omnipotence, narcissistic injury, fetishisation, psychosomatic illness, burnout and vicarious trauma are evident throughout the data.

Research Limitations: There were methodological limitations to the study. This inquiry offers one interpretation of the data and does not claim exclusivity from other possible interpretations.

Conclusions/Implications: The implication for working in these clinical settings highlights the emotional impact of suicide prevention and the need for structuring ways in which staff can process it. The present study highlights how the ‘talking cure' as the ‘love transfusion' or ‘love cure' educates us to the life-promoting attributes of attachment, containment and psychic holding. Conversely, it teaches that the absence or perversion of these properties can manifest as lethal deadliness or a "nameless dread" that can destroy the human spirit.

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Tara Morrey & Alison Rolfe

Professional Role: Counsellor, PhD student
Institution/Affiliation: University of Birmingham and Newman University College
Contact details: Department of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT
Email: TDM592@bham.ac.uk

ABSTRACT: Paper                                                                                          (Fri, 15.00 - 15.30)

Keywords: formulation, integration, Integrative therapy, counselling training, trainee counsellors.

What are trainee counsellors' experiences of developing integrative formulations?

Aim/Purpose:  Research into training in psychotherapy formulation within counsellor training programmes has had little attention. It is suggested that as movement towards psychotherapy integration increases, efforts to develop an Integrative model of formulation will also increase. This qualitative study therefore aimed to explore the experiences of trainee therapists in developing Integrative formulations.

Design/Methodology: Seven third year Foundation degree Integrative trainee counsellors at Newman University College took part in semi-structured interviews to discuss their experiences of developing Integrative formulations. Data were analysed using Interpretative Phenomenological Analysis. Ethical approval was given by Newman University College Ethics Committee.

Results/Findings: Four super-ordinate themes were identified: (1) A search for - how to integrate multi-faceted learning platforms and Integrative formulation processes. This theme focuses on trainees' experiences of trying to pull together several apparently disparate strands without feeling they had a solid base.  (2) A search for - how to receive and connect with Integrative formulation teaching, in which participants responded in a variety of ways to teaching on formulation, including anxiety, and a journey towards insight. (3) A search for - how to develop personal learning strategies in constructing Integrative formulations. Here, thinking activities that were guided by published formulation models and imaginative processes led towards the development of hypotheses. (4) A search for - ways to understand the meaning of formulation. Views of formulation as a ‘guiding process' like a map or a central mechanism, like a ‘heart' were referred to.

Research Limitations: Participants experienced raised anxiety due to final course assignments which may have influenced their interview responses. The interviewer and lead presenter was also an Integratively trained counsellor and may have made assumptions during interviews due to a shared theoretical vocabulary.

Conclusions/Implications: The reception and understanding of Integrative formulation may be impacted by the way ‘integration' is both experienced and taught on Integrative training courses. This may suggest that both processes could be addressed in parallel.  It may be of benefit to make learning processes explicit as part of formulation training. 

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Matthew Munyon & Mark Young

Professional Role: Counsellor Educator and Relationship Researcher
Institution/Affiliation: University of Central Florida, Orlando, FL USA
Email: matt@mattmunyon.com; myoung@cfl.rr.com

ABSTRACT: Methodological innovation paper                                               (Fri, 15.50 - 16.25)

Keywords: dyads, dyadic data analysis, non-independence, statistical methodology.

Dyadic data analysis: a method for examining how shared experiences influence outcomes in couples work.

Background and introduction: Dyads take various forms, such as romantic relationships, supervisor-supervisees, and siblings, among others. Yet assessments of two participants who are the same dyad may not be independent, i.e. a change in one affects the other and the dyad. Dyadic data analysis is a method that allows us to look at two individuals such as a couple and examine how they affect each other and the couple as a whole. In this session, we will examine research we conducted on couples receiving relationship education at the UCF Marriage and Family Research Institute.

Nature of the methodological innovation/critique being proposed: This session will address the need for dyadic data analysis and methods for using it in counselling research.

Conclusion and relevance to counselling and psychotherapy research practice:  Previously counselling research on couples and others dyads such as supervisor/supervisee have treated each member as separate and independent agents without recognizing the need to look at  their effects on each other and the two-person group. By using dyadic data analysis, we can answer questions such as, "Did the couple improve?" "Did the couple's improvement have an effect on the individual's member's symptoms? Similarly, other dyads such as supervision can shed light on the following issues: "Was the supervisee/supervisor relationship productive?" and "Did the relationship have an effect on supervisor and supervisee?"

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Susan Osborne

Professional Role: Volunteer counsellor, Freelance facilitator of reminiscence workshops for older clients 
Institution:
Bower House Counselling Service, Market Harborough, Leics
Email: susan@theosbornefamily.co.uk

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: older clients, poetry, therapeutic groupwork.

Group poetry therapy as a means of helping older clients find a voice: an auto-ethnographic study.

Aim/ Purpose: Research as a tool of professional development: examination of the researcher's practice of facilitating group poetry sessions for older clients. 

Design/Methodology: Small-scale auto-ethnographic study based on the researcher's notes and reflections over seven months as she planned and delivered two poetry workshops to a group of frail, elderly clients in a day-centre situation. Literature review studying use of poetry as an intervention, within a context of existential approaches, with specific attention to application of Rogerian core conditions; overview of literature about needs of people with dementia.   Intervention: performance of poems and group singing of songs around a theme supported by open-ended questions and sensory stimuli, including visual prompts, natural artefacts.   Participants: she consulted day-centre carers as observers of her sessions, using semi-structured interviews after a process of information-giving and informed consent. Ethical approval and supervision provided by Warwick University. Appropriate data protection.

Results/Findings: The researcher developed ways of contracting, evaluation, respecting the autonomy of her frail, older clients. She discovered the importance of self-acceptance as a pre-condition for unconditional positive regard. Well-chosen artefacts triggered memories and drew people in. Group singing and recitation facilitated participation and engagement. Relationships with carers and service provider proved to be vital.

Research Limitations: The self-focus of research method was also its limitation.  The study excluded writing of poetry by participants. Ethical parameters of research precluded disclosure of workshop participants' responses.

Conclusions/Implications: Poetry and song are powerful triggers for reminiscence work with older clients. Therapeutic group work needs to extend to service provider and carers. Self-writing is a valuable tool for professional development.

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Peter Pearce et al.

Other presenters: Ros Sewell and Sarah Osman

Professional Role: Head of Person-Centred Department
Institution/Affiliation: Metanoia Institute
Contact details: 13 North Common Road, Ealing, London, W5 2QB
Email: peter.pearce@metanoia.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 13.50 - 14.20)

Keywords: efficacy, randomised controlled , school-based, Person-Centred.

The ALIGN project: a randomised controlled trial of school-based person-centred counselling.

Aim/Purpose: This study intends to build on the findings of two earlier trials of School Based Person-Centred Counselling (SBPCC) Evaluating the Efficacy of SBPCC and to make a contribution to the evidence base for the clinical effectiveness of counselling in schools.

Design/Methodology: A Randomised Controlled Trial. The principle experimental hypothesis is that, for young people experiencing emotional distress, weekly counselling will be more effective than waiting list conditions after one school term. Referrals will be through the usual Pastoral Care Team route and assessment will be undertaken using the Strength and Difficulties Questionnaire, Rosenberg's Self Esteem Inventory, YP-Core and a Goal Based Outcome Measure at initial assessment and following randomisation, for both experimental conditions after 6 weeks, 3 months (the end of the counselling condition) and then also at 6 and 9 months follow up.  At 3, 6 and 9 months a qualitative adapted change interview will also be undertaken.  All sessions will be recorded and a random selection of recordings will be audited using the Person Centred and Experiential Psychotherapy Scale (PCEPS) scale to ensure adherence to the Skills for Health Humanistic Competency Framework. The sample size will be 60 students for the entire project, randomised to receive counselling or to remain on the waiting list to receive counselling in the autumn term 2013.

Results/Findings: Preliminary results for the study are in line with previous school based counselling studies and are showing positive outcomes. A more in depth analysis of both quantitative and qualitative data is currently in progress.  

Research Limitations: The study is a pragmatic small scale study which takes place within naturalistic settings mapping onto the usual system for referral within school counselling services. The participating schools were inner city London schools in areas of very significant deprivation and cultural and religious diversity. Whilst the schools represented many of the challenges in this setting, individual schools can differ in the makeup of their institutional systems, which could impact the generalizability of the results.                                           

Conclusions/Implications: This project will make an important further contribution to evaluating the efficacy of school based Person-Centred counselling.

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John Petko 1

Professional Role: Addiction counselor/rehabilitation counselor
Institution: University of Central Florida
Email: jpetko2009@knights.ucf.edu

ABSTRACT: Paper                                                                                  (Fri, 14.25 - 14.55)

Keywords: counselor education and development, interest in research, research self-efficacy, research mentoring.

Counselor Education doctoral students' levels of research self-efficacy, interest in research and research mentoring: a cross-sectional investigation.

Aim/Purpose: To discuss results of dissertation research on doctoral student in the field of counselor education (from a national sample of counselor education doctoral students) with regards to research self-efficacy, interest in research and research mentoring.

Design/Methodology: Quantitative research design employing survey methodology. A sample of 261 doctoral students in counsellor education were asked to complete:

1) The Research Self-Efficacy Scale (RSES) - a 38-item scale designed to measure doctoral students' research self-efficacy. 

2)  The Interest in Research Questionnaire (IRQ) - a 16-item scale designed to measure doctoral students' interest in conducting research-related activities. 

3)  The Research Mentoring Experiences Scale (RMES) - a 28-item questionnaire designed to measure the mentoring experiences of doctoral students with respect to research-related activities.

Statistical analysis includes cross-sectional correlational design and structural equation modeling. 

Results/Findings: A positive correlation was observed between the relationship of research self-efficacy and interest in research. A negative correlation was observed between research self-efficacy and research mentoring experiences. No significant relationship was observed between interest in research and research mentoring experiences. Structural equation modeling results were not parsimonious to recommend continuation of the use of SEM.

Research Limitations:

  • 1. Study was non-experimental in design.
  • 2. Low response rate of 40.7% from programs requested to participate in study.
  • 3. The variables in the study were examined ex-post facto or after they occurred. No manipulation of the variables occurred.
  • 4. Response to survey items was self-report.
  • 5. The study was cross-sectional and correlational in design which does not allow for causation.

Conclusions/Implications: There was an inverse relationship between research self-efficacy and research mentoring. The results of the structural equation modeling did not improve the relationship of research mentoring (as measured by the Research Mentoring Experiences Scale) on research self-efficacy (as measured by the Research Self-efficacy Scale) due to its correction for measurement error in the instruments.

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John Petko 2

Professional Role: Drug Court Counselor, graduate University of Central Florida PhD program.
Institution: University of Central Florida
Email: jpetko2009@knights.ucf.edu

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: counseling theory, theoretical orientation, counseling students.

Selecting a theory of counseling: what influences a counseling student to choose?

Aim/Purpose: To examine how master-level counseling students acquire their theoretical counseling orientation.

Design/Methodology: Qualitative study involving structured interview questions was administered with 19 master's level students in a graduate counseling course covering theories of counseling. A section of a counseling theories course was contacted to gain permission to interview potential participants. The class size was 37 students of which, 19 agreed to participate. Participants were divided up among 7 interviewers and asked to respond to a 7-item open-ended questionnaire and complete a 9-item Likert scale on theory selection. Results of the questionnaires were compiled for common codes and themes amongst the participants. 

Results/Findings: The response themes of the participants included such themes as: 1) counseling theory is similar to my personal value system; 2) the theory makes sense logically; 3) I like the techniques this theory uses, etc. Implications from the study are also discussed. Counseling students oriented to counseling theories based on: 1) logic of theory; 2) similarity of theory to own worldview; and 3) usability of counseling techniques.

Research Limitations: The study is qualitative in nature and is only specific to the participants involved. Study only evaluated the participants at the beginning of their counseling studies and not at the end. 

Conclusions/Implications: The participants in the study were showing orientations to counseling theory based on: 1) worldview; 2) techniques employed: 3) logic of theory.

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Lynne Phillips

Other Author: Alison Rolfe

Professional Role: Counsellor
Institution/Affiliation: St Martin's Centre for Health and Healing, Birmingham
Email: lynne-moira@hotmail.co.uk

ABSTRACT: Paper                                                                                          (Sat, 10.55 - 11.25)

Keywords: client writing, IPA, clients' experiences, Psychodynamic.

Words that work?  Exploring client writing in therapy.

Aim/Purpose: To explore from a Psychodynamic perspective  the experience of clients who wrote voluntarily whilst in therapy.

Design/Methodology: Five participants were recruited through the researcher's professional networks using snowball sampling. All participants had chosen to write whilst in therapy, and had shared (in some way) what they wrote with their therapists. Ethical approval for the study was given by the Ethics Committee of Newman University College, Birmingham. Participants were initially asked to write a descriptive account of how they had used writing whilst in therapy. Following this, they took part in a semi-structured interview, in which the written account was used as an initial prompt. Analysis was carried out using Interpretative Phenomenological Analysis.

Results/Findings: There were 5 super-ordinate themes: (i) Catharsis, (ii) Containment, (iii) Writing and the self, (iv) continuation of the therapy, and (v) Communication.  The study found that clients used their writing to create a safe container for unmanageable material, for the hidden or ‘true self', and to hold onto and internalise the therapeutic process.  Writing was also used to explore the unconscious self, and when shared with a therapist, could help the client to communicate, re-own projections depositing in their writing, and work towards self-acceptance.

Research Limitations: The study used a culturally homogenous sample, and included 3 participants  who were counsellors themselves. It would have been enlightening to have been able to explore the experience of the counselling dyad for those who brought writing to therapy, but this was outside of the research remit for this paper.

Conclusions/Implications: The study's findings suggest that working with clients' writing within a Psychodynamic framework could be helpful, enabling the self to be heard, when speaking out may yet feel too threatening.  This may have relevance for specific client groups who may be avoidant of face-to-face counselling.

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Wendy Platt

Professional Role: Counsellor, supervisor, trainer
Institution/Affiliation: University of Newport
Email: wendyplatt@btinternet.com

ABSTRACT: Paper                                                                                          (Sat, 15.20 - 15.50)

Keywords: discourse, supervision, regulation, support, BACP.

An analysis of contemporary supervision discourse.

Aim/Purpose: The purpose of this research was to explore contemporary supervision discourse and highlight its potential influences on the dynamics of counselling/psychotherapy in practice: To bring into focus how supervision is presented so that accepted or familiar ideas about its nature and purpose might become more open to challenge and change.

Design/Methodology: A discourse analysis examining how the meaning/s of supervision has been constructed in published texts within the context of an intensifying regulatory gaze on the practice of counselling/psychotherapy in this country.  The study explored the role of the BACP in presenting supervision through its publication Therapy Today and how this might influence current practice. The data for study was generated by an online search of the term Supervision via the website http://www.therapytoday.co.uk/ providing a composite of texts ranging from the generic BACP News, to articles, to book reviews, to information on conduct hearings, presenting a snapshot of a year in the life of supervision discourse constructed by the BACP through its publication.

Results/Findings: The analysis revealed a variety of ways in which the supervision discourse has attempted to reconcile the apparent opposition inherent in supervision's design to nurture the developing practitioner and inspect their practice to ensure quality control.  The BACP construct of supervision as presented in Therapy Today, however, did not appear to acknowledge the same tensions.

Research Limitations: The data generated was subject to the fallibility of an online search and its "quality" was potentially unstable and sporadic.  To avoid personal bias, all the data was included in the study which meant there was a risk of reinforcing and even accentuating certain hierarchies of meaning/s, thereby generating further possible tensions within the discourse.

Conclusions/Implications: The complexity and perhaps contradictory nature of supervision is compounded by the BACP's apparent lack of acknowledgement of these tensions.  This absence of transparency potentially causes confusion regarding accountability within therapeutic practice.  This risks generating a culture of reproach and censorship rather than openness and honest reflection which is more likely to jeopardise good practice rather than encourage it.

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Sue Proudlove

Professional Role: Counsellor (school-based and private practice)
Institution/Affiliation: MA Dissertation, University of Wales, Newport
Email:  sue.proudlove@talk21.com

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: counsellors, faith, heuristic, self-disclosure, supervision.

Faith, self-disclosure and congruence: counsellors' experiences and perceptions.

Aim/Purpose: The purpose of this project was to explore the perceptions of counsellors regarding the place of their personal religious beliefs in their work with clients in secular contexts. In particular, the study aimed to explore experiences and challenges related to self-disclosure and congruence, with a view to identifying possible implications for practice and supervision.

Design/Methodology: The research was carried out qualitatively, using semi-structured interviews of six qualified Integrative counsellors. The use of heuristic-style research methods enabled the researcher to include herself as a participant. Analysis, based on Moustakas' guidelines (Moustakas, 1990), involved initial immersion in the data, leading to categorisation of themes and experiences emerging in interviews. A ‘composite depiction' gathered together common themes among the participants' responses, and a ‘creative synthesis' aimed to present the ‘essential meanings of the phenomenon' (ibid). Ethical approval was granted by the University.

Results/Findings: All the practitioners interviewed regarded their faith as important to them in their work, but views on the appropriateness or otherwise of self-disclosure on matters related to faith varied widely. All participants took personal responsibility for their decisions about these matters, but supervision did not appear to be an active part of their discernment, either because it had not seemed relevant, or because practitioners had not felt ‘safe' or understood when discussing faith-related issues.

Research Limitations: Although the researcher did not wish to exclude participants from any established faith community, the counsellors who responded to advertisements and mailings were predominantly members of Christian denominations. The small sample and limited range of backgrounds may affect the generalisability of the study.

Conclusions/Implications: The study depicts counsellors integrating their personal faith into their practice, whether implicitly or explicitly, with reference to their own perception of therapeutic need and ethical propriety. The fact that some do not feel able to access support on faith-related issues through supervision suggests that practitioners and supervisors might benefit from dialogue and increased mutual understanding around these issues.

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Jo Reader

Professional Role: Counsellor
Institution/Affiliation: Self Employed
Email: jo@joreader.com

ABSTRACT: Paper                                                                                          (Fri, 15.00 - 15.30)

Keywords: discrimination, fat/obesity, oppression, women, stigma

Fattitude: stigma and the fat body.

Aim/Purpose: the aim of this study is to research whether it is possible for therapists to avoid reinforcing the stigma of fat to clients, exploring how omnipresent societal attitudes can affect the ability of therapists to remain non-judgemental. The intention is to:

  • portray an experience of being fat which is not found in existing literature
  • invite counsellors to consider their own beliefs and values in relation to fat
  • encourage counsellors to explore how unconscious fat prejudice may leak into the counselling room and the subsequent impact on the therapeutic relationship.

Design/Methodology: The data is presented through auto-ethnographical accounts of the author's struggles with being fat, from discrimination and oppression faced every day, to a personal turning point towards self-acceptance through therapy. It is followed by a semi-structured interview with the author's therapist to explore how she appeared so unbiased and avoided bringing into the relationship the commonly held societal belief that fatness must be changed. The stories are told through memories, conversations and journal extracts.

Results/Findings: Analysing themes that arose both in the author's experiences and in the views of the therapist whose practice was non-discriminatory, the study discovers it is possible that societal and personal prejudices can be kept out of the therapeutic relationship, and that clients can expect not to be stigmatised; however, it finds general awareness to be neglected and inconsistent when applying ethical principles and core conditions to fat clients. Attitudes appear to be rationalised on the grounds that fat is unhealthy and therefore can be excused from the counselling ‘basics'.

Research Limitations: This is just one middle-class, white, female's experience, therefore not necessarily the experience of all fat people. This research would benefit from accounts across class, colour, culture, sexuality and gender; furthermore, whether fat oppression exists in counsellors to the same degree as it appears socially is debatable without more extensive research from a cross-section of the profession.

Conclusions/Implications: The findings are intended to provide more effective counselling through awareness that we sometimes unknowingly stigmatise and discriminate against fat; therefore, counsellor self-reflexivity in relation to fatness should be exercised in the same way as all other areas.

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Biljana van Rijn

Other Author: Ciara Wild

Professional Role: Head of Clinical and Research Services
Institution/Affiliation: Metanoia Institute
Email: Biljana.Vanrijn@metanoia.ac.uk

ABSTRACT: Paper                                                                                          (Fri, 10.55 - 11.25)

Keywords: research clinic, routine outcome evaluation, Humanistic counselling, Integrative psychotherapy, counselling psychology.

Research clinic: routine outcome evaluation of humanistic and integrative therapy.

Aim/Purpose: To evaluate routine outcomes of Humanistic and Integrative psychotherapies (Transactional Analysis, Gestalt, Integrative Counselling Psychology) and Person Centred counselling by: measuring a  reduction in scores on  measures for depression; anxiety and general well-being; comparing the effectiveness of different theoretical orientations and monitoring the adherence to the model in clinical supervision.

Design/Methodology: Methodology was a naturalistic, non-randomised, evaluation of routine outcomes. Therapy was evaluated using: sessional measures (GAD7; PHQ9; Core 10); pre and post measures (BDI-II; CORE 34) and adherence questionnaires every six sessions.

Results/Findings: 67 therapists and 321 clients took part. There was a high percentage of completed data sets (over 90% for sessional measures). The outcomes showed that clients who continued in therapy after the assessment period, achieved a significant improvement on measures for depression, anxiety and general outcomes. There were no differences in effectiveness between theoretical orientations despite high levels of adherence to the model. Levels of attrition and length of therapy were analysed additionally. The analysis of attrition and requests to change therapists during the assessment period showed that, once their request was met, clients achieved the same levels of improvement as those who made a good working relationship with their initial therapist. Analysis of the length of therapy showed that a number of sessions varied between clients, but was not directly related to the outcomes.

Research Limitations: Limitations were relevant to the methodology of naturalistic research: no randomisation or control groups and limited monitoring of therapist techniques in sessions.

Conclusions: The outcomes showed that clients who attended counselling after the assessment period made statistically significant improvements. This demonstrated that these approaches could be used effectively in the treatment of anxiety and depression within a community setting, as well as for difficulties related to general wellbeing. Additional analysis demonstrated an importance of the clients' choice of therapists and the length of therapy. Further research is needed to establish full efficacy of these approaches.

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Coral Russell & Anne Napier

Other Authors: Hayley Shaw, Jacqui Banton-Laurance, Lisa Daw, Sophia Basran and Zarife Akkaya

Professional Roles: Trainee Counsellor
Institution/Affiliation: LCandCTA (Lewisham Counselling and Counsellor Training Associates)
Contact details: c/o Juanita Harriot, LCandCTA, Broadway House, 15-16 Deptford Broadway, Deptford, London. SE8 4PA
Email: c/o Juanita.harriot@lcandcta.co.uk

ABSTRACT:
Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: sex-addiction, diagnosis, treatment, person centred approach (PCA), label.

Person-centred counsellors' experiences of working with sex addiction.

Aim/Purpose: Sex addiction is not currently included as a disorder in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM - IV) (APA, 2010) and there is a debate about its classification (Fong, 2006).  Despite this, treatment models such as those based on 12-step theory and practice and therapy such as cognitive behavioural therapy (CBT) and Psychodynamic therapy are favoured (Fong, 2006). The PCA approach is recommended less often. This study aims to explore the PCA as an alternative treatment option.

Design/Methodology: Three psychotherapeutic practitioners who were trained in the PCA took part in semi-structured interviews conducted by members of the research group. All interviews were recorded and transcribed and all participants had worked with client(s) presenting with sexual addiction. The main question focused on exploring practitioners' experiences of extending the PCA to this client group. Our research was analysed using Interpretative Phenomenological Analysis (IPA) which followed a series of steps including reading and re-reading, initial noting and identification of themes (McLeod, 2011). The project adhered to the BACP ethical guidelines for counselling research (Bond, 2004).

Results/Findings: Our results indicate that Person-Centred therapists did not find the sex addiction label to be a helpful one when working with clients. The main themes inherent in our data indicate the following: PCA focuses on the whole person and their feelings about their behaviour rather than trying to change it; the PCA explores possible underlying issues and other reasons for their behaviour; PCA is extended as a core model but therapists may need to be flexible in their approach.

Research Limitations: The small sample of respondents makes it difficult to assess the relevance of these finding for the wider professional community. Also, due to ethical considerations, clients could not be interviewed as part of the research.

Conclusions/Implications: Person centred counsellors see the PCA as an effective model for working with this client group but for clients to benefit fully, practitioners should adopt a flexible approach to extending this model and be open to offering other skills and knowledge, where appropriate.

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Aaron Sefi

Other Authors: Terry Hanley, Zehra Ersahin

Professional Role: Researcher
Institution/Affiliation: Xenzone Alliance
Contact details: Xenzone Alliance, Lancastrian Office Centre, Talbot Road, Manchester. M32 0FP
Email: aaron@xenzone.com

ABSTRACT: Poster                                                                                         (Fri, 10.05 - 10.30)

Keywords: online counselling, goal-based outcome measure, youth counselling, pluralistic framework, routine evaluation.

A pluralistic study to assess the trialling of a goal-based outcome measuring tool used within an online counselling service for young people. 

Aim/Purpose: To explore whether the inclusion of a pluralistic goal-based outcome measuring tool to a range of outcome measures and demographic data can build a comprehensive picture of the impact of different interventions and therapeutic tools utilised in an online counselling, support and advice service for young people (www.KOOTH.com).

Design/Methodology: This study is part of a routine evaluation and utilises YP-CORE, end of session questionnaires, demographic information and data from the trialling of a new goal-based outcome measuring tool called CoGS (Counselling Goals System).  CoGS not only records goal achievements reported by the young people, but also the corresponding tasks and method are recorded by the practitioner.  These goals are being coded according to the Bern Inventory of Treatment Goals (and where necessary, suing Grounded Theory for previously unclassified goal types), as well as utilising other prominent categories from the literature in order to codify corresponding tasks and methods.

Results/Findings:  As work is in its infancy, and has been delayed due to technical challenges, there are no findings to report yet. We are expecting to record outcome data from over 2000 counselling interventions online and examine implications for how we can measure impact using a range of measures in routine evaluation.

Research Limitations:  As this is a pilot study, it cannot draw decisive conclusions about which interventions are effective with particular client groups, but it can suggest a suitable research design for larger-scale future projects.  At present the lack of available data highlights the double-headed challenge of implementing routine evaluation projects into a busy service alongside using technology to develop outcome measures.

Conclusions/Implications: By trialling CoGS and its use alongside other measures in routine evaluation, we can begin to explore what interventions work for which client groups on-line, and this research design can be replicated in face-to-face services.

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Geraldine Sheedy

Professional Role: CEO/Clinical Director, Counselling Centre. Part-time lecturer (Ireland)
Contact Details: SouthWest Counselling Centre, Emmets Road, Killarney, Co. Kerry.
Email: gmsheedy@gmail.com

ABSTRACT: Paper                                                                                          (Fri, 13.50 - 14.20)

Keywords: between bodies, implicit, intersubjective, relational.

Between bodies: an implicit relational model.

Aim/Purpose: The main aim of this study was to generate a theory of what happens between the body of the therapist and client in a psychotherapeutic setting. The study documented and analysed first-hand therapists' experiences of their own embodied experiences in the psychotherapeutic process.

Design/Methodology: A descriptive phenomenological design was adopted using a grounded theory methodology. Nine female and three male psychological therapists participated in the study. Data were collected through use of Semi-structured interviews and were transcribed and coded in a systematic manner.

Results/Findings: The Core Category of Between Bodies emerged from this analysis which is divided into five sub-categories - including (i) Body to Body (ii) Connection (iii) Somatic Experiencing of Other (iv)Embodied Process and (v) Intersubjective Space. The findings show that when two bodies meet much happens at the implicit level of relating and implicit bodily exchanges take place. A bidirectional, somatic communication occurs which is facilitated by micro-body to body processes. These processes underlie the co-created container of the embodied intersubjective field of client and therapist. This field between the two bodies creates the fertile ground within which Connection and Somatic Experiencing of Other can be attended to, the Embodied Process emerges and the Intersubjective Space is cultivated.

Research Limitations: The researchers own background may have impacted on the interaction with participants, and meaning could have been attributed to the actions and behaviour of participants. Furthermore, the data collection relied on participant recall, which could be unreliable. Participants' perspectives and experiences of what happens between the body of the therapist and client during therapy does not necessarily reflect the client's perspective.

Conclusions/Implications: Findings describe a theoretically salient Implicit Relational Model of what happens between bodies in the psychotherapeutic encounter. This research highlights the importance of exploring and attending to implicit processes. The findings are discussed in relation to current research on neuroscience, trauma theory and infant studies. Such theory will add to knowledge and understanding of the implicit intersubjective field of the therapeutic relationship. It will also help to inform specific recommendations for supervisors, trainers, therapists and researchers.

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Trevor Smith & Sandy Francis

Professional Role: Counsellor, Supervisor and Trainer in Private Practice.
Email:  info@newdirections.counselling.co.uk

ABSTRACT: Paper                                                                                          (Sat, 14.25 - 14.55)

Keywords: supervision, addictions, counselling, motivational model.

Aim/Purpose: This paper introduces a new model of supervision, designed to be used with anyone who is undertaking client work within an addictions setting. The model was developed as a result of previous research by the authors where the outcomes suggested that workers within various addictions settings did not feel that the supervision that they were receiving was effective. Our research question was "Do supervisees feel more satisfied with supervision, compared to previous experiences of supervision, when the 4-Set Model is employed?"

Design/Methodology: The first researcher conducted supervision in 3 separate groups over a period of 6 months. Qualitative and limited quantitative data were gained via questionnaires returned by the supervisees after each session, in conjunction with the supervisor's own observations on the process, to test whether the model offered better outcomes in levels of supervisee satisfaction. The second researcher monitored the process and an element of Action Research took place, as the mechanisms for conducting the research were evaluated and changed as the process of delivering the supervision developed. The model itself also changed and developed as part of this action research modality, until it became the finished article - A Motivational Model of Supervision.

Results/Findings: Both qualitative and quantitative findings suggest that overall the model was well-received by the participants and thought to be better than previous experiences of supervision.

Research Limitations: Only 3 groups were used for this research, and the number of attendees varied: on one occasion only 1 person from a closed group of 5 was able to attend, and on another a group comprised 13 attendees. Overall 28 Sessions were conducted, and so more sessions in more groups would have given a wider data spectrum.

Conclusions/Implications: From the findings it would appear that the new model is effective in encouraging supervisees to become more reflective in their practice, and the managers that were involved reported an encouraging growth in staff self-awareness, both professional and personal. This conclusion is supported by staff and managers where the model is now being employed on a permanent basis.

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Dave Smits

Professional Role: Doctoral student
Institution: Katholieke Universiteit Leuven
Contact details: Afdeling Klinische Psychologie, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium
Email: dave.smits@psy.kuleuven.be

ABSTRACT: Paper                                                                                         (Fri, 15.55 - 16.25)

Keywords: postgraduate program in client-centred psychotherapy, anxiety problems, working alliance, alliance patterns.

Working alliance in client-centred therapy for anxiety: a comparison of successful versus unsuccessful cases.

Aim/Purpose: A study is presented that aims to investigate differences in working alliance between successful and unsuccessful cases and to identify alliance patterns over time.

Design/Methodology: The study involves data from three cohorts of client-centred trainees (n=51). Only clients suffering from anxiety problems were selected (n=27). The selection was based on the initial BSI-NL anxiety score (moderate to severe anxiety). Only the first 20 sessions were analyzed. The RCI on the BSI-NL total score was used to differentiate between successful (RCI > 1.96) and unsuccessful cases (RCI < or = 1.96). The quality of the working alliance was measured by the WAV-12, the Dutch revised version (Stinckens, Ulburghs and Claes, 2009) of the Working Alliance Inventory (Horvath and Greenberg, 1982). To identify if and how the working alliance evolves over time, alliance scores were studied at 5 different moments (at sessions 3, 5, 10, 15 and 20).

Results/Findings:  The majority of the clients (70%) reported a significant positive change in level of anxiety. 30% of the cases was not successful (26% showed changes that were not significant, 4 % worsened). The global quality of the working alliance throughout therapy was evaluated as good, both in successful and unsuccessful cases. There were no significant differences between successful and unsuccessful cases with respect to the different aspects of the working alliance: bond, goal and task aspects.

Research Limitations: Only client-centred trainees were involved in this study, no trainees of other postgraduate training programs. No long-term or follow-up effects were studied.

Conclusions/Implications: Client centered trainees are highly effective in reducing anxiety problems. Although investing in a good therapeutic relationship is often considered to be crucial in any treatment, in this study the alliance quality did not distinguish between successful or unsuccessful cases. Results suggest that other therapeutic ingredients need to be added on top of a strong alliance to increase likelihood of positive outcomes.

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Lesley Spencer

Professional Role: Senior Lecturer in Counselling
Institution/Affiliation: University of Wales, Newport
Contact details: University of Wales Newport, Caerleon Campus, Caerleon, Newport NP18 3QT
Email: lesley.spencer@newport.ac.uk

ABSTRACT: Methodological innovation paper                                               (Fri, 16.30 - 17.00)

Keywords: ethnography, narrative, case study, genetic counselling.

Developing an ethnographic method in order to compare multiple narratives in a genetic counselling appointment.

Background and introduction: The doctoral work presented in this paper forms part of an ethnographic study of one woman's experience of receiving genetic counselling for an inherited cardiovascular condition. The purpose of this exploration is to show how the researcher evolved a new approach to observing and recording the relational dynamics played out in a genetic counselling appointment. Subsequent interviews with participants enabled the investigator to create a multi-layered case study involving positioned re-tellings (Etherington 2002) of the same clinic appointment with the researcher acting as narrator. 

Nature of the methodological innovation/critique being proposed: To record the impact of the clinic dialogue, a process record was created tracking moments of tension (‘bumping places' - Clandinin et al 2006) and empathetic attunement between participants, alongside identifying dominant, subjugated and counter narratives (Andrews 2002). Following post-clinic interviews with participants (triangulation), a case study was produced from the researcher's observations of the clinic, interspersed with the individual voices of the participants at key points of the narrative. The methodology helped the ethnographer to understand the different perspectives of participants and a vignette, exploring the impact of using a photo of a diseased heart as a teaching tool, will be presented to illustrate one of the outcomes of using of this innovative approach. These techniques rely on the observer's ability to record and remember details of the clinic appointment. However official clinic notes confirmed factual information conveyed and the researcher's observations of the potential relational impact were compared to the narratives of individual clinic participants in subsequent interviews.

Conclusion and relevance to counselling and psychotherapy research practice: The resulting case study tracked, over time, the impact of the use of the diseased heart photo on the woman attending clinic and as well as the reluctance of the nursing staff to challenge the doctor about his use of the photo with patients. As a result this study, the clinical team have ceased using such photos with families at risk of heart disease. This methodology would be useful to therapists working with families and small groups, because it enabled the ethnographer to observe and understand how the different agendas of participants in a genetic counselling consultation played out with one another. Also being able to interview the woman over time showed the long-term impact of the genetic counselling she experienced.

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Sheila Spong 1

Other Author: Elaine Davies

Professional Role: senior lecturer/research manager
Institution/Affiliation: University of Wales Newport
Contact details: Faculty of Education, Lodge Road, Caerleon, Newport NP18 3QT
Email: sheila.spong@southwales.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 14.25 - 14.55)

Keywords: school-based counselling, primary schools, discourse, evaluation, Wales. 

Differing discourses/shared commitment: counsellors and teachers discussing a primary school counselling service.

Aim/Purpose: There is as yet limited literature available on counselling delivered in primary schools. This study reports qualitative data from the evaluation of the first 18 months of a schools-based counselling service for 48 primary schools in Newport, South Wales. The study compares the perceptions of head-teachers, link teachers, counsellors and the service manager, identifying barriers to communication.

Design/Methodology: A mixed methods approach was adopted:

  • an e-survey (qualitative and quantitative data) distributed to both the head teacher and the link teacher for counselling in each school.
  • focus groups and interviews with a small sample of head teachers and link teachers.
  • a focus group in which all counsellors in the service participated.
  • an interview with the service manager.

Results/Findings: A substantial majority of those schools which responded were highly positive about the service and saw it as having great potential, with the most frequently stated suggestion being the need for greater availability. Most schools which responded reported few or no difficulties with the service. However, where concerns were identified these were primarily focused on unclear expectations, or differences of understanding between schools and counsellors/ counselling providers.  A small number of schools reported an incongruity between the primary school ethos (especially Early Years) and the language and practices of counsellors.

Research Limitations: As this was an ‘arm's length' internal evaluation, the validity of the findings is limited by the positioning of the authors. These findings do not include perspectives of parents or children. Findings cannot be generalised from a case study of a single service in one geographical area but may form a basis for further exploration.

Conclusions/Implications:

  • Communication between primary schools, counsellors and service provider organisations is complex and requires consistent attention.

The development of a shared discourse between counsellors and school staff may help embed counselling, particularly in infants schools.

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Sheila Spong et al. 2

Other presenters: Lesley Spencer, Judith Mulcahy 
Other Authors: Blanka Hubena

Professional Role: Senior Lecturer/ Research Manager
Institution/Affiliation: University of Wales Newport
Contact details: Faculty of Education and Social Sciences, Lodge Road, Caerleon , Newport NP18 3QT
Email: sheila.spong@southwales.ac.uk

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: counselling research clinic, community, research infrastructure, funding.

Community-based counselling research: piloting a research / practice infrastructure to meet local needs.

Aim/Purpose: Counselling research clinics offer an approach to developing research capacity in counselling by providing high quality counselling at no/low cost to service users, and at the same time advancing knowledge about outcomes and processes of counselling through systematic research activity. This poster describes an innovative approach to such a practice/ research synergy, serving the needs of vulnerable groups in an under-resourced community and drawing on contemporary impetus towards user-led research.

Design/Methodology: A scoping project was undertaken, liaising with community and statutory services to identify groups with highest unmet needs for counselling in the Newport area. Following this, Newport University Community Counselling Service (NUCCS) developed a community-based counselling service for potential client groups including carers, refugees and asylum seekers, gypsies and travellers and the BME communities. The service is largely funded from charitable sources, including the Big Lottery, and the funding includes an element for community-based counselling research.

Results/Findings:  NUCCS has a built-in focus on developing an infrastructure for data collection to facilitate small scale research projects related to meeting the psychological and emotional support needs of those client groups using the service. This data collection infrastructure facilitates the speedy development of small-scale research projects to answer questions identified in conjunction with community group partners, or to support funding bids for more substantial projects. Findings can then be disseminated to and through community partners as well as through the usual academic routes.

Research Limitations: This project is in its first year of development as a community-based service and the long-term sustainability is yet to be shown.

Conclusions/Implications: Adopting an adaptable focus for small-scale research projects and looking at innovative funding sources can enable the development of a research/ practice infrastructure that engages with the principles of user-informed/ user-led research to meet local needs.

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Chomphunut Srichannil

Professional Role: PhD student
Institution/Affiliation: The University of Edinburgh
Contact details: School of Health in Social Science, The University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG
Email: C.Srichannil@sms.ed.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 14.25 - 14.55)

Keywords: Buddhist counselling, counsellors, experience, Interpretative Phenomenological Analysis, indigenous counselling.

Buddhist counselling: an interpretative phenomenological analysis of counsellors' experiences.

Aim/Purpose: Buddhist counselling, which represents an attempt at establishing a culturally appropriate form of counselling in Thailand, is still under-researched. The aim of this research was to explore how this counselling approach operates and how counsellors make sense of their experience of practising Buddhist counselling. This research is part of a wider PhD project which also involves researching clients' experience of Buddhist counselling.

Design/Methodology: A focus group was conducted with five counsellors who had practised Buddhist counselling professionally in Thailand. This was followed by a semi-structured individual interview with each counsellor. Transcripts of the focus group and interviews were analysed for recurrent themes using Interpretative Phenomenological Analysis (IPA), and the analyses of both individual interviews and focus group data were then combined.

Results/Findings: Five superordinate themes were identified: taking up Buddhist counselling; developing the counsellor's personal qualities; the conceptualisation of Buddhist counselling; the impact of practising Buddhist counselling; and evaluating Buddhist counselling. These themes illuminate how these participants understand and give meaning to their experience of practising Buddhist counselling. Central to all the participants' accounts is the acknowledgement that their personal and professional lives are intertwined: they feel that their counselling competence is largely determined by their own personal development, that this development is a result of internalising Buddhist ideas and following Buddhist practices, and that this internalisation plays a significant part in their achieving effective therapy. 

Research Limitations: The study was conducted with a relatively small sample drawn from a homogeneous group of people in one specific cultural context. Further research in different cultural contexts is needed to confirm and/or extend the findings.

Conclusions/Implications: The study suggests Buddhist ideas and practices are useful tools in developing the personal qualities necessary for therapeutic competence. It also offers an example of a culturally relevant counselling approach in a non-Western culture and suggests counselling needs to be indigenized, both in order to be in accord with the local practitioner's personal values and philosophy, and to serve clients more effectively.

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Nele Stinckens

Professional Role:  Professor
Institution:  Katholieke Universiteit Leuven
Contact details:  Afdeling Klinische Psychologie, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium
Email:  nele.stinckens@psy.kuleuven.be

ABSTRACT: Paper                                                                                         (Sat, 12.05 - 12.35)

Keywords:  client-centred psychotherapy, anxiety problems, helpful and hindering events.

Helpful and hindering events in client-centred therapy for anxiety: a comparison of successful versus unsuccessful cases.

Aim/Purpose: A study is presented that aims to map helpful and hindering events that clients report on a session-to-session base and to investigate if there are differences between successful and unsuccessful cases.

Design/Methodology: The study involves data from three cohorts of client-centred trainees. Only clients suffering from anxiety problems were selected. The selection was based on the initial BSI-NL (Brief Symptom Index) anxiety score (moderate to severe anxiety). Only the first 20 sessions were analyzed. The Reliable Change Index on the BSI-NL total score was used to differentiate between successful and unsuccessful cases. The helpful and hindering events were mapped by the Session Evaluation List.

Results/Findings: The majority of the clients (70%) reported a significant positive change in level of anxiety. 30% of the cases was not successful. Over the total sample 92% helpful events were reported. Three subcategories of helpful events were highly represented: Increased insight in personal functioning; increased insight in future possibilities, directions and plans; Self-exploration and Experiencing. Hindering events were only marginally (8%) reported. The most common hindering events were: Lack of self-exploration and Experiencing; Lack of Positive Self-Experiences; Lack of Therapist Engagement and Availability. In the successful cases clients report significantly more events than in the not-successful cases. They report significantly more helpful events but also more hindering events.

Research Limitations: Only client-centred trainees were involved in this study. No long-term or follow-up effects were studied.

Conclusions/Implications: Client-centred trainees proved to be highly effective in reducing anxiety problems. Clients report a high amount of helpful events. They mostly focus on the narrative, experiential and existential dimension to evaluate the quality of the sessions. Behavioral and relational aspects of the therapeutic approach are underrepresented. In the unsuccessful cases clients report significantly less helpful and hindering events. This might indicate that they have problems identifying and anchoring important microprocesses in therapy. This could be due to certain client factors, but the present therapists might also be less able to facilitate or mark these processes.

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Jill Swindells

Professional Role: Qualitative social researcher, Victim Support volunteer and volunteer counsellor (in a rape and sexual abuse agency, a hospice, a prison and a school inclusion unit)
Institution/Affiliation: Warwick University
Email: jill_swindells@ntlworld.com

ABSTRACT: Poster                                                                                         (Sat, 10.10 - 10.30)

Keywords: victim, crime, pre-trial, therapy, counselling.

Counselling victims and witnesses of crime - are they a specialist group requiring specific knowledge or expertise?

Aim/Purpose: To explore how therapists perceive and work with ‘victims and witnesses of crime'(VWC's), particularly at the pre-trial stage, highlight any issues, assesses awareness/use of Crown Prosecution Service (CPS) guidance and develop good practice guidance if needed.

Design/Methodology:  Small-scale qualitative research study to evaluate current sources of relevant information, advice and guidance from the counselling arena, including training/CPD, therapist/agency policies, procedures and practice, Victim Support, Police and CPS sources.  Ten in-depth interviews, using a phenomenological approach, with independent/agency therapists working with abuse/PTSD/trauma/VWC's from 3 key modalities: Person-Centred, Psychodynamic and CBT.  Data analysis was thematic (deductive-latent approach), findings were member-checked and ethical clearance was from Warwick University.  

Results/Findings: A lack of relevant and up-to-date information and appropriate training aimed at or originating from the counselling world on counselling VWC's was evident. Therapists' working with VWC's rarely perceived them as such, so potentially conflicting legal/ethical issues and clients' needs relating to criminal justice were not fully appreciated.  Limited awareness, promotion and use of CPS guidance (2001), along with inadequate counselling supervision and therapist/agency policies, procedures and practice, relating to this client group, risks compromising trials for any clients who may end up going to court.

Research Limitations: Counselling centric, small sample size, lack of participants with pre/trial experience.

Conclusions/Implications: Amongst other possible interventions, such as adopting common terminology for ‘Pre-Trial Therapy', positioning ‘victims and witnesses of crime' as a discrete group would highlight clients' needs, the importance of specialist knowledge/expertise and the implications for counselling practice in relation to criminal justice.  With more awareness, insight and understanding, therapists could better meet the needs of this marginalised group and fulfil a much needed and potentially highly valued role in the criminal justice system.  The time is ripe given that currently CPS guidance is under review and the government are consulting on ‘Getting it right for Victims and Witnesses'.  Implications for practice span the role of professional counselling bodies, statutory/voluntary criminal justice and support organisations, multi-agency training, counselling/supervision training, CPD, supervision, therapists/agencies counselling policies, procedures and practice.

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David Taylor-Jones

Professional Role: PhD Student, trainer and practitioner
Institution/Affiliation: University of East Anglia
Email: d.taylor-jones@uea.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 11.30 - 12.00)

Keywords: training, relationships, development, change, mixed methods.

An interpersonal education: how do counselling students feel their relationships during training affect their professional development?  

Aim/Purpose: This mixed methods study intends to extend our understanding of the experiences that students have during training, an area of research that deserves further study (Grafanaki, 2010). The study explores students' experiences of relationships and associated experiences of change within the context of their transition to becoming qualified counsellors.

Design/Methodology: Ethical approval was granted by the Research Ethics Committee of The University of East Anglia. The study employs qualitative and quantitative methods to explore the participants' experiences of their relationships while on their training courses and any influence they feel these relationships had on their development. Self-selected participants were invited to a series of semi-structured interviews throughout the duration of their training. Sixteen students took part in the study, 9 from a Person-centred course and 7 from a Psychodynamic one. Alongside the interviews the Strathclyde Inventory was employed to provide both reflexive and quantitative material about any changes participants may have experienced whilst on the courses.

Results/Findings: This presentation discusses the findings of the quantitative data which revealed a significant change in participants' perception of their congruence through the duration of their training. Post-hoc comparison of the three phases of interviews suggests that the patterns of these changes were idiosyncratic. Further analysis of change in relation to demographic variables (including gender and course modality) suggests that there is no significant correlation (p= > .05) between change in congruence and these covariates, however potential Type II error cannot be discounted. Preliminary findings from the qualitative material indicate broad themes including, for example, the range of relationships that influenced the participants during their training such as: with their peers, groups, tutors, supervisors, counsellors, clients, chosen theoretical model, academia and career path.

Research Limitations: The sample was relatively small so generalisations will be difficult. For pragmatic reasons the study only covered two modalities and this may also limit the results.

Conclusions: It is anticipated that this study will provide material to extend our understanding of the diversity of experiences that students have during their training. This material will be beneficial to training providers as well as to future students.

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Nicola Terry

Professional Role: Part-time MA student and Counsellor  
Institution/Affiliation: University of Chester
Email: email@nicolaterry.co.uk

ABSTRACT: Paper                                                                                          (Fri, 14.25 - 14.55)

Keywords: diet, nutrition, lifestyle, therapeutic process, heuristic research.

How do counsellors and psychotherapists understand diet and nutrition as part of the therapy process?  A heuristic study

Aim/Purpose: To explore the meaning of diet and nutrition for practitioners and how such knowledge and understanding might be integrated within the therapeutic process. In terms of heuristic study, the researcher wished to further her own understanding of such issues within therapy through interaction and study of participants.

Design/Methodology: This qualitative heuristic study used semi-structured telephone interviews to explore the views and experiences of 6 qualified counsellors and psychotherapists. Using interpretative phenomenological analysis, themes and master themes were identified in the data. Due to the researcher's personal connection to the subject matter, a heuristic approach was chosen with the researcher's process also apparent in the study.

Results/Findings: Diet was of personal importance to all participants, linked to management of own or family's health alongside a desire to approach therapy in a practical manner, seeking to understand the root causes of client's distress more fully. Clients' dietary attitudes and behaviour were also understood to be indicative of ability to self-care.

Research Limitations: A small scale study, all 6 participants were female, self-selecting and with an existing interest in this area. This meant no consideration of male practitioners and with participants' average career length of 27 years, no voice for those less experienced. All participants practised integrated or eclectic therapy meaning other theoretical orientations were not explored. With the researcher as part of this work using the heuristic method, her history and perceptions are understood to influence the design and findings.

Conclusions/Implications: Diet and nutrition were considered personally and professionally in a variety of ways depending on the personal history and education of the practitioner. Implications for practice included the development of a multidisciplinary approach involving a dietary expert, as well as practitioners becoming conversant with the information available pertaining to diet, nutrition, mental and physical health, enabling them to discuss issues with clients competently. A need for training and support from professional bodies for counsellors/psychotherapists in this area was also identified.

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Iris Tinto & Clare Symons

Professional Role: Counsellor in private practice and Mental Health Worker with Mind
Institution/Affiliation: The University of Leicester
Email: iris@enclavecounselling.co.uk

ABSTRACT: Paper                                                                                          (Sat, 13.50 - 14.20)

Keywords: Counsellors, psychodynamic, trainees, therapy, motivations.

"Being hit between the eyes." Exploring what motivates and influences psychodynamic trainees to undertake personal therapy.

Aim/Purpose: Increasingly, many counselling training institutions require trainees to undertake personal therapy, although this is not mandatory on all courses.  This small scale research project sought to study the motivations and influences of trainees who chose to engage in personal therapy during their Psychodynamic training where they were not required to do so. This is an under-researched area and holds importance for its contributions for future trainees to think about personal therapy as part of their own development.

Design/Methodology: Semi-structured, face-to-face interviews were conducted with eight participants who were currently engaged in or who had recently completed Psychodynamic counsellor training. Interviews were audio recorded, transcribed and analysed using Interpretative Phenomenological Analysis.

Results/Findings: Findings were organised into nineteen themes, which constituted five master categories, these being: Psychodynamic training generated the process; Extreme and overwhelming emotions arising within the training; Reaching my essence; Ethical awareness towards self and clients, and Feeling confused and time pressured. The trainee perspective revealed insights into their deepest emotional states during training where they either had a direct or a growing awareness that they were in need of therapeutic help.  The ‘risks' associated with their demanding training, together with confused states of mind, were outweighed by the ‘benefits' of self-knowing as a way into becoming caring, ethical, competent and reflective practitioners who wanted to know themselves and make up their own minds about their therapy decisions. 

Research Limitations: The small number of participants is a limitation of the study as is the focus on Psychodynamic trainees, meaning that these results are not generalizable.

Conclusions/Implications: The implications of the research findings suggest that institutions offering Psychodynamic training may need to incorporate more support and information about the role that personal therapy plays in therapist development, in order to demystify the process of deciding when and how to enter therapy.

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Sara Turner

Professional Role: Masters student
Institution/Affiliation: University of Oxford.
Email: turnersarajane4@gmail.com

ABSTRACT: Paper                                                                                          (Sat, 15.55 - 16.25)

Keywords: psychic skin, counter transference, primitive communication, resistance, space.

The sense of a psychic skin in the consulting room: a qualitative investigation into the psychic skin and how we experience it in the therapeutic relationship.

Aim/Purpose: The study questioned if the psychic skin concept could be useful in the consulting room for practitioners working with children and adults.  The aim was to see if it existed for them, to what extent, and if so how it could be used as a tool for understanding communication in the therapeutic relationship. 

Psychic Skin Definition: The baby has a fear of "falling to pieces", which the mother defends against, and acts as a skin boundary by her touch, gaze, holding, and care of the infants body. If the care is consistent enough, the infant is able to internalize the mother's capacity for containment as its own and make use of ‘introjection', and in doing so establishes a psychic skin boundary to protect itself.

Design/Methodology: I chose Interpretative Phenomenological Analysis (IPA), a methodology developed by Jonathan Smith (2009), and it derives from a phenomenological basis, which looks at the moment-by-moment experience that people encounter through their lived human experience. Research involved semi-structured recorded interviews with nine participants who were Psychodynamic therapists and child psychotherapists.

Results/Findings: 1) Identifying the psychic skin boundary allows for deeper work in the room. 2) Identifying where the psychic skin comes from, and its displacement from the Self. 3) Acknowledging resistance in ‘skin' patients - a link to primitive communication. 4) Combining ‘skin' patients and third space communication.

Research Limitations: Participants who volunteered to do the research may have already been aware of the concept of the psychic skin, or had been open to suggestions about primitive processes.

Conclusions/Implications: The psychic skin concept was useful, in different ways for different participants because it could be related to so many theoretical models, where it was being used in a variety of contexts; therefore it is adaptable in its usage for the individual. Having a sense of the psychic skin boundary around clients allowed the therapist and client to develop a deeper relationship, linking this to the notion that everyone needs a platform, from which to begin to relate to other people. It is from this which the boundary of the self develops, starting from the mother in the earliest relations to the infant.

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Sue Wheeler 1

Other Author: Delia Cushway

Professional Role: Professor of Counselling and Psychotherapy
Institution/Affiliation: University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester, LE17PA
Email: sw103@le.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 15.55 - 16.25)

Keywords: supervision, social work, stress, process, outcome.

Can clinical supervision ameliorate the stresses of safeguarding children in social work?

Aim/Purpose: The purpose of this research was to explore whether the provision of clinical supervision/consultative support by experienced counselling/psychotherapy supervisors could ameliorate the stress of safeguarding social work.

Design/Methodology: A total of 41 social work employees of an urban city council were recruited into the project.  Supervision was provided by 4 highly trained and experienced counselling supervisors and clinical psychologists. The intervention involved 15 sessions of individual or group supervision over 9 months. A range of measures and qualitative questionnaires were used before, during and after the supervision that provided a rich mix of data to be analysed. Focus groups were held at the end of the project.

Results/Findings: While there was no significant difference before and after the intervention on the modified Stress in Mental Health Professionals scale, two of the three domains of the Maslach Burnout inventory returned significant differences before and after the intervention. Participants scored significantly lower on depersonalisation and emotional exhaustion at the end of the supervision intervention. A qualitative analysis of data produced five domains of helpful events during the supervision: Reorganisation, Relationships at work, Doing the work, the Person behind the role, and the Impact of supervision. The domain of the Impact of Supervision will be reported in detail.

Research Limitations: The research was carried out at a difficult time for the organisation.  It was under an improvement notice following an OFSTED inspection in July 2010.  A major reorganisation of the department took place at the beginning of the project and several participants were made redundant. Despite gallant efforts by the researchers and the supervisors, it was hard to get the message across how important the research questionnaires were.

Conclusions/Implications: The primary conclusion is that clinical supervision/consultative support can be beneficial to social workers engaged in safeguarding children. Supervision as provided by counsellors/psychotherapists gave valuable insight into relationships with service users and other staff members and in some cases enabled teams to function more effectively. It also provided insight into ways in which supervision can be conducted to be supportive rather than bureaucratic, controlling and punitive.

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Sue Wheeler 2

Other Authors: Michael Barkham and William B. Stiles

Professional Role: Professor of Counselling and Psychotherapy
Institution/Affiliation: University of Leicester
Contact details: Institute of Lifelong Learning, 128 Regent Road, Leicester, LE1 7PA
Email: sw103@le.ac.uk

ABSTRACT: Paper                                                                                          (Sat, 11.30 - 12.00)

Keywords: counselling, psychotherapy, effectiveness, dose-responsiveness, outcome.

Dose-effect relations for short term counselling in routine practice: extension to additional service delivery settings.

Aim/Purpose: The aim of this research was to evaluate the effectiveness of different durations of short term counselling (up to 20 sessions) as observed in routine counselling and psychotherapy practice.

Design/Methodology: In 2011, 236 services in the UK were invited to donate their data collected through using the Clinical Outcomes in Routine Evaluation (CORE) questionnaires, a population of approximately 303000 potential clients.  Ethical considerations about the way in which the data was to be stored, used and managed thereafter were explained. A total of 50 services provided data on 104,000 clients.

Results/Findings: Services that responded included primary care, secondary care, tertiary care, workplace, voluntary sector, universities, and private practices. Initial assessment information was complete for 91,365 clients; closing information was complete for 75,685 clients.  CORE questionnaires were collected at the beginning and end of a completed therapy for 40,500 clients. This paper in part replicates the work of Barkham et al. (2006) and Stiles et al. (2008), who found that average CORE-OM scores improved during the course of treatment with a substantial effect size in primary care mental health services. The mean pre-counselling to post-counselling change in CORE-OM scores was approximately constant regardless of the number of sessions attended (between 0 and 20).  They concluded that therapists and clients tend to make appropriate decisions about the number of sessions needed to effect change, ending treatment when a good-enough level of improvement has been reached.

The analysis of this larger data set is currently in progress. We will assess whether results in this data set's broader sample of settings (e.g., workplace, voluntary sector, private practices) are similar to those found in the previous study, that is significant improvement in most clients when therapy is completed regardless of the number of sessions used to effect change.

Research Limitations: The major limitation of this research is that there is only complete pre and post data on 40% of the clients for whom data has been submitted.

Conclusions/Implications: Counselling has been shown to be effective in routine practice in previous studies using much smaller samples. The results of the analysis of this larger sample should provide more robust and reliable evidence that counselling produces change.

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Mike Whitfield & Andrew Reeves

Professional Role: Training and Talking Therapies Manager, North East Wales Mind
Institution/Affiliation: MBACP, MBPsS
Email: mike_whitfield@me.com

ABSTRACT: Paper                                                                                          (Fri, 16.30 - 17.00)

Keywords: suicide, experiential, risk, responsibility, qualitative.

Exploring counsellors' experiences of working with suicidal clients with particular focus on the issue of responsibility.

Aim/Purpose: In re-visiting the work of Reeves and Mintz (2001), to explore counsellors' internal processes when working with suicidal clients and what influences might arise from beliefs, experiences, training and organisations, whilst extending the focus to the issue of responsibility identified as salient in the literature.

Design/Methodology: A qualitative methodology was chosen to look in depth at the experiences of individual counsellors in therapeutic interactions with suicidal clients. Participants were Person-Centred or Integrative counsellors with at least three years' post qualification experience, in on-going supervision and currently or recently working with suicidal clients. Six semi-structured interviews were conducted, transcripts analysed using the ‘constant comparative method' and twelve categories or ‘outcome propositions' derived. Approval for the study was granted by the University of Chester Ethics Committee.

Results/Findings: Contextual findings indicated the importance of training and the development of appropriate experience in working with suicidal clients, as well as the influence of organisational setting.  Findings related to direct work with clients included counsellors' thoughts and feelings in response to the disclosure of suicidal potential and how these shaped the therapeutic process, as well as locus of responsibility for risk, and particularly in young clients.

Research Limitations: The composition of the sample highlighted issues of responsibility especially regarding young people, but may lack representativeness and generalizability through concentrating on one client group and context. The focus on responsibility, whilst providing exploratory insight, gave no definitive answers and needs further investigation.

Conclusions/Implications: The need to address working with suicide in basic counselling training is highlighted. Individual counsellors might consider the issue and seek further training where necessary whilst also reflecting on the amount of responsibility they feel and take for suicidal clients. Organisations and managers of counsellors should reflect carefully that policy, implementation and working relationships, not only protect the organisation but also support practitioners to better support suicidal clients. The need for self-care and good supervision when working with suicidal clients is emphasised and supervisors might wish to reassess their monitoring and support of supervisees in this area.

SYMPOSIA

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Symposium A - Mick Cooper et al.

Other Authors: Rosanne Knox, David Murphy, Sue Price (formally Wiggins)

Professional Role: Professor of Counselling
Institution/Affiliation: University of Strathclyde
Contact details: mick.cooper@strath.ac.uk           

ABSTRACT: Symposium A overview                                                             (Fri, 10.55 - 12.25)

Keywords: relational depth, therapeutic alliance, mutuality, Person-Centred, Humanistic psychology

Relational depth: new perspectives and developments.

The aims of the symposium: This symposium builds on the publication of Relational depth: Contemporary perspectives (ed. Knox, Murphy, Wiggins and Cooper) in 2013, with the intention of presenting and discussing new research into the in-depth encounter client-therapist relationship. 

Contribution of each symposium paper to the overall theme: The first paper in our symposium is a key contribution to the relational depth literature which establishes, for the first time, that clients who experience a greater depth of relating at significant moments in therapy experience better therapeutic outcomes.  This is followed by a case study exploration of the development of mutuality, a core component of relational depth, in the therapeutic relationship.  This is a new method for exploring in-depth therapeutic relationships, and the paper examines the intricacies and details of this process.  The third paper takes a very different, and again new, angle on the question of deepening therapeutic relationships, by looking at what inhibits therapists from relating at depth with their clients.  The fourth paper broadens this out further, and looks at the kinds of issues and concerns that students have about forming and developing therapeutic relationships with their clients.  This helps to identify key areas for future training in this area.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: The quality of the therapeutic relationship is now known to be a key predictor of positive outcomes, and this suggests that therapists should work to deepen their quality of relating with clients in therapy.  The papers in this symposium look at how this can be done: through the establishment of mutuality, through reflecting on ways in which we may disconnect from our clients, and through addressing a broader range of relational issues.

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Symposium A - Sue Price (formerly Wiggins)

Other Authors: Robert Elliott, Mick Cooper

Professional Role: Therapist in private practice
Institution/Affiliation: University of Strathclyde
Contact details: spwiggins@gmail.com

ABSTRACT: Symposium A paper 1                                                               (Fri, 10.55 - 12.25)

Keywords: relational depth, working alliance, outcome/improvement, therapeutic relationship, outcomes

Moments of relational depth and therapeutic improvement.

Aim/Purpose: The aim of this study was to explore the relationship between moments of relational depth and therapeutic improvement/outcome.  In addition, an objective was to explore whether such moments of relational contributed to therapeutic improvement over and above the working alliance between client and therapist.

Design/Methodology: Participants were 42 clients from the Strathclyde Research Clinic. Ethical approval was granted by the University of Strathclyde and the NHS. Participants completed the Relational Depth Inventory, Working Alliance Inventory and various outcome measures, including CORE at every 10 sessions (e.g. at 10th, 20th and 30th session). Data was analysed using quantitative methods, namely hierarchical multiple regression which focuses on the change in predictability associated with particular predictor variables entered later in the analysis over and above that contributed by predictor variables entered earlier in the analysis.  Therefore, the contribution that Relational Depth made to therapeutic improvement was able to be explored over and above what Working Alliance made (to improvement).

Results/Findings: Results evidenced that moments of relational depth contribute significantly to therapeutic improvement. The results suggest that such therapeutic movement appears to be the case when the client's pre-therapy state is taken into account and when the experience working alliance is taken into account. Conversely, the experience of working alliance does not appear to contribute to therapeutic improvement when relational depth is taken into account.

Research Limitations: Whilst this research provides evidence that a relational depth event might be associated with therapeutic improvement, there is not evidence that the Relational Depth Inventory-Revised (RDI-R) has a predictive quality simply because RDI-Rs and outcome measures were completed at the same stage of therapy.  To rectify this, RDI-Rs need to be completed at an earlier stage of therapy than outcome measures.

Conclusions/Implications: The results from this research would imply that there is something which leads to improvement which working alliance does not predict but that relational depth does. In terms of practice, it suggests that therapists may need to be open to the occurrence of relational depth in order to facilitate positive therapeutic improvement.

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Symposium A - Emma Tickle & David Murphy

Professional Role: Lecturer in Counselling and Trauma Studies
Institution/Affiliation: University of Nottingham
Contact details: david.murphy@nottingham.ac.uk

ABSTRACT:  Symposium A paper 2                                                              (Fri, 10.55 - 12.25)

Keywords: mutuality, Person-Centred Approach, therapeutic relationship, relational depth, Person-Centred

Mutual experiencing of Rogers' therapeutic conditions: a case study.

Aim/Purpose: The bi-directional nature of the therapeutic relationship and the association found between deep connection and positive therapeutic outcomes is suggestive of the mutual impact client and therapist has on the other. The aim of this research was to consider the development of mutuality within the therapeutic relationship.

Design/Methodology: Individual psychotherapy took place with a 42-year-old-female client who presented with a series of significant distressing traumatic events within interpersonal relationships.

The first researcher was both the therapist and lead author and undertook the case study for completion of her Masters dissertation. The second co-researcher was the dissertation supervisor.  The study is based on a heuristic process and adopted a phenomenological approach to understanding the data. Data were gathered through the therapist's recording of her own reflections on the therapeutic relationship; the co-researchers held three reflective interviews that were conducted as research supervision sessions. In order to capture specific moments within the therapy relationship to show opportunities, taken and/or missed, for mutuality; three therapy sessions were audio-recorded. The client also contributed by providing reflection on the different levels of mutuality experienced in the therapeutic relationship and how this related to a growing sense of agency intra and interpersonally.

Results/Findings: The case shows how the client's strategies for ‘staying out of relationship' became the focus of therapy. Mutual recognition of the client as a distinct other and the development of mutual empathy became key therapeutic processes that were ultimately critical in orienting the therapy relationship towards a satisfying outcome for the client.

Research Limitations: The study has limitations in terms of its potential to generalise the primary findings to the wider population. Some methodological issues concern the reliance on verbatim records.

Conclusions/Implications: The study shows how a focus on processes of mutuality in the therapeutic relationship can be helpful in uncovering the dialogic nature to the therapeutic encounter. The study implies that when therapists and clients are explicitly concerned with bi-directional process they can usefully consider their strategies for disconnection in the therapeutic relationship.

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Symposium A - Mick Cooper

Other Author: Rosanne Knox

Professional Role: Professor of Counselling
Institution/Affiliation: University of Strathclyde
Contact details: mick.cooper@strath.ac.uk

ABSTRACT: Symposium A paper 3                                                               (Fri, 10.55 - 12.25)

Keywords: relational depth, therapeutic alliance, mutuality, person-centred, humanistic psychology

Therapists' chronic strategies of disconnection: prevalence in everyday life and in therapy.

Aim/Purpose: Chronic strategies of disconnection (CSoDs) are patterns of behaviour that people develop to keep themselves safe from intimacy, but which can become ‘sedimented' and ultimately lead to a lack of in depth connection.  This study looks at the CSoDs that therapists, themselves, have developed in their everyday life; and the extent to which these strategies may be prevalent in their therapeutic work.

Design/Methodology: 168 UK-based trainee and practicing therapists, primarily of a Person-Centred orientation and participating in experiential workshops on relational depth, completed a questionnaire which asked them to list their CSoDs.  Once they had completed this, they were then asked to rate each one on presence in therapy. Data was analysed using thematic qualitative analysis and inferential statistics.  Ethical approval was granted by the University Ethics Committee of the University of Strathclyde.

Results/Findings:  39 categories of CSoDs were constructed and organized into seven domains.  The most common CSoDs that counsellors adopted, overall, were behavioural strategies (e.g., physical avoidance), followed by ‘passive' strategies (e.g., going silent), intrapsychic strategies (e.g., intellectualization), hostile strategies (e.g., criticism of others) and communication strategies (e.g., avoiding eye contact).  In terms of presence in therapy, 55.5% of the CSoDs were rated as being present at least to a minimal extent, with males indicating greater levels of presence than females.  Most commonly, passive CSoDs were rated as being present in the therapeutic work, followed by disingenuous strategies (particularly for younger participants), humour, and then intrapsychic strategies.

Research Limitations:  Participants primarily came from one therapeutic orientation, such that it is not clear how valid the findings are for therapists of other orientations.  The research was also only able to tap conscious CSoDs. 

Conclusions/Implications: Therapists have a range of ways in which they disconnect from others in everyday life, and many of these are carried over into the therapeutic relationship: in particular, being overly-passive and disingenuous.  Awareness of this can inform training and practice.

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Symposium A -  Rosanne Knox

Other Author: Mick Cooper

Professional Role: Therapist in private practice; Manager in children's charity
Institution/Affiliation: University of Strathclyde
Email: rosanneknox@aol.com

ABSTRACT: Symposium A paper 4                                                               (Fri, 10.55 - 12.25)

Keywords: therapeutic relationship, relational styles, interpersonal, Humanistic, relational depth.

What issues most concern trainee therapists about the therapeutic relationship?

Aim/Purpose: The aim of this study was to identify the questions, concerns and anxieties that trainee counsellors and psychotherapists had about establishing and developing therapeutic relationships with their clients.  This is so that teaching resources can be more specifically targeted to students' key training needs.

Design/Methodology: A combination of open-ended online questionnaires and focus groups was chosen, inviting trainee and beginning counsellors to explore the questions and anxieties they have about the therapeutic relationship. The focus groups ranged from 6-12 participants and were facilitated by the researcher using an unstructured, Person-Centred approach to encourage an open dialogue. Invitations for the focus groups were sent via training institutions. A link to the online questionnaire was sent to college tutors, with a request that they pass it on to current and recent students. There were six focus groups in all, and approximately 50 respondents completed the online questionnaire.  The data was analysed using a grounded theory approach, categorising the items within the different domains. Ethical approval granted by the University of Strathclyde.

Results/Findings: Areas most concerning participants include the level of boundaries, for example touch, or allowing contact outside the therapy hour; knowing what to do when a relationship appears to be breaking down; how to prevent a relationship from becoming too close, or drifting towards friendship or attraction; how much of yourself to share or disclose to the client, if at all.

Research Limitations: It would be difficult to generalise too widely due to the relatively small sample size, although inferences may be drawn. Trainees may have been inhibited by the college setting, or by the presence of their peers in the focus groups, especially where peer feedback is part of the assessment criteria for the course. 

Conclusions/Implications: In the context of increased attention recently being given to the relational aspects of therapy, trainees' wide ranging concerns and questions can be usefully used both in training and as personal development aids encouraging reflection on personal relating styles and enhancing interpersonal skills including preparation for dealing with any issues that might arise.

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Symposium B - Robert Elliott et al.

Other Authors: Amanda Barge, Catherine Cowie, Catherine Ryan and Brian Rodgers

Professional Role: Professor of Counselling
Institution/Affiliation: University of Strathclyde
Email: fac0029@gmail.com

ABSTRACT: Symposium B overview                                                             (Fri, 13.50 - 15.20)

Keywords: social anxiety, Person-Centred therapy, emotion-focused therapy, outcome research, change process research

Person-centred and emotion-focused therapy for social anxiety: outcome and key change processes.

The aims of the symposium: Good evidence exists for the effectiveness of Person-Centred-experiential (PCE) psychotherapies with clients experiencing depression; however, evidence for its effectiveness with anxiety is much more sparse.  Social anxiety (or social phobia) is a chronic condition with wide-ranging effects on interpersonal, occupational and psychological functioning.  Almost all previous research on social anxiety has been carried out on CBT and psychopharmacological interventions.  The goal of the Social Anxiety Project at the University of Strathclyde was to develop and test out alternative Humanistic approaches for working with clients with social anxiety.  The aims of this symposium are first to offer a summary of the main quantitative outcome findings and second to begin to provide a closer look at key change processes by which these outcomes came about.

Contribution of each symposium paper to the overall theme: We present four very different papers highlighting successively closer looks at the data from this study.  First, Elliott will present the overall post-therapy outcome results from the study, highlighting similarities and differences in the outcomes of Person-Centred and Emotion-Focused therapies. Next, Ryan will present a qualitative analysis of hindering processes in PCE therapies. After that, Barge will report on the results of a qualitative study of client post-therapy experiences of a key change process: ending therapy, comparing social anxiety clients to a general mixed sample of clients. Finally, Cowie will use conversation analysis to provide a close look at a key change process as it unfolded in a good outcome case of Person-Centred therapy, delivered by an expert therapist with a pattern of consistent success with this client group.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: The presentations in this panel all point to different ways of improving PCE therapies for social anxiety: by providing more structure and offering emotion-focused tasks; by providing clients with more resources to make use of the therapeutic offer; by better preparing clients for ending; and by depicting what effective empathic exploration looks like with this client group.

Name of symposium discussant: Laco Timulak, Trinity College Dublin.

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Symposium B -  Robert Elliott

Other Author: Brian Rodgers

Professional Role:  PhD student/Counsellor
Institution/Affiliation: University of Strathclyde
Email: fac0029@gmail.com

ABSTRACT: Symposium B paper 1                                                               (Fri, 13.50 - 15.20)

Keywords: social anxiety, Person-Centred-experiential psychotherapy, outcome

Outcomes of person-centred and emotion-focused therapies for social anxiety.

Aim/Purpose: The purpose of this presentation is to present the results of an outcome study comparing two forms of Humanistic-experiential psychotherapy for clients with social anxiety: Person-Centred Therapy (PCT) and Emotion-Focused Therapy (EFT).

Design/Method: We used a partially-randomized two group pre-post design with a community sample of adults seeking treatment for social anxiety and meeting standard diagnostic criteria for Social Anxiety Disorder.  We assessed client outcome on the Social Phobia Inventory (SPIN), CORE-OM, Personal Questionnaire, Inventory of Interpersonal Problems, and Strathclyde Inventory.  Fifty-two clients were seen for up to 20 sessions of either Person-Centred or Emotion-Focused Therapy.

Results/Findings: Using modified intent-to-treatment analyses, pre-post data for all clients with at least 3 sessions of therapy will be presented.  PCT and EFT results will be presented together and separately, including pre-post significance testing, effect size, reliable change, and clinical significance calculations. Overall, clients in both conditions showed large, statistically-significant pre-post gains, comparable or better than bench-marked previous research on CBT and medication; clients in EFT received more sessions, showed better outcomes on three of the five outcome measures and overall, and had lower drop-out rates.  Outcomes in both PCT and EFT improved over the course of the study.  Analyses of reliable change and client recovery suggest that there is room for improvement.

Research Limitations: The study was only partially randomised.  Power was low for some of subgroup analyses. Treatment diffusion or overlap may have reduced obtained differences.  Adherence ratings have not yet been carried out, and follow-up data are not yet available.

Conclusions/Implications: Despite the limitation of being only partially randomized, this is to our knowledge the first study of bona fide Humanistic therapies for social anxiety, and provides a basis for further research. Our results are promising and begin to provide justification for using PCE therapies for social anxiety, and also point to ways to improve outcomes.

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Symposium B - Catherine Ryan

Other Author: Robert Elliott

Professional Role: MSc Student and BACP Accredited Counsellor
Institution/Affiliation: University of Strathclyde
Email: catherine_ryan@hotmail.com

ABSTRACT: Symposium B paper 2                                                               (Fri, 13.50 - 15.20)

Keywords: hindering processes, social anxiety, Person-Centred therapy, emotion focused therapy, qualitative research

Client perceptions of hindering processes in person-centred experiential psychotherapy for social anxiety.

Aim/Purpose: While much is known about helpful factors experienced by clients in counselling and psychotherapy, we have less information about what clients find hindering or unhelpful. The aim of this study was to discover what socially anxious clients experience as unhelpful in Person-Centred-experiential (PCE) psychotherapy.

Design/Methodology: 38 clients in PCE therapy were recruited and screened as part of a larger study comparing Person-Centred to emotion-focused therapy for social anxiety.  The Change Interview, a semi-structured interview, was used to investigate client experiences of what had been unhelpful or hindering in their therapy.  Grounded theory analysis was then used to create a structure of related categories summarising these negative experiences .  

Results/Findings: Clients found a wide range of factors unhelpful, ranging from things that happened before the therapy started to disappointments over the overall outcome of therapy.  More specifically, these included external factors, factors contributed by the client (including the influence of the presenting issue, i.e., social anxiety) and factors contributed by the therapist (including what the therapist did and did not do).  Hindering factors directly related to therapy sessions included things clients found difficult to do (as well as things they found more generally unhelpful about the sessions.  A core category emerged from the analyses: Clients found themselves hindered by a lack of various resources needed for them to meet what was on offer in their therapy.

Research Limitations: This is a small scale research with a relatively small number of participants and relatively thin data (about a page of transcribed material per client).

Conclusions/Implications: Information on client perceptions of hindering processes in therapy can contribute directly to improving the delivery of counselling or psychotherapy, particularly by attending to helping clients find the interpersonal and emotional resources for them to make use of their therapy.  Qualitative methods work well for studying this topic, and socially anxious clients are a particularly appropriate client for studying because their high degree of interpersonal vigilance attunes them to potentially hindering processes.

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Symposium B - Amanda Barge

Professional Role:  PhD student/Counsellor
Institution/Affiliation: University of Strathclyde
Email: amandasgbarge@aol.com

ABSTRACT: Symposium B paper 3                                                               (Fri, 13.50 - 15.20)

Keywords: endings, termination, internalisation, therapists' representation, grounded theory.

Clients' experiences of ending in person-centred or emotion-focused therapy.

Aim/Purpose: The aim of this study was to examine client experiences of ending Person-Centred-experiential psychotherapy.  Little research has been carried out on this crucial stage of therapy, with most previous studies limited to student counsellors or psychoanalytic psychotherapies.

Design/Methodology: Using client post- and follow-up interview data from the University of Strathclyde's Research Clinic, 22 clients' experiences, as reported in the semi-structured Client Change Interview, were analysed using Grounded Theory and Emotion Scheme Analysis. The clients were seen either in time-limited therapy for social anxiety or longer-term therapy for other difficulties; they were seen by either Person-Centred or emotion-focused therapists for 20 - 67 sessions.

Results/Findings: Results suggest that clients experienced ending with their therapists as significant events.  Clients appreciated their therapist's preparations for ending and benefitted from tapering sessions. The last sessions sometimes left clients feeling abandoned and sad. Often the impact of ending was not explored in any depth before the last session, and clients struggled at times to be genuine about their reaction to the termination of therapy.  Emotion Scheme analyses produced a ‘family' of ending emotions, which illustrated a wide range of negative and some positive feelings the clients experienced after ending. Some clients reported vivid representations of their therapists in their memories, which they could call upon when they needed support.

Research Limitations: The ending section of the Change Interview is relatively short, was added partway through the larger study, and came near the end of a long interview process.  This resulted in a limited amount of data, inadequately trained interviewers, and thin data protocols that were sometimes difficult to analyse.

Conclusions/Implications: The initial conclusions point to the need for therapists to be more aware of their clients' experiences as they approach ending therapy.  Open discussion of ending is likely to reduce the danger of the client leaving therapy feeling abandoned and at a loss. Therapists might want to consider taking extra responsibility at this stage of therapy and discussing support networks and the potential value of mindfully retaining memories of the work and their therapist.

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Symposium B - Catherine Cowie

Other Author: Robert Elliott

Professional Role: MSc Student
Institution/Affiliation: University of Strathclyde
Email: catherine.g.cowie@strath.co.uk

ABSTRACT: Symposium B paper 4                                                               (Fri, 13.50 - 15.20)

Keywords: therapeutic change, therapeutic relationship, discourse analysis, skilled practice

Conversation analysis of significant change processes in a good outcome case of
person-centred therapy for social anxiety.

Aim/Purpose: Results of the Social Anxiety project support the effectiveness of person-centred-experiential (PCE) therapies for clients with social anxiety.  However, while quantitative outcome measures etc can indicate that pre-/post- therapy change has happened, immersion in the minutiae of the therapy process co-created by therapist and client gets closer to the ‘how' of client change. 

Careful attention to language in client-therapist interactions can reveal what therapist and client offer to each other, and what each does with what is on offer, as the therapeutic relationship develops and change begins.  This research is an in-depth study of therapist-client turn taking sequences found in sessions of a single good outcome case of counselling undertaken within the Strathclyde Social Anxiety project. 

Design/Methodology (including sample and ethical approval): The case selected was one of several involving an experienced therapist in the person-centred arm of the project whose clients showed particularly good quantitative outcomes.  Key therapy sessions were identified, and significant therapist-client turn taking sequences within these sessions were logged and subjected to conversational analysis.

Results/Findings: A key process identified was the development of effective empathic exploration, tracked from initial client puzzlement and awkwardness, through to client-therapist easy mutual collaboration and client transfer of in-therapy processes to her life outside therapy.

The conversation analysis illustrates the client-therapist negotiation of this process through: (a) changes in turn-taking organisation, from early client use of conversational latching to maintain speaking turns to later easy mutual exchange; (b) close therapist following of the client, and the therapist's skilful use of indicators of client readiness for therapist response; and (c) subtle use of tenses by the therapist and subsequent client temporal re-framing.  In contrast to Elliott et al.'s (2004) analysis of EFT empathic exploration, the therapist here followed rather than initiated sequences.

Research Limitations: As this research is based on a single case of a client with a particular story-telling processing style, findings may not be generalisable.

Conclusions/Implications: The findings provide a detailed exemplar of the effective use of empathy in skilled person-centred therapy, as applied to social anxiety.

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Symposium C - Jo Pybis et al.

Other Authors: Charlie Jackson, Dave Stewart, Andy Hill, Jack Rogers; Mick Cooper, Jacqueline Sparks, Lisa Bunting, Sylvia Jones, Hillary Hill

Professional Role: Research Facilitator (Jo Pybis)
Institution/Affiliation: BACP
Contact details: BACP House, 15 St. John's Business Park, Lutterworth, Leicestershire, LE17 4HB
Email: jo.pybis@bacp.co.uk

ABSTRACT: Symposium C overview                                                            (Sat, 10.55 - 12.25)

Keywords: school counselling, practice research network, outcome monitoring, policy

Outputs from a practice research network for school-based counselling (SCoPReNet).

The aims of the symposium: This symposium aims to demonstrate the potential role that practice research networks can have in shaping policy by bringing together practitioners, researchers and policy makers to work collaboratively.

Contribution of each symposium paper to the overall theme: Paper one opens the symposium with results from a survey of members of a school-based counselling practice research network (SCoPReNet) outlining who they are, what they hoped to gain from being part of the network and their views on outcome monitoring. Paper two continues with an evaluation of the experiences of SCoPReNet members involved in a pilot data collection process using routine outcome measures, with suggestions for future improvements but also an insight into the views of service managers and practitioners to using such measures. Paper three reports on the impact of incorporating systematic client feedback into school-based counselling, The study suggests that this approach could make significant contribution to the alleviation of psychological distress for children who experience social, emotional or behavioural difficulties. Finally paper four provides an example from the Welsh Government of how collaborative working between researchers, practitioners, and service managers/providers can lead to a change in policy and implementation of services.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: This symposium will demonstrate the important and potential impact of researchers, practitioners and policy makers working collaboratively to make demonstrable changes in policy.

Name of symposium discussant: Andy Hill

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Symposium C - Charlie Jackson

Other Authors: Andy Hill, Jo Pybis, Jack Rogers

Professional Role: Research Officer
Institution/Affiliation: British Association for Counselling and Psychotherapy (BACP)
Contact details: BACP House, 15 St. John's Business Park, Lutterworth, Leicestershire, LE17 4HB
Email: charlie.jackson@bacp.co.uk

ABSTRACT: Symposium C paper 1                                                               (Sat, 10.55 - 12.25)

Keywords: practice research network, school-based counselling, demographics, outcome measures, research interests.

A survey of the members of a school-based counselling practice research network (SCoPReNet).

Aim/Purpose: To determine who the users of a school-based counselling practice research network (SCoPReNet) are in terms of: demographic details and research interests; what users are looking to gain from the network; and their suggestions for improvement.

Design/Methodology: A questionnaire containing items related to demographic details, research interests and use of outcome measures, was distributed electronically to all 285 SCoPReNet members. Completed questionnaires were returned by 82 individuals (response rate = 28.8%) and a descriptive analysis was conducted to determine the commonality of responses to each question.

Results/Findings: The majority (93.9%) of members were female, 81.7% were between the ages of 40 and 59, living in England (87.7%) and were of a White British ethnicity (85.4%). School-based counsellors made up over two-thirds of the respondents and almost one-third reported being a supervisor. Over two-thirds of respondents reported using routine outcome measures; however, less than 20% of these used an electronic system to file the responses. Of those respondents who stated their research interests (53.7%), the majority (36.4%) were concerned with any research which examined the general effectiveness of school-based counselling; this was followed by those who were interested in using outcome measures or developing assessment tools (20.5%); and then those who had an interest in self-harm research (15.9%). The remainder expressed a broad range of other research interests. 

Research Limitations: Due to the limited response rate, there is a possibility of response bias towards those who believe that research is an important aspect of school-based counselling; this limits generalisability and could misrepresent the diversity of the members of the network as a whole.

Conclusions/implications: The results of the survey indicate that the majority of members do use routine outcome measures; however, the measures used differ greatly amongst members and only a minority report having a systematic, electronic storage system. It is suggested that having a central electronic database to store and aggregate data would enable large quantities of data to be analysed easily and effectively. An understanding of what members want to gain from a practice research network and suggestions for improvements are also discussed.

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Symposium C - Jo Pybis

Other Authors: Andy Hill, Charlie Jackson, Jack Rogers

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

ABSTRACT: Symposium C paper 2                                                               (Sat, 10.55 - 12.25)

Keywords: routine outcome measures, school based counselling, practice research network

Feedback from a pilot data collection using routine outcome measures in school counselling. 

Aim/Purpose: The aim of this study was to gain insight into the views and concerns of PRN members in the use of routine outcome measures; to learn what can be changed to improve the process for a future larger scale roll out.

Design/Methodology: All PRN members (n = 285) were contacted and asked if they wished to participate in a pilot data collection process. 32 indicated willingness to participate and 6 members were randomly selected to take part. Participants were sent instructions of which outcome measures to use, how to use them and an excel file for recording the collected data. The outcome measures used were YP-Core (every session), SDQ (pre and post), Goal measure (every session) and a demographic data collection form was also included. A consent form and information sheet were also provided to gain informed consent from all clients prior to their data being used in the study. Approximately 2 months into the data collection process, all 6 participants were contacted and asked to take part in an interview regarding their thoughts on the pilot.

Results/Findings: Interviews were analysed using a thematic analysis. Preliminary findings indicate an understanding of the importance of collecting routine outcome data amongst service managers and school counsellors, however there is a need for careful consideration of the practical implications of collecting such data before it can be integrated into routine practice.

Research Limitations: This is a very small sample of participants from a much larger group of interested parties and therefore results may not be generalizable of the whole of the school-based counselling practice research network. However, the results of this study can be used for a wider consultation, via questionnaire, or the whole PRN, prior to the development of the wider data collection process.

Conclusions/Implications: Preliminary findings indicate some reservations amongst school-based counsellors in the use of routine outcome measures, however there is an understanding of the importance of using such measures and suggestions for how a process of data collection could be more manageable. The roll out of outcome monitoring could result in the widespread, routine use, of such measures amongst school-based counsellors.

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Symposium C - Dave Stewart

Other Authors: Mick Cooper, Jacqueline Sparks, Lisa Bunting

Professional Role: Children's Services Manager
Institution/Affiliation: Barnardo's Northern Ireland
Contact details: 234 Ormeau Road, Belfast, BT7 2FX
Email: dave.stewart@barnardos.org.uk

ABSTRACT: Symposium C paper 3                                                               (Sat, 10.55 - 12.25)

Keywords: client feedback, practice-based evidence, school counselling, eclectic psychotherapy, PCOMS

The impact of incorporating systematic client feedback into school-based counselling.

Aim/Purpose: To outline the impact of using the ‘Partners for Change Outcome Monitoring System' (PCOMS) (Miller, Duncan, Sorrell and Brown, 2005) on both clients and counsellor's engaged in school-based counselling.

Design/Methodology: Naturalistic cohort design comparing baseline and endpoint levels of psychological distress. Participants were 288 7-11 year olds experiencing social, emotional or behavioural difficulties.

Results/Findings: The school-based counselling intervention incorporating the PCOMS feedback system was associated with significant reductions in psychological distress, with a pre-post effect size (d) of 1.49 on the primary outcome measure and 88.7% clinical improvement. The effect size as measured by the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) indicate a two-fold advantage in effect on the caretaker completed SDQ when the PCOMS is used compared with UK school-based counselling where PCOMS was not used.

Research Limitations: The principal limitation is that the school-based counselling using systematic feedback was not directly compared against a similar intervention without systematic feedback. The lack of a non-therapy control means it is not possible to establish how much change was due to the intervention. A third limitation is the small to moderate levels of inter-rater reliability on the measures. A further limitation is a lack of data on clinical diagnosis which makes it difficult to interpret the relevance of the findings to established clinical populations.

Conclusions/Implications: The study suggest that a school-based counselling intervention incorporating systematic feedback may make a significant contribution to the alleviation of psychological distress for children who experience social, emotional or behavioural difficulties. The findings provide support for the use of systematic feedback in therapeutic work with children.

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Symposium C - Sylvia Jones

Other Author: Hillary Hill

Professional Role: Previous coordinator for school-based counselling in Wales
Institution/Affiliation: Welsh Government
Email: sylvia.rjones@ymail.com

ABSTRACT: Symposium C paper 4                                                               (Sat, 10.55 - 12.25)

Keywords: Strategy, practice, monitoring and evaluation, statutory entitlement

School-based counselling in Wales from strategy to entitlement.

Aim/Purpose: This presentation aims to provide an understanding of how the collection of routine outcome data across school counselling services in Wales, and the collaborative working between researchers, practitioners, service managers and the Welsh Government has led to statutory provision for school counselling across Wales.

Design/Methodology: BACP was commissioned by the Welsh Government (WG) to undertake an evaluation of its school-counselling strategy. Part of the evaluation involved the collection of routine outcome data using either the YP-CORE or the SDQ.  Data was collected by school-counselling and collated by local authority leads who returned the data to the welsh government periodically. It was then aggregated and analysed by the evaluation team.

Results/Findings: The routine outcome data provided to the evaluation team indicated significant reductions in psychological distress for young people accessing school-based counselling, with an overall effect size of 0.93. In addition, counselling was associated with improvements in attendance, behaviour and attainment. The evaluation report and the results obtained from routine outcome monitoring had a significant role in supporting the evidence required for the WG to take forward the School Standards and Organisation Bill 2012 which will provide ring fenced funding for school-based counselling.

Research Limitations: This Research was conducted fairly early into the implementation of the School-based Counselling Strategy.

Conclusions/Implications: Collaborative working and the collection of routine outcome data can contribute to developments in policy implementation. The initial funding (2008-11) was increased to £14.25m over three years (2011-2014) due to the success of the Strategy. The WG is currently making counselling statutory for all 11-18 year olds through the School Standards and Organisation (Wales) Bill 2012 and funding will be devolved to local authorities who will have a Duty to ensure an entitlement to counselling for all young people.

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Symposium D - David Murphy et al.

Other Authors: Stephen Joseph, Keiran Meht, Lucinda Brabbins, Steve Regal, Liz Blakey 

Professional Role: Lecturer in Counselling and Trauma Studies
Institution/Affiliation: University of Nottingham
Email: david.murphy@nottingham.ac.uk                                                        

ABSTRACT: Symposium D overview                                                            (Sat, 10.55 - 12.25)

Keywords: trauma, posttraumatic growth, Person-Centred psychotherapy, training

Developing person-centred approaches to trauma.

The aims of the symposium: This symposium builds on the work in recent years on the concept of posttraumatic growth. Specifically, we will consider the development of the concept in a range of fields of trauma, of Person-Centred psychotherapy and of training practitioners in all modalities in trauma. 

Contribution of each symposium paper to the overall theme: Our first paper looks at the development of relationship based approaches to working in the field of trauma and specifically for facilitating posttraumatic growth. The development of posttraumatic growth is relevant for counselling as it considers the move towards optimal functioning as opposed to the reduction of posttraumatic stress symptoms. The second paper is a consideration of training professionals in the field of trauma studies. The paper will review the development of an interdisciplinary course delivered within a Person-Centred Approach. The third paper is a review of the research evidence looking at survivors of child sexual abuse and posttraumatic growth. This study is the first review of its kind and will present findings from a systematic review of the literature. Evidence shows that the Person-Centred Approach is useful for people who have experienced trauma in relational contexts.  The fourth paper is a review presenting audit data from a clinical service within the Centre Trauma, Resilience and Growth. The final paper is a ethnographic study of being a trainee psychotherapist in a clinical trauma service.

Implications of the symposium theme for counselling and psychotherapy theory, research and practice: Trauma is an increasingly important area of concern for professional counsellors and psychotherapists. Posttraumatic growth is a contemporary theoretical construct that provides practitioners with a vision for client growth following trauma that goes beyond medical model thinking. Training practitioners in trauma work needs to incorporate a focus on growth in addition to strategies for reducing symptoms. The symposium offers those practicing non NICE approved therapy an insight to practice within the NHS of Person-Centred Therapy.

Name of the symposium discussant: Belinda Harris

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Symposium D - Stephen Joseph

Other Author: David Murphy

Professional Role: (SJ) Professor of Psychology and Social Care
Institution/Affiliation: Centre for Trauma, Resilience and Growth, University of Nottingham
Email: stephen.joseph@nottingham.ac.uk

ABSTRACT: Symposium D paper 1                                                               (Sat, 10.55 - 12.25)

Keywords: trauma, therapeutic relationship, contexts, processes, practice

Relationship based practice and approaches to trauma therapy in UK specialist trauma services.

Aim/Purpose: The aim of this paper is to present the findings of a survey study scoping the prevalence of Person-Centred therapy in specialist trauma services in the UK. The paper will also provide an opportunity for reflection on the relative role of the therapeutic relationship and therapeutic techniques in the facilitation of posttraumatic growth.

Design/Methodology: A survey based study was carried out with specialist trauma services in the UK. A survey was sent to the information officer of twenty six NHS Trusts using the Freedom of Information Act. Fourteen services responded. The study received ethical approval from the University if Nottingham.  

Results/Findings: The findings indicated that CBT is the treatment most frequently provided in UK specialist trauma services. However, Person-Centred and experiential therapies were shown to have increased in their availability in UK specialist trauma services and Psychodynamic therapies were shown to have declined in availability. UK specialist trauma services provide a wide range of therapeutic services but social workers were underrepresented; a finding that is in contradiction of the NICE Guideline 26 for Post-traumatic Stress Disorder.

Research Limitations: Survey design was weak; only 57% of services responded.

Conclusions/Implications: The conclusion is the Person-Centred approach is increasingly available in specialist trauma services in the UK. Person-Centred therapy is being provided in some UK specialist trauma services. Therapies provided vary widely from the NICE Guidance. Further research is needed.

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Symposium D - David Murphy

Other Author: Stephen Joseph

Professional Role: (DM) Lecturer in Counselling and Trauma Studies
Institution/Affiliation: University of Nottingham
Email: david.murphy@nottingham.ac.uk

ABSTRACT: Symposium D paper 2                                                               (Sat, 10.55 - 12.25)

Keywords: trauma, post-traumatic growth, Person-Centred Approach, training

Development of a Master's degree in trauma studies: a person-centred approach.

Aim/Purpose: The aim of this paper is to report on the challenges in developing a Master's Degree in the field of Trauma Studies and adopting a Person-Centred Approach. The paper will consider pedagogical issues, for trainers and trainees working in the field of trauma counselling and psychotherapy.

Design/Methodology: Students on the programme were interviewed and were asked to talk about their experience of being in a nondirective learning environment. The interviews were recorded and provided the data for analysis. Thematic analysis was used to highlight key themes.

Results/Findings: The following areas from the findings will be considered: firstly, how can students be empowered to learn in this field? How to support the balance between students having optimal responsibility for their learning in a fee paying structure within Higher Education Institute? Second, how best can trainers hold the tension between pressure to deliver training in line with National Institute for Clinical Excellence Guidance prescription for therapeutic intervention when guidance are based on theories of therapy that are inconsistent with the pedagogical approach to the course? Finally, are there benefits of providing training in an interdisciplinary setting for counsellors and psychotherapists working in the field of trauma?

Research Limitations: The paper will be based on the experience of a single course and therefore will be limited in scope.

Conclusions/Implications: Trauma continues to be an area of interest for counselling and psychotherapy practitioners and trainees. This paper will provide practitioners with a chance to consider training issues and the implications for practice.

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Symposium D - Keiran Meht

Other Authors: David Murphy, Stephen Joseph

Professional Role: Person-Centred Therapist and MA Trauma Studies student
Institution/Affiliation: University of Nottingham
Email: david.murphy@nottingham.ac.uk

ABSTRACT: Symposium D paper 3                                                               (Sat, 10.55 - 12.25)

Keywords: childhood sexual abuse, post-traumatic stress, post-traumatic growth, systematic review

Childhood sexual abuse and post-traumatic growth: a systematic review of the literature.

Aim/Purpose: The aim of this study was to review the literature for post-traumatic growth following childhood sexual abuse (CSA). Posttraumatic growth is an emerging area for psychotherapy and research. Research findings in this area can be helpful in guiding and informing interventions by counselling and psychotherapy practitioners.

The research set out to answer the following question: to what extent do survivors of child sexual abuse also provide self-reported posttraumatic growth?

Design/Methodology: 302 studies were identified articles from four databases; Medline, Web of Knowledge, PsychArticles and ScienceDirect  using the following search parameters; post-traumatic stress (PTS), childhood sexual abuse (CSA), post-traumatic growth (PTG), benefit finding, positive  coping, perceived benefits, meaning making attempts, positive adjustment, stress related growth, thriving, positive- benefit finding, psychological changes, and adversarial growth. Articles were included in the review on the basis they had used a standardised self report measure of PTG, that the study involved adult victims of CSA, studies were reported in a peer reviewed journal. Studies included in the review were typically cross sectional papers reporting on the association between CSA and PTG and were not looking necessarily at effectiveness of counselling.

Results/Findings: From this sample 14 studies (n=14) fitted the criteria. A range of factors were identified that influence either positive or negative change. Findings suggest that coping strategies such as social support and spirituality/religious coping are related to positive outcomes for CSA survivors. Participants who showed growth also seemed to suffer lower levels of distress.

Research Limitations: The study was limited due to the use of varied measurements of PTG; a range of definitions of sexual abuse operative within studies reviewed; the inference of incidence of both PTS and PTG need to be made with caution.

Conclusions/Implications: Trauma caused through child sexual abuse is a distressing life event. Survivors struggle for many years to process and resolve distress. Survivors who show successful working through of their experiences can live meaningful lives. Therapists should consider these findings to support clients reporting child sexual abuse; adopt therapeutic approaches that the literature supports as growth promoting.

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Symposium D - Lucinda Brabbins

Other Authors: Stephen Joseph, David Murphy, Steve Regel

Professional Role: Honorary Assistant Psychologist
Institution/Affiliation: Centre for Trauma, Resilience and Growth, University of Nottingham
Email: lucindabrabbins@gmail.com

ASTRACT: Symposium D paper 4                                                                  (Sat, 10.55 - 12.25)

Keywords: trauma centre, demographic, complex trauma clients

Inside the filing cabinet of a trauma centre.

Aim/Purpose: The aim of this paper is to provide an overview to the service user demographic of a clinical service within a UK-based trauma centre.   

Design/Methodology: An audit of a UK trauma centre was carried out. Data was collected for a total of 70 service users referred to the service within a two year period. The data is provided from a service audit and is publicly available NHS research ethics was not required.

Results/Findings: The findings suggest clients seen in a secondary mental health care service are far more complicated than those included in clinical trials. Analyses showed that of 70 referrals (41= male; 29= female; mean age = 39.8 yrs; rang = 17-68 yrs) the average length of time between trauma event and referral to the centre was 11.7 years. 54% had more than five years pass between the trauma and the treatment at the centre. The data was reported for ethnicity) N=63) and 53 (79%) were white, 2 (3%) were African and 3 (5%) were mixed race. Thirty nine were taking prescribed medication including anti-depressants, anxiolytics and analgesics.  A wide range of traumatic triggering events reported. 61% had experienced more than one traumatic event. Over a half of clients experience co-morbid symptoms the most common of which are anxiety and depression, although eating disorders and alcohol dependency are not uncommon.

Research Limitations: The data reports descriptive statistics for a two year period. Missing data risks presenting an incomplete picture of the total demographic.

Conclusions/Implications: Prolonged periods of time between initial traumatic experience and referral exacerbates the complexity of clients' problems.  Effects of unresolved trauma over 10 or 15 years impacts personal, family and work lives and strains support networks that otherwise act as protective factors promoting recovery.  Severity of symptoms can lead to relationship breakdowns, loss of employment, social isolation or drug and alcohol use.

High rate of clients suffering multiple trauma raises questions whether unresolved trauma increased vulnerability and maladaptive response towards further adverse life events.

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Symposium D - Liz Blakey

Other Author: David Murphy

Professional Role: Visiting therapist
Institution/Affiliation: Centre for Trauma, Resilience and Growth
Email: Liz.blakey@nottshc.nhs.uk / bettyblakey@goooglemail.com

ABSTRACT: Symposium D paper 5                                                               (Sat, 10.55 - 12.25)

Keywords: trauma, NHS, Person-Centred Approach, trainee placement, experience

NICE and beyond: reflections on the experience of being a person-centred trainee in an NHS placement.

Aim/Purpose: To present findings from the experience of working in a NHS setting within a Person-Centred modality whilst on a psychotherapy training placement.

Design/Methodology: Experiential reflective autoethnography of working as a trainee Person-Centred psychotherapist within a UK specialist trauma clinic. Autoethnography draws on personal experience. The author identified several key learning experiences considered as transformative moments in the learning journey.  Data was derived through the trainee's personal learning journal; personal process notes from group supervision. The data were analysed using thematic analysis. Several key themes emerged. Analysis is ongoing. Key themes presented will be linked to theory and policy of providing therapy for traumatised clients.

Results/Findings: Working in a specialist trauma service provided a valuable learning experience. Challenges arose from training in an approach that is outside of the NICE guidelines of offering 8-12 sessions of trauma focussed CBT. Working within a Person-Centred model allowed the flexibility to work within the client's frame of reference and was consonant with the belief in the client's potential to know what is best for them in their path to recovery and growth. Supervision offered from a multi-theoretical approach presents a challenge for a placement trainee working in a specific model and the benefits and limitations of this are discussed.

The paper provides a 'snapshot' of the experience of working in a UK specialist service as a placement psychotherapy trainee and will provide valuable points of learning for trainees and training placement providers to consider. The route into such a placement, the benefits and drawbacks will also be discussed. 

Research Limitations: Auto ethnography is limited by findings based on a single participant.

Conclusions/Implications: Working within a Person-Centred approach can be beneficial for traumatised clients. Having trainees in placements can add value to the wider team and increasing the range of therapies available within a team is ethically consonant with the needs of service users in a trauma service.

Practice implications: support from training institutions with sourcing placements, remaining philosophically congruent with the core training modality, support in placement and the potential future of Person Centred therapy in the trauma field.

 
       
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