Research Conference 2016
BACP's 22nd Annual Counselling and Psychotherapy Research Conference entitled 'Research matters: evidence for an evolving profession' took place on 20 - 21 May 2016 at Holiday Inn, Brighton Seafront.
Presenters: Professor Mick Cooper & Professor John McLeod
Professional Role: Professor of Counselling Psychology; Professor of Psychology
Institution/Affiliation: University of Roehampton; University of Oslo
Email: email@example.com; firstname.lastname@example.org
ABSTRACT: pre-conference workshop
Client helpfulness interview (CHI) studies: conducting qualitative research that can make an impact
The aim of this workshop is to provide an accessible, 'hands-on' introduction to conducting Client Helpfulness Interview (CHI) studies. These are qualitative interview studies that examine what particular groups of clients find helpful and unhelpful in counselling and psychotherapy. CHI studies are based on the pluralistic assumption that clients can be helped by therapy in a multiplicity of ways; as well as the phenomenological principle that clients' accounts of their experiences are a valid source of knowledge on what 'works' in therapy. CHI studies consist of conducting in-depth qualitative interviews with clients on what they found helpful and unhelpful in therapy, and analysing the data using a recognised qualitative methodological approach such as thematic analysis. The workshop will begin by exploring the rationale for CHI studies, and then go on to explore methodological and conceptual issues. Key steps in the design, conduct and analysis of a CHI study will be discussed. In the workshop, we will explore specific examples of CHI studies, and give live illustrations of some of the research methods. This workshop will be particularly suited to student or early stage researchers who are embarking on a project, and are looking for a qualitative method that may help them make a useful contribution to the counselling and psychotherapy field.
Friday keynote presentation
Presenter: Professor Mick Cooper
Professional Role: Professor of Counselling Psychology
Institution/Affiliation: University of Roehampton
ABSTRACT: keynote presentation
From local evaluation to national impact: developing a programme of research on school-based counselling
Without evidence of effectiveness, counselling and psychotherapy practices are under threat. But what is it that members of the therapy community can do to develop the evidence base for their profession?
This presentation describes the journey taken by Mick and colleagues at BACP and across the UK to develop a programme of research on school-based counselling. This programme began with evaluations studies; and went on to involve a range of in-depth academic and student projects: qualitative interview studies, practice-based evaluations, measure development studies, and small scale randomised controlled trials. As the programme evolved, it was recognised as making a significant impact on policy and practice in the UK and, most recently, has led to the award of a major ESRC grant for a fully-powered trial.
The presentation will discuss what has been learnt from this journey about the ways in which counsellors and psychotherapists can develop 'research that matters'. This includes developing a focused programme of study, and developing collaborations across sectors.
Saturday keynote presentation
Presenter: Professor Kenneth N. Levy
Professional Role: Associate Professor
Institution/Affiliation: Pennsylvania State University, USA
ABSTRACT: keynote presentation
Recognizing and treating borderline personality disorder: what the research tells us
Borderline personality disorder (BPD) is one of the most difficult and perplexing problems faced by clinicians in practice. Recent research indicates that one in five clients in outpatient samples meets criteria for BPD and BPD is frequently comorbid with other disorders such as depression, bipolar disorder, PTSD, substance use disorders and eating disorders. This comorbidity negatively affects the course and outcome for these other disorders. Compounding the situation, BPD is known to be difficult to treat, with patients displaying high levels of hostility and suicidality, frequently not adhering to treatment recommendations, using services chaotically, and repeatedly dropping out of treatment. Thus, many clinicians are intimidated by the prospect treating BPD patients and are pessimistic about the outcome of treatment. Therapists treating patients with BPD have displayed high levels of burnout and have been known to be prone to enactments and even engagement in iatrogenic behaviors. The high level of comorbidity and high prevalence rates of BPD suggests that it cannot be easily avoided and all clinicians should be prepared to assess, treat, or triage patients with BPD. This presentation will focus on understanding the implications of epidemiological, experimental, meta-analytic, and treatment studies. In recent years there has been a growing empirical literature on the treatment of BPD. Beginning with Linehan's seminal randomized controlled trial (RCT) of Dialectical Behavior Therapy, there are now a range of treatments –deriving from both the cognitive-behavioral and psychodynamic traditions – that have shown efficacy in RCTs and are now available to clinicians. Data and their implications from two recently completed meta-analyses will be presented in order to derive clinically relevant evidence-based principles for recognizing and treating BPD that can be used by all clinicians in outpatient practice.
The following abstracts are ordered alphabetically by First Author surname:
Presenter: Louise Boardman
Other Authors: Dr Pam Ramsay & Dr Claire Kydonaki
Professional Role: Counsellor, Co-Investigator
Institution/Affiliation: University of Edinburgh/NHS Lothian
Keywords: anxiety, depression, trauma, intensive care, counselling
Counselling for patients and families after intensive care: a feasibility study
Aim/Purpose: There are few interventions to address known high rates of psychological distress among Intensive Care (ICU) survivors and their family members. This study will evaluate the impact of counselling on anxiety, depression and post-traumatic stress symptomatology/disorder (PTSS/D), and explore participants' experiences of counselling provision.
Design/Methodology: A feasibility study with mixed methods evaluation. A minimum of six counselling sessions with a BACP registered counsellor is offered. Recruitment is via self-referral. The study has ethical approval. Data collection commenced in May 2015, and will be completed in December 2016.
Quantitative evaluation: Participants are invited to complete: Hospital Anxiety and Depression Scale (HADS) 1, Post-Traumatic Stress Disorder Checklist (PCL) 2 and the CORE-103, both pre and 6 and 12 weeks post-counselling. Pre- and post- scores are compared using paired t-tests and Wilcoxon signed-rank tests.
Qualitative evaluation: Six weeks after the final session, participants (n=20) will be invited to participate in a semi-structured interview to explore experiences, expectations and acceptability of counselling provision. Data will be subjected to thematic analysis.
Results/Findings: Data on the prevalence of psychological trauma pre-intervention and attendance are presented. To date, 6 ICU survivors and 13 family members (5 bereaved) have participated. ICU survivors attended a mean 4.8 sessions (1-9 range), 3 were male: 3 female; mean age 56 (SD=8.5). 83% of patients scored above the accepted cut-off point for anxiety and 67% for depression. 50% met DSM-5 criteria for PTSD. We currently have no post-intervention data for patients. Family members attended a mean 6.8 sessions (1-18 range), 4 were male: 9 female; mean age 52 (SD=12.7). 85% of family members scored above the accepted cut-off point for anxiety and 69% for depression. 69% met DSM-5 criteria for PTSD. Post-intervention data for family members (n=3) is inconclusive at present.
Research Limitations: Despite known high prevalence of psychological distress after critical illness, recruitment has been unexpectedly challenging.
Conclusions/Implications: We currently have limited post-intervention data to draw any conclusions about the impact of counselling provision.
Presenter: Chris Brown
Other Authors: Dominic Cookson, Liz Willows & Alison Williams
Professional Role: Training Development Director/Coordinator & Tutor
Institution/Affiliation: LC&CTA (Lewisham Counselling and Counselling Training Associates)
Keywords: borderline personality disorder, attachment behaviour, helpful/unhelpful diagnosis
Counsellors' experience of the helpfulness, for clients, of the borderline personality disorder diagnosis
Aim/Purpose: Borderline Personality Disorder (BPD) is diagnosed when pervasive patterns of instability in relationships and self-image, marked by impulsivity, are noted in an individual (APA - DSM IV, 2013). 1% of patients with a mental health disorder are diagnosed with BPD (Levy in Quinn, 2013); a significant number of clients potentially accessing psychotherapeutic services. Therefore, we aimed to explore counsellors' experience of the helpfulness, for clients, of a BPD diagnosis.
Design/Methodology: Five semi-structured, audio-recorded interviews were conducted with counsellors working in the relevant field. Thematic analysis, informed by the Duquesne Method of Empirical Phenomenology (McLeod, 2001) was used to identify the common themes and highlight anomalies within our data. Our research followed BACP ethical guidelines for research in counselling and psychotherapy (Bond, 2004).
Results/Findings: Findings, based on respondents' experiences, indicate both positive and negative outcomes for clients in being diagnosed with BPD. Diagnosis appears helpful when it can be used to assist clients in making sense of intrapersonal-distress and in seeking further help and support; and when it is used to formulate a treatment-plan purposeful in changing self-negative beliefs and unsuitable attachment-patterns.
Conversely diagnosis appears to have an adverse effect when clients experience stigmatisation and/or distress by feeling 'labelled-by'/'stuck- in' the diagnosis; and when clients feel misdiagnosis or under-diagnosis has occurred.
Research Limitations: The qualitative research method used only asserts the subjective experiences of our respondents therefore, results cannot be generalised. This was a small research project, limited by time and resources; ethically we were unable to interview clients. However, careful data analysis does provide a cross-respondent descriptive account and therefore, a possible basis for understanding the experiences of counsellors in the field.
Conclusions/Implications: Findings indicate that clients diagnosed with BPD are best helped when a treatment-plan focused on raising positive self-belief and minimising intrapersonal-distress/negative attachment-patterns is formulated. Counsellors may need to consider encouraging clients to engage with additional support therefore; may need to be aware of the support organisations/services available to such clients; and to be aware of diagnosis-recourse options for the client. It seems counsellors need to pay singular attention to any shame/defamation, arising from diagnosis, experienced by the client.
Presenter: Pamela Campbell
Professional Role: Lecturer in Psychology, Counsellor and psychotherapist.
Institution/Affiliation: University of the West of Scotland
Keywords: university-based counselling, gender of counsellor, counselling preference, individual counselling, location
University students' preferences for location, format and gender of counsellor
Aim/Purpose: The purpose of the study was to investigate three factors which may affect student's willingness to attend a university counselling service: gender of the counsellor, format of the counselling provided (individual or group): and location of the service (campus based or external). The research paper replicated previous research conducted by Cooper (2006) and Quinn & Chan (2009).
Design/Methodology: 120 under graduate students were surveyed from a Higher Education institution in the West of Scotland using random sampling. In terms of ethnic origin, students indicated that they were of Scottish origin, British origin and non- British origin. Students from social mixed communities were surveyed. With reference to gender of the counsellor a chi squared analysis was performed, a two way analysis of variance using age and gender as fixed factors was used to analyse format and location of counselling.
Results/Findings: There was a marked preference for both male and female university students wishing to see a female counsellor (61.3%), with over 71% of students definitely or probably preferring to seek counselling within the university setting; and more than two thirds (72.1%) expressing a preference for seeing a counsellor on their own.
Research Limitations: Whilst the findings appear to be representative, cautious links must be taken with the findings, given the reasonably small scale of the survey, coupled with the fact that the survey was conducted in only one higher education institution in the United Kingdom. Future research could seek to modify these limitations by assessing larger numbers of respondents from multiple universities, UK wide.
Conclusions/Implications: The present study found a marked preference amongst university students for one-to-one counselling, based in their university, by a female counsellor. Such findings have important implications for delivery and provision of counselling services within universities. However more research must be carried out with university students, preferably not in a university setting, to provide strong support for the generalisability of this data. The research does provide a firm basis from which further research can be conducted.
Presenter: Tracey Clare
Professional Role: Counsellor
Institution/Affiliation: University of Chester
Keywords: perceived parental rejection, Self, self-acceptance, interpersonal rejection, personal development
The impact of personal development in processing perceived parental rejection in childhood
Aim/Purpose: This qualitative research is an exploration into the impact of Personal Development (PD) in processing perceived parental rejection in childhood, and to consider in context where their meaning making of parental rejection and Personal Development (PD) converged and differed in timbre. The aim therefore was to investigate the effect of PD on perceived parental rejection, specifically asking, 'does the experience of personal development in counsellor training impact on residual adult feelings derived from perceived parental rejection in childhood?'
Design/Methodology: Purposive sampling was implemented to recruit person-centred counsellors who responded to an advertisement placed within health care institutions in North Wales and North West England, who had self-perceived parental rejection in childhood and who had engaged in the PD component of a counsellor-training course. Semi-structured interviews were conducted with 4 participants, and the data analysed using Interpretative Phenomenological Analysis.
Results/Findings: The superordinate themes that emerged in the study, focus on 'The experience of rejection in childhood', 'Self in relation to others' and 'The healing journey'.
Research Limitations: A limitation of the study was the researcher's subjectivity. This was addressed by the transparent disclosure of her ontological framework and personal experience, and her ability to bracket personal issues.
Conclusions/Implications: The findings suggest that the experience of PD is a contributory factor in processing the pain of childhood rejection, and engagement in 'accepting' relationships, outside of counsellor training, were also identified as a therapeutically enhancing experience. The findings are useful to Counsellors and Psychotherapists, as they enable a greater awareness, and therefore empathy, of client issues embedded within the experience of perceived parental rejection. In addition, it is hoped that this small scale body of research stimulates more professional interest in, and awareness of, the outcomes of perceived parental rejection, and a renewed interest in providing support and care for those adults and children who continue to suffer the effects.
Presenter: Anna Constantine
Other Authors: Prof. Peter Gubi, Dr. Alessandro Pratesi & Dr. Paul Wagg
Professional Role: Counsellor, PhD Student
Institution/Affiliation: University of Chester
Keywords: sex, sexuality, counselling, psychotherapy, training
An exploration of the experiences of working with issues of sex and sexuality within training and practice
Aim/Purpose: The purpose of this study is to explore the experience of working with issues of sex and sexuality in counselling and psychotherapy training and practice and to consider if the training received was adequate in preparing therapists to understand and work with these topics within their practice. Issues relating to sex and sexuality are concerns clients may bring to therapy, expressed openly or implicitly. Counselling and psychotherapy training programmes can play a significant part in assisting trainee practitioners to develop reflective self awareness and competence to work with these matters. There is a paucity of material in this area and an aim of the study is to increase awareness of a topic which is often overlooked.
Design/Methodology: A hermeneutic phenomenological methodology is employed. Data analysed by a thematic approach. There are two stages to data collection. Stage 1 is the therapist sample; Stage 2 the programme leader/trainer sample. To date Stage 1 of the process is complete. Nine therapists who had finished primary training within the last five years were recruited through an online advertisement. The training approaches of participants include person-centred and integrative modalities. Individual semi-structured interviews were undertaken and subsequently transcribed. Recruitment of participants for Stage 2 is ongoing.
Results/Findings: All participants reported limited input on the subject of working with issues of sex and sexuality within their training. Participants experienced their training as inadequate in preparing them to work with these issues as qualified therapists and described a sense of reluctance from members of their training group, and tutors, to engage with the topic. An increase in self awareness, gained through their training, did in some way, assist participants to work with issues of sex and sexuality within their practice.
Research Limitations: Potential limitations could be sample size and cultural context.
Conclusions/Implications: It is anticipated that the study will be of interest to trainees, practitioners, training providers and the wider therapeutic community. The development of counselling and psychotherapy training programmes may be influenced by the research findings on completion of the study.
Presenters: Elizabeth Crunk, Edward H. Robinson III, Sandra L. Robinson, Naomi J. Wheeler & Hannah E. Acquaye
Professional Role: Doctoral Student
Institution/Affiliation: University of Central Florida
Keywords: complicated grief, grief counseling, complicated grief treatment, complicated grief prevention, best evidence synthesis
Complicated grief prevention and treatment: a best evidence synthesis
Aim/Purpose: Complicated grief (CG) is a protracted, debilitating, and sometimes life-threatening response to the loss of a loved one. The aim of this study is to provide an overview of the current state of research on prevention and treatment interventions for CG.
Design/Methodology: The researchers utilized best evidence synthesis (Slavin, 1995) research methodology to summarize the current state of the research on the prevention and treatment of CG. Following a review of the literature on the prevention and treatment of CG, studies (N = 14) were selected based on Slavin's (1995) Principles of Inclusion: (1) studies germane to the issue at hand, (2) methodological adequacy of the studies to minimize bias, (3) well-controlled studies that provide internal and external validity, (4) and relevant studies using several methods.
Results/Findings: Although most bereaved individuals are able to adapt to loss without professional support, treatment is indicated for individuals experiencing CG. Findings revealed that treatment interventions are effective in reducing symptoms of CG and in improving mood in complicated grievers. In contrast, preventive interventions for CG received less support. This poster will share research findings and discuss strategies for treating CG.
Research Limitations: Limitations in the above studies varied, but included low sample size, potential influence of the characteristics of study participants, and a limited number of studies available on preventive interventions for CG.
Conclusions/Implications: Research findings provided greater insight into ways that counselors can target their interventions when working with clients with CG. Specifically, research indicates that treatment interventions are effective in reducing symptoms associated with CG, but preventive strategies may not be effective in countering the onset of CG and symptoms associated with CG.
Presenter: Mehboob Dada
Professional Role: Trainee Counsellor
Institution/Affiliation: Lewisham Counselling and Training Associates (LC&TA)
Email: c/o email@example.com
Keywords: Muslim, gay, ethnicity, critical-reflection, counsellor training
A minority within a minority: a process of self-reflection
Aim/Purpose: Explore how identities of ethnicity, faith and sexuality, are lived with and experienced as part of counsellor training through my own experience as a researcher. As a minority within a minority, the research is motivated by a personal process and self-reflection. The paper utilises critical self-reflection as a strategy, highlighting intricacies of how a set of integrated identities impact the counselling training process.
Design/Methodology: Phenomenological self-reflective research paradigm was applied. Research involved using a semi-structured questionnaire, with the collection and analysis of non-numerical data, providing descriptions and possible 'meaning making' explanations. Informed by qualitative approaches to research (Coyle, A and Murtagh, 2014) and using Identity Process Theory (Rusi, J and Breakwell, 2014), common threads were identified and anomalies noted, with thematic data analysis agreed by LC&CTA in adherence of BACP Research Guidelines (Bond 2004).
Results/Findings: Recognizing social location as a crucial component of empathetic processes in counselling, such reflection can be used in challenging ethnic, faith, racial, class and heteronormative structures of domination. Self-reflection on the privileges and disadvantages associated with social location can enrich counselling processes that can contribute to an anti-oppressive praxis. More critically, resisting the reproduction of dominant power relations rests on an analysis of ones subjectivity, subject positions and the intersections of ones identity as a person and a counsellor in training.
Research Limitations: This research is subjective and unique to my lived experience. Mindful of personal biases, it's important to acknowledge that the knowledge produced, might not generalise to other people or settings. Developing a comprehensive understanding of how the interactions of identity can be used, further comprehensive research and implications for counselling practice are needed.
Conclusions/Implications: Research highlights the importance of enabling environment supportive of trainees with integrated identities. Self-reflection in training and in supervision can be applied, in addressing social divisions and structural inequalities in counselling work. Recommendations are presented regarding the training, and the need for further research, exploring integrated identities and their impact on the wellbeing and mental health of ethnic minority populations.
Presenter: Kelly Dickson
Professional Role: Psychotherapist, Research Officer
Institution/Affiliation: The Minster Centre (student), UCL Institute of Education
Keywords: psychotherapy, premature endings, client's experiences, therapeutic alliance, interpretative phenomenological analysis
Clients' experience of ending psychotherapy prematurely
Aim/Purpose: Clients who prematurely end psychotherapy remains an important field of inquiry. The majority of research in this area has focused on establishing which client factors predict premature termination or uses survey methodology to explore client's reasons for ending. Neither of these approaches capture the subjective experience of ending therapy as a process. To fill this gap in the evidence-base this study uses qualitative methods to explore client's perspectives of prematurely ending therapy.
Design/Methodology: Purposive sampling was used to recruit participants who self-identified as having left therapy prematurely after a minimum of six sessions and who were not trainee or qualified psychotherapists. Eight participants shared their experiences via semi-structured interviews. Data was analysed thematically using Interpretative Phenomenological Analysis (IPA). The study obtained ethical approval from the Minster Centre and adhered to the BACP Ethical guidelines for research and counselling.
Results/Findings: The findings indicate that participants end therapy prematurely when it no longer meets their needs or expectations. Difficulties in the therapeutic alliance were also reported as contributing to clients feelings of dissatisfaction and discontinued engagement in therapy. Some participants struggled to communicate their dissatisfaction and withdrew from therapy without an ending session.
Research Limitations: By sampling eight participants, using IPA, the findings fell somewhat short of providing biographical accounts of participant's experiences. The analysis was also shaped by theoretical and practice biases on repair and rupture in the therapeutic alliance. Although an unfunded piece of research, a further step in the analysis could have been to involve co-researchers to explore, reflexively and critically the generation of themes presented, to address some of these limitations.
Conclusions/Implications: The findings provide a timely reminder of the reparative potential of negotiating ruptures in the therapeutic alliance and encouraging open discussion with clients about negative aspects of their therapy. Overall the study highlights the value of generating qualitative data on client's experiences in a field dominated by quantitative research. Further areas for qualitative primary research are also suggested.
Stephen Paul Ferris
Presenter: Stephen Paul Ferris
Professional Role: PhD Candidate (F/T); Person-centred counsellor
Institution/Affiliation: Keele University
Keywords: loneliness, experience, subjectivity, heuristics, disconnection
A lonely separation in childhood and the pain of loneliness
Aim/Purpose: Loneliness has been a source of painful puzzlement for this researcher over many years – a sense of loneliness within his own self and a sense of loneliness within his own family of origin. The purpose of this investigation is to uncover the complexities of loneliness by rigorously examining personal experience.
Design/Methodology: The investigation utilises a qualitative research method pioneered by Clark Moustakas (1990) called, Heuristic Inquiry, which gives practitioners and researchers the opportunity to explore internal questions by collecting and interpreting data holistically. The essential research question – What is my experience of loneliness? – has emerged from the researcher's own personal experience of loneliness from childhood through to adulthood. Data was collected primarily through extended interviews in the form of self-dialogues and bracketing interviews but also included personal documents, research journals and memos, poetry, pictures and artwork. The data was analysed and interpreted using the heuristic processes of focussing, concentrated gazing and the internal frame of reference, which reveal the essence and meaning of the researcher's experience of loneliness.
Results/Findings: The inquiry is uncovering several structures to this researcher's experience of loneliness which includes a sense of inner disconnection from his own self and an outer disconnection from significant others.
Research Limitations: This inquiry into loneliness is subjective; it is, therefore, biased. Heuristic self-inquiry can lose its power and integrity if it shifts to an objective analysis or to a critique of the phenomenon under investigation. What appears to be emerging from this bias is the researcher's distinctive voice that seeks to relate his experience of loneliness, which is revealing something of the complex structure of this phenomenon.
Conclusions/Implications: It has proven difficult to locate literature on counselling those who experience loneliness. This internal investigation can bridge the apparent gap in the counselling literature as well as encouraging a practitioner to think about the complex phenomenon of loneliness in his or her own life and in the lives of his or her clients.
Presenter: Josie Flight
Other Author: Dr Amy Harrison
Professional Role: Assistant Practitioner & Honorary Research Assistant
Institution/Affiliation: Regent's University London
Keywords: experienced meditators, mindfulness, working memory, cognitive control
Meditation, mindfulness & working memory: the effects of general meditation practice and a comparison of meditation techniques
Aim/Purpose: Research suggests meditation improves Working Memory (WM), which accounts for wider purported health benefits. WM refers to a cognitive model outlining a 'central executive' attentional control system, with sub verbal-auditory and visual-spatial systems sustaining and manipulating information over short-time periods. Meditation refers to a broad category of spiritual and/or religious mind-body practices within multiple traditions. Mindfulness meditation refers to secularised Buddhist meditation practices, including therapeutic applications like Mindfulness Based Cognitive Therapy (MBCT). Literature is divided on explanations for the WM-meditation phenomenon and there is little examination into differences between meditation techniques. Therefore, the present study aimed to examine whether improved WM observed in meditation practitioners might also be explained bymeditation techniques.
Design/Methodology: Participants consisted of experienced meditation practitioners (n = 46) across three groups and an IQ-matched control group (n = 19). Participants completed three paper-WM measures: the colour-word interference task (Delis, Kaplan & Kramer, 2001), the symbol span test and the logical memory test (Wechsler, 2009). Three factorial MANOVAs and post-hoc tests were used to compare differences between meditation conditions and the control group.
Results/Findings: Meditators outperformed controls across all WM tasks (p < 0.05), particularly in visual-spatial skills (p < 0.005), although effect sizes were small-medium (np2 = 0.15). Significant differences were not seen between meditation groups (p > .05, ηp2 = .11) or techniques (p > .05, ηp2 = .18).
Research Limitations: Study findings were constrained due to insufficient test standardisation and recording accuracy and the cross-sectional design. A future study could use standardised lab environments, consider computerised tests and a longitudinal, randomised study design.
Conclusions/Implications: The study supports that regular meditation, regardless of technique, induces improvements in WM. These findings might be important given previously identified associations between WM and positive wellbeing. The WM mechanism might potentially contribute to explaining why various meditation techniques prevent relapse from mental illness like depression. The study therefore might be of use to "third wave" Cognitive Behavioural Therapies, notably MBCT, for highlighting developmental areas and providing explanation to clients.
Presenter: Katrina Harris
Other Author: Dr. Wendy Hoskins
Professional Role: Assistant Professor in Residence
Institution/Affiliation: University of Nevada, Las Vegas
Contact Details: Department of Educational and Clinical Studies, College of Education, University of Nevada, Las Vegas, Las Vegas, NV 89154-3014
Keywords: self-advocacy, counseling minorities, college students, readiness scale, competencies
Development and empirical analysis of a self-advocacy readiness scale with a university sample
Aim/Purpose: The purpose of this study was to develop and conduct an empirical analysis of a 55- item self-advocacy scale and to determine if there were differences in response patterns between minority and non-minority college students on the Self-Advocacy Readiness Scale (SARS). The following questions guided the research: 1. Does the Self-Advocacy Readiness Scale and its subscales provide a reliable measure of self-advocacy behavior? 2. Do the subscale components of the Self-Advocacy Readiness Scale adequately assess distinct self-advocacy skills and competencies? 3. Are there any significant differences in response patterns on the Self-Advocacy Readiness Scale total scores and subscale scores between minority students and non-minority students?
Design/Methodology: The Self-Advocacy Readiness Scale (2008) was developed to assess students' beliefs, knowledge, and experience to determine their willingness to advocate for their academic needs. The instrument contains five subscales (autonomy, control, experience, knowledge, and motivation). Items addressing Control, Motivation, and Autonomy were designed to assess competencies and skills students may need to self-advocate. Items addressing the constructs of Experience and Knowledge were developed to assess experience and knowledge of advocacy and self-advocacy. In addition, a sub-component of experience was included to assess students' experiences with their college advisors.
Results/Findings: The initial findings of the study indicate that the scale and subscales produced adequate estimates of internal consistency reliability. Exploratory factor analysis revealed the possibility of a self-advocacy construct. There were no significant differences between minority and non-minority students.
Research Limitations: The sample size, number of minority students, and the social desirability of participants' responses on self-report based instruments.
Conclusions/Implications: This study represents an initial contribution to the literature in the development and analysis of a scale to determine students' readiness to self-advocate. As the number of students seeking post-secondary education increases so does the need for an instrument to assess the readiness of students to self-advocate and provide a guide to counselors to help and prepare students for the academic rigor expected in an university setting.
Presenter: Ingela Jackson
Professional Role: Counsellor / Supervisor
Institution/Affiliation: Dept Lifelong Learning, UEA
Keywords: substance use, mothering, metanarratives, self-concept
What impact, if any, does having an adult child who uses substances have on mothers, and how do they make sense of their experience?
Aim/Purpose: This research explored how mothers made sense of their experience of having an adult child using substances in terms of their self-concept and identity. Previous research has focused on the impact of substance use on the whole family system, and whether certain family dynamics are common in families with substance use in them; the particular experience of mothers of substance users is discounted, even though they bear the brunt of the care of the substance user.
Design/Methodology: Five participants were interviewed using semi-structured interviews. Interpretative Phenomenological Analysis (IPA) (Smith, Flowers & Larkin 2009) was selected as the methodology most appropriate to explore their lived experience.
Results/Findings: The findings showed the significant financial, physical, social and psychological cost to these mothers; loss was a major part of their sense making. The findings showed their experience is misunderstood and unsupported in western societies where mothering metanarratives produce a mother-blaming culture.
Research Limitations: This small sample was ethnically unrepresentative and limited to western cultures. The analysis is inevitably influenced by the researcher's own mothering experience and interpretations. This was managed using Critical Thinking at the Edge and examining this client group's experiences through wider western mothering metanarratives.
Conclusions/Implications: This study helps counsellors understand the experience of mothering in difficult circumstances where there is little support and societal disapproval. It demonstrates how the participants' efforts to align themselves with mothering metanarratives creates a tension between their experience of being a mother and others' perception of them, so they lose their autonomy psychologically and experientially. It demonstrates counselling can help alleviate the guilt and shame arising from the mothering metanarratives, thereby addressing the clients' disconnect between their self-concept and experiencing.
Shondelle James & Michael McQueen
Presenters: Shondelle James & Michael McQueen
Professional Role: Higher Professional Diploma, 2nd Year Students
Institution/Affiliation: Lewisham Counsellor and Counselling Training Association. (LC&CTA)
Email: c/o firstname.lastname@example.org.
Keywords: schizophrenia, semi-structured, thematic analysis, person-centred, effectiveness
Person-centred counsellors' experiences of working with clients experiencing schizophrenia
Aim/Purpose: To investigate, explore and describe the perspectives of Person-Centred counsellors working with clients experiencing schizophrenia.
Design/Methodology: Three Person-Centred Approach (PCA) Counsellors with experiences of working with clients' diagnosed with schizophrenia were interviewed; interviews were semi-structured and audio-taped. Thematic Analysis informed by the Principals of Phenomenology (Moustakas, 1994) was used to analyse our data. We followed the BACP Ethical Guidelines for Researching Counselling and Psychotherapy (Bond, 2010).
Results/Findings: In our respondents' experiences it appears the PCA allows clients experiencing schizophrenia to better maintain their own organismic sense of self and individualistic self-defined frame of reference. This appears to enhance clients' life experiences through the support received during the therapeutic process and organically assists such clients to live with greater positivity. Clients often reported to their counsellors that therapy had been helpful in the maintenance of their daily lives. Additionally it appears that the PCA alliance with such clients often needed to be long term; and on occasions focusing the clients' attention and goal-setting activities seemed to be extremely helpful to this client group.
Research Limitations: The qualitative research methodology we chose means our findings are based on a small respondent sample of PCA Counsellors .Therefore, our results may be unique to the relatively few counsellors who were included in our study and our findings cannot be generalised to other counsellors in other settings (J. McLeod, 2003). However, such methodology did allow our findings to provide descriptive detail of participants' subjective and phenomenological experience of working with this client group; established through the process of cross-respondent/case comparison and careful analysis to highlight the common themes and anomalies inherent in the data.
Conclusions/Implications: According to respondents' subjective experiences, findings suggest that PCA counsellors may need to be aware that working with this client group often leads to long-term alliances; which appear to assist such clients in managing their lives with greater positivity. It also appears that the PCA practitioner may need to be willing to occasionally employ directive/goal orientated techniques when working with this client group; which appears to be linked to the practical aspects related to clients' managing their everyday lives more effectively.
Philippa Power & Paul Mortimer
Presenters: Philippa Power & Paul Mortimer
Other Authors: Yasmin Nariman & Jane Thompson
Professional Roles: Trainee Counsellors Institution/Affiliation: LC&CTA (Lewisham Counselling and Counselling Training Associates)
Email: c/o email@example.com
Keywords: depression, effectiveness, older-persons, person-centred, relationship
Person-centred counsellors' experiences of working with clients over 65 presenting with depression
Aim/Purpose: Hill and Brettle's (2004) systematic review of counselling older people (over 65) indicated there is a lack of UK research in relation to this client group. Therefore, our research focused on exploring the experiences of Person-centred Approach (PCA) counsellors who worked with members of this client group presenting with depression.
Design/Methodology: We conducted semi-structured, audio taped interviews with four PCA counsellors. Thematic analysis informed by the principals of phenomenology (Langdridge, 2007) was used to identify the emerging themes within the resulting data and to highlight any anomalies. We adhered to the BACP ethical guidelines for research in counselling and psychotherapy (Bond, 2004).
Results/Findings: Our findings, drawn from PCA counsellors' experiences, suggest that respondents' older clients initially struggle with the counselling process and the non-directive alliance. The respondents' clients also seem to defend against revealing feelings of loss, isolation and/or lack of relational contact/communication and denial appears central in the clients' early disclosures; especially in relation to being a burden, fear of change and depression itself. Additionally it seems respondents' clients feared the possibility of being diagnosed with a mental-health disorder. However, according to our respondents' experiences, clients who stayed with the PCA process benefited significantly from the alliance; becoming more self-aware/empowered through a deeper acceptance of self.
Research Limitations: This was a small research project. Ethically we were unable to interview clients because the resources appropriate to supporting such respondents following their participation were not accessible therefore; we were limited to exploring the experiences of PCA counsellors. The qualitative research method employed only provides evidence of the subjective views and experiences of our respondents and thus may not be open to generalisation.
Conclusions/Implications: Our findings indicate there is a need for older clients to be better informed as what to expect from PCA counselling. It also appears that such clients may be better facilitated if PCA counsellors discussed the potential difficulties that a client may experience in disclosing/expressing his/her feelings. Additionally it seems clients maybe further helped if clarification of and/or information on mental health disorders was given at onset of the alliance. Nevertheless, further research is required to advance/generalise our findings.
Other Authors: David Whittingham, Dawn Stevens, Elaine Doyle & Monika Ober-Sahnoun
Professional Role: L5Higher Professional Diploma in Counselling Students
Institution/Affiliation:Lewisham Counselling & Counsellor Training Associates (LC&CTA)
Email: c/o firstname.lastname@example.org
Keywords: gambling, addiction, experience, person-centred approach, effectiveness
Person-centred counsellors' experiences of working with clients self-identifying as problem gamblers
Aim/Purpose: To explore the experiences of Person-Centred Approach (PCA) counsellors (Rogers, 1951) who work with clients self-identifying as problem gamblers.
Design/Methodology: Semi-structured audio taped interviews were carried out with two PCA therapists working in the field who had experience of working with clients self-identifying as problem gamblers. Thematic Analysis informed by the principles of the Duquesne Method of Empirical Phenomenology (Moustakas, 1994) was applied to examine our data and identify the themes within it. Our research followed the BACP Ethical guidelines for researching counselling and psychotherapy (Bond, 2004).
Results/Findings: The subjective experiences of our respondents suggest that problem gambling does not emerge as the presenting issue when clients self-refer for counselling, but is rather disclosed as problematic after clients' other self-diagnosed addictions have been discussed. Our respondents' experiences suggest that problem gambling can either exacerbate the other addictions which clients report or be exacerbated by these other addictions (such as substance misuse). Our findings also suggest that respondents' found that clients with problematic gambling issues may terminate the PCA alliance early but appear to seek alternative help from organisations such as GamCare (G/C).
Research Limitations: The research was limited by its small scale and the apparent lack of PCA counsellors working with this client group. The qualitative method employed in our research was heavily dependent on our skills as researchers and could have been influenced by our personal biases. However, the semi-structure nature of our interview questions gave some assurance that parity of enquiry ensued and we made careful note of any additional probing questions we asked respondents; examination of this was carefully explored during our data analysis.
Conclusions/Implications: The subjective experience of our respondents indicates that problem gambling may not be presented as the primary issue bringing clients into a PCA alliance; additionally it seems that the PCA modality maybe ineffective with clients identifying as problem gamblers; as such client seem to leave the alliance early in pursuit of alternative help. The shortage of suitable respondents may indicate that PCA counsellors do not frequently work with this client group.
Presenter: Kelly Stewart
Professional Role: Counsellor/ Psychotherapist
Institution/Affiliation: Private Practice
Keywords: suicide, bereavement, heuristic, survivor, therapy training
A thorn in my flesh – a heuristic exploration of the impact of a mother's suicide
Aim/Purpose: The purpose of this study was to explore the lived experiences of female trainee psychotherapists whose mothers had committed suicide.
Design/Methodology: Previous research seemed to miss an understanding of the catastrophe of maternal suicide bereavement at the deepest level, perhaps hindered by methodologies not placing the researcher's personal experience as central. This heuristic inquiry therefore aimed to address the challenges of 'experience close' third person research by exploring the researcher's own lived experience in the first instance, supported by the stories of two other trainees also bereaved in this way. Data was collected through interviews, journal entries, dreams and artwork, with a creative synthesis of all findings depicted through the composition of a song.
Results/Findings: Five key themes were identified: 1) A mother's suicide rarely happens in isolation – understanding its wider context is fundamental to 'making sense' of it. 2) The pain continues beyond the immediate aftermath of suicide, in terms of attachment, abandonment and fear. This often manifests itself as a hypervigilance around safety and trust in relationships. 3) Suicide can leave bereaved individuals with unprocessed feelings – 'the shit.' 4) Suicide can feel like a catastrophic loss that people not bereaved by suicide do not 'get.' 5) Psychotherapy training can be a complicated experience for trainees bereaved by maternal suicide.
Research Limitations: Several limitations were identified: 1) The sample comprised of just three co-researchers. 2) The student researcher was new to research, which made heuristic inquiry a challenging choice of methodology. 3) The highly subjective nature of this research was both its greatest limitation, yet arguably also its greatest strength.
Conclusions/Implications: The researcher concludes that losing a mother to suicide is in many ways indigestible, not least because of a mother's significant role in her child's life. Suicide survivors would benefit from more structured support and a greater emphasis on self-care, because of their increased risk of depression, suicidal ideation and completed suicides. This implication is relevant to psychotherapy trainings and therapists working with suicide-bereaved clients.
Presenter: Ruth Wilson
Other Authors: Crispin Day, Tim Weaver & Daniel Michelson
Professional Role: Research Worker
Institution/Affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London
Keywords: personality disorder, parenting programme, child emotional and/or behavioural problems, feasibility
Helping families: a feasibility study of a psychoeducational parenting programme for parents with personality disorders who have children with significant mental health needs
Aim/Purpose: To test the feasibility of participant recruitment and intervention procedures for a new parenting programme targeted at parents with personality disorders who have children with significant mental health needs
Design/Methodology: Feasibility testing in a linked case series conducted in NHS child and adolescent mental health services (CAMHS) and adult mental health settings. Quantitative process data are being collected on rates of identification, approach, consent, screening and eligibility for potential parent participants. Parent and clinician views on recruitment and intervention procedures are being explored in semi-structured interviews. The interview sample will include up to N=12 parents who have been screened for eligibility; N=12 referring key workers; and N=4 research therapists.
Results/Findings: Emergent process data indicate two main challenges to recruitment: (1) the low conversion rate of referred participants (currently 8%) and (2) slow overall place of referrals. Findings (n=6) from the qualitative interviews identified five emerging themes: 1) feelings of reservation towards the programme 2) stigma 3) balance between a structured or flexible approach 4) quality and nature of the therapeutic relationship and 5) positive changes.
Research Limitations: The final sample size for the case series was reduced from the original target of N=12. Operational criteria for parental personality disorder will require further refinement to improve acceptability for both clinicians and parents. This will be addressed in the subsequent phases of the research.
Conclusions/Implications: This study highlights the challenges of providing targeted interventions that span mental health services for children and adults. Targeted parenting interventions may have benefits for high-need families but there are significant barriers to delivery and evaluation in routine settings.
The following abstracts are ordered alphabetically by First Author surname:
Hannah E. Acquaye
Presenter: Hannah E. Acquaye
Professional role: Doctoral Candidate (Counselor Education, UCF)
Institution/Affiliation: University of Central Florida
Keywords: posttraumatic growth, war-related events, Africa
The moderating effect of religious commitment on the relationship between posttraumatic stress and posttraumatic growth in former refugees
Aim/Purpose: Refugee issues fill the airwaves in the world. Despite the diverse psychological challenges refugees experience, some have also experienced psychological growth. The study therefore explored the influence of religious commitment on the relationship between posttraumatic stress and posttraumatic growth in adult Liberian former refugees traumatized by war-related events.
Design/Methodology: Permission from UCF's IRB was obtained prior to data collection. A purposive sampling provided responses from 400 participants. Participants are adult Liberian former refugees and internally displaced persons who currently reside in Liberia. Instruments used were the Posttraumatic Growth Inventory (PTGI, Tedeschi & Calhoun, 1996), Religious Commitment Inventory (RCI-10, Worthington et al., 2003), and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5, Weathers et al., 2013).
Results/Findings: Multiple regression procedure (Field, 2013) indicated that religious commitment (RC) had a small moderating effect on the relationship between trauma and growth. However, RC had a stronger predictive ability on growth than did trauma alone. Counselors are recommended to hone in on their spiritual/religious competencies to help traumatized refugees obtain growth.
Research Limitations: This study is limited by: (a) lack of random sampling procedures, (b) restricted inclusion criteria, i.e. only participants with 8th grade English comprehension abilities.
Conclusions/Implications: This study adds to literature on posttraumatic growth in non-western populations. It encourages therapists to assess spirituality and/religiousness with traumatized clients.
Hannah E. Acquaye & A. Elizabeth Crunk
Presenters: Hannah E. Acquaye & A. Elizabeth Crunk
Professional role: Doctoral Candidate (Counselor Education, UCF)
Institution/Affiliation: University of Central Florida
Keywords: refugee trauma, complicated grief, post-traumatic growth
The role of trauma and complicated grief in psychological growth
Aim/Purpose: This phenomenological study (Creswell, 2006; Moustakas, 1994) discovered the he lived experiences of former refugees who experienced trauma and complicated grief in a decade long war, and further re-traumatization and grief in battling the nation-wide Ebola epidemic. Additionally, we explored how these experiences aided or prevented the acquisition of posttraumatic growth. To our knowledge, limited research exists on complicated grief within war-related refugee populations, especially in Africa.
Design/Methodology: Permission from UCF's IRB was obtained prior to data collection. Twelve participants (Creswell, 2006) were purposefully sampled to take part in the study. Participants were Liberian former refugees and/or internally displaced persons during the 14-year long civil war. Face-to-face and focus group semi-structured interviewing were the data collection procedures. Using Colaizzi's 8 strategy for phenomenological studies, transcripts of interviews were read, significant statements identified, and clusters of themes extracted.
Results/Findings: Some themes that emerged were suffering, vivid remembrance of difficult situations, adverse change in social position because of the war, and a sense of hope for the rise of the country and the people. Hopefulness can help traumatized people gain healing even from complicated grief.
Research Limitations: This study is limited by restriction of participants to just Monrovia and not former Liberian refugees residing outside Liberia, since their experiences may be different from those who returned home and may not have experienced the fear of the Ebola outbreak.
Conclusions/Implications: This study adds to literature on posttraumatic growth and complicated grief with respect to multiple traumas in war-related populations. An understanding of these experiences will help therapists to combine knowledge about trauma and grief in helping refugees gain closure while they obtain a positive outlook on life, reducing their risk for suicides and other prosocial behaviors.
Presenter: Youssef Aloteabi
Other Authors: Belinda Harris & David Murphy
Professional Role: Ph.D. Research Student
Institution/Affiliation: University of Nottingham, School of Education and King Abdulaziz University
Keywords: school counselling, quantitative, special needs, provision, barriers
Exploring the provision of school counselling for students with special educational needs in Saudi Arabian schools
Aim/Purpose: In the Saudi Arabian context, the Ministry of Education facilitates the education of students with special educational needs (SEN) by means of integrating them into mainstream schools. However, students with SEN may not be offered counselling in their respective schools. Due to the dearth of the relevant literature in this area, the aim of this quantitative study was to explore the provision of counselling for students with SEN in Saudi Arabian schools.
Design/Methodology: A survey was designed and distributed to 240 Saudi counsellors working in 240 schools that include students with SEN in three different cities (Jeddah, Mecca and Taif, including both urban and rural schools); of these, 138 were completed and returned, representing 138 schools in total (one counsellor per school), resulting in a response rate of 57.5%. The Statistical Package for Social Science (SPSS) was utilized to analyse the data obtained from the questionnaires.
Results/Findings: The results of the study showed that 58.7% of the participants have dealt with these students. However, the majority of participants reported that they have not obtained any training in providing counselling for students with SEN and perceived this as an important omission regarding their skills.
Furthermore, this research indicates that the level of learning disabilities was the first important obstacle to working with these students, followed by the lack of counselling training. Also, the results indicated that school counsellors support providing counselling services to students with SEN in schools, regardless of the lack of adequate training to deal with this group.
Research Limitations: A limitation for this study includes the relatively low response rate. Moreover, no in-depth qualitative date were collected.
Conclusions/Implications: The study has implications for the school counselling profession in Saudi Arabia, particularly regarding raising awareness of the right of students with SEN to access school counselling. However, professional training must be provided to counsellors to better deal with students with SEN.
Fiona Ballantine Dykes
Presenter: Fiona Ballantine Dykes
Professional Role: MA student, Counselling and Psychotherapy by Research
Institution/Affiliation: University of Warwick
Keywords: competence, gatekeeping, fitness-to-practise, academic ability, training
Tutor experience of making difficult decisions about counselling trainees' fitness-to-practise in the UK
Aim/Purpose: To explore in depth tutor experiences of managing challenges and problems associated with making decisions about student competence and fitness-to-practise on counselling training courses in the UK. Tutors are by default the gatekeepers to the counselling profession but their experience of managing such problems has been under researched to date.
Design/Methodology: This qualitative study used purposive sampling. Semi-structured interviews were recorded with five experienced female trainers delivering practitioner training courses ranging from level 4 vocational diploma to Masters level programmes in both a Further Education and Higher Education context. Four training centres were in England and one in Scotland, each delivering different counselling modalities. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA).
Results/Findings: Tutor experience is discussed under six themes: (1) the personal stress of managing problems (2) the challenge of the 'gatekeeping' role (3) the difficulty of assessing relational skills/personal characteristics (4) the relative importance of academic versus relational skills (5) difficulties associated with the training context itself 6) the role of the tutor-student relationship including the need to be fair to students.
Research Limitations: This is a small-scale qualitative study so the findings, although rich, are illuminating rather than generalisable. The strengths and weaknesses of the IPA approach and the qualitative methodology are explored. The study includes a reflexive statement and critical evaluation of the role of the researcher.
Conclusions/Implications: This study shows that tutors experience great stress and challenges to their personal integrity. They see gatekeeping principally in terms of 'doing no harm' and unanimously agree that this is around relational skills and personal characteristics rather than academic ability. Assessment structures and the training context often hinder rather than help them with assessment dilemmas and existing structures are not always 'fair' to students or effective for preventing unsuitable candidates from passing. The findings raise important questions about the future of counselling training and suggest that much could be learned by bringing tutors together to share best practice.
Presenter: Anne Bentley
Professional Role: Manager of the Student Counselling & Personal Development Service
Institution/Affiliation: Plymouth University
Keywords: educational experience, transformational, academic ability, existential learning, student learning
'I was just like wow!': university students' perceptions of how counselling benefitted their academic ability
Aim/Purpose: Since the marketisation of education in 2013, University income is mainly derived from student fees. This has engendered greater competition for students. Some counselling services have experienced service reductions, particularly in Further Education. To defend and sustain in-house counselling provision, counselling services need to define and articulate how they may benefit the educational task of the institution. The aim of the study was to explore students' perceptions of how counselling helped their academic ability.
Design/Methodology: Semi-structured interviews were conducted with seven students who had experienced counselling. Students were identified through purposive sampling; in a post-counselling questionnaire, all had cited counselling as 'an important' or 'the most significant' factor' in helping them to do better in their academic work. The interviews were analysed thematically using grounded theory.
Results/Findings: All students experienced counselling as a learning process and reported enhanced academic engagement. Five students linked it to improved grades. Three students perceived their counsellor as 'expert' and conceived the counselling process in terms of acquiring the counsellor's knowledge. These students located responsibility for the success of counselling as residing outside of themselves. Four students perceived their counsellor as co-facilitator and described counselling as transformational learning. As well as experiencing academic benefits, they reported existential learning, leading to a reframing of their self-concept, and appeared to take responsibility for developing their own learning bothin and outside of counselling.
Research limitations: The sample size of seven participants was not large enough to indicate whether saturation was achieved. Participants were selected because they had previously indicated that counselling had enhanced their academic experience. It could be useful for future research to inquire into the experience of those students who did not perceive themselves as acquiring academic benefits from counselling.
Conclusions/Implications: Counselling is a learning process which students considered to have enhanced their academic ability and evoked existential change. Further research with a wider cohort could enable the development of a nuanced picture of how counselling can enhance the business aims of a university and help sustain the specialism of in-house university counselling.
Kelly Birtwell & Dr. Linda Dubrow-Marshall
Presenters: Kelly Birtwell & Dr. Linda Dubrow-Marshall
Professional Role: Clinical Research Recruitment Facilitator
Institution/Affiliation: Manchester Mental Health & Social Care Trust
Contact details: Research & Innovation dept., 3rd floor, The Rawnsley Building, Manchester Royal Infirmary, Hathersage Rd., Manchester, M13 9WL
Keywords: dementia, loss, coping, support, qualitative
Psychological support for people with dementia: an exploratory study
Aim/Purpose: A systematic review (Olazaran et al, 2010) of non-pharmacological therapies for people with Alzhheimer's disease concluded that these are useful and potentially cost effective interventions for improving quality of life in dementia for both patients and carers. This study aimed to explore the attitudes to, and acceptability of, psychological support for people with mild dementia, from their perspective.
Design/Methodology: Semi-structured interviews were conducted with five people with mild dementia, identified from secondary care services. Questions concerned the experience of being diagnosed, experience of support services, and their opinion of different possible support options. Interviews were audio-recorded, transcribed, and analysed using thematic analysis.
Results/Findings: Three main themes were identified: loss, coping, and support. Loss of physical abilities was associated with a loss of identity, particularly working identity and place in the community. Loneliness and stigma associated with dementia were common. Methods of coping varied: acceptance or denial, feeling a loss of control or asserting control, and through growth and development, e.g. engaging in new activities or using humour. Knowledge was a vital aspect of support – about the condition, support and services, and knowing how to find further information. Individual needs and preferences were key, including a person-centred approach from staff, and support for people at different stages of dementia. There were concerns around the provision of services: financial cuts, accessibility, and eligibility for support. Opportunities to talk about how they were feeling and social aspects of support were seen as particularly valuable. Counselling, mindfulness, and group-based activities including walking and gardening were viewed positively. Support from Admiral Nurses or Specialist Nurses tended to be viewed in terms of physical health needs and most needed in later stages of dementia.
Research Limitations: Limitations include the small sample size, potential inaccuracies acknowledged by participants regarding their recollections of events, and researcher bias in hoping that psychological support would be well received.
Conclusions/Implications: Talking therapies and psychosocial interventions were acceptable sources of support. Support for people with dementia must be person-centred: personal preferences as well as physical and cognitive abilities should be considered in order to support people with dementia to adjust to a diagnosis and live well.
Presenter: Emma Broglia
Other Authors: Michael Barkham & Abigail Millings
Professional Role: PhD Researcher
Institution/Affiliation: University of Sheffield
Keywords: outcomes, CORE-10, counselling, student-specific, academic
An initial evaluation of the counseling center assessment of psychological symptoms (CCAPS): comparisons with CORE
Aim/Purpose: UK university counselling services (UCSs) have previously used the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), but CORE-OM was not designed to capture student-specific symptoms (e.g., academic distress or alcohol misuse). CCAPS is an American assessment and outcome measure designed specifically for a student clinical population but there is currently no empirical data allowing comparison to the CORE measures. Accordingly this study aimed to compare one of the suite CORE measures, CORE-10, with CCAPS in a UK clinical student sample.
Design/Methodology: Two UK UCSs contributed intake data on CORE-10 and CCAPS completed by 294 students accepted for counselling during April-July 2015. A range of psychometric properties were examined between CORE-10 and CCAPS-62 intake data (pre-treatment) and results were compared to the US CCAPS sample.
Results/Findings: CORE-10 and the CCAPS Distress Index (19 items) were highly correlated, r(294)= .73, p=.001. Compared to US, UK students were elevated on all CCAPS subscales, most noticeably for depression, Generalised Anxiety Disorder, social anxiety, and academic distress. All CCAPS subscales were shown to be reliable with alpha values ranging 0.80-0.90. The overall CCAPS distress index and CORE-10 total were also shown to be reliable: =.82 and =.77 respectively.
Research Limitations: Data were provided from two UK UCSs and may not be generalizable to other UCSs therefore further comparisons are needed between more geographically diverse universities across the UK. Initial analyses focused on pre-treatment data only and further analysis is required on post-treatment data to explore indices of client change.
Conclusions/Implications: Initial findings indicate that CORE-10 and CCAPS reliably measure similar psychological symptoms in a UK student clinical sample. They also demonstrate the added benefit of a student-specific tool to capture contextual experiences (e.g., academic distress, alcohol misuse, family distress). Comparisons with US students suggest that UK students approach counselling services with a higher symptom severity. Taken together, these findings provide evidence of an evolving profession with services actively engaging in research to inform and develop services.
Presenter: Sarah Cantwell
Other Authors: Dr John Rae, Dr Joel Vos & Professor Mick Cooper
Professional Role: Doctoral researcher and counsellor in a community counselling service
Institution/Affiliation: University of Roehampton
Keywords: pluralistic therapy, working collaboratively, Conversation Analysis
A conversation analytic survey of how clients and therapists talk about what might be therapeutically helpful in pluralistic therapy
Aim/Purpose: Pluralistic therapy recommends clients and therapists collaboratively discuss what therapeutic approaches and activities might be helpful for the client in achieving their goals. To date, descriptions of how clients and therapists talk about what might be helpful are derived from post-hoc reports of therapy sessions and clinical experience (e.g. McLeod, 2013). However, these descriptions may not be optimally informative about how such talk is actually achieved, since skilled practices can be organized at a level of interactional detail difficult for practitioners to remember and articulate (Hepburn et al., 2014). There is therefore a need for research on the concrete interactional skills used in pluralistic therapy (Cooper & McLeod, 2011). The current observational study aimed to initially address this by surveying how therapists and clients initiate talk about what might be helpful.
Design/Methodology: 42 audio-recorded sessions were selected from a representative sample of 7 dyads (5 therapists; 7 clients) who participated in the Pluralistic Therapy for Depression research study (Cooper et al., 2015). Instances of talk about what might be helpful were identified and Conversation Analysis (e.g. Madill, 2015) was then used to describe how this talk was initiated.
Results/Findings: Suggestions by therapists regarding what might be helpful were by far the most common means of initiation. Suggestions differed in length, in how many were included in one conversational turn and in how explicitly the therapist elicited the client's view on the suggestion(s). The next most common means of initiation was therapists' questions. Direct questions about what might be helpful in the future were frequently treated as non-straightforward by clients and therapists, with further pursuit by the therapist often necessary to elicit client views. Instances of client initiation were much less frequent.
Research Limitations: The relationships between these interactionally-focused findings and broader therapeutic processes and outcomes are currently being investigated.
Conclusions/Implications: Talk about what might be helpful was predominantly initiated by therapist suggestions in the current data sample. Implications for practice include how therapists might invite more client participation in such talk.
Presenter: Liddy Carver
Professional Role: Lecturer, Counselling Skills
Institution/Affiliation: University of Chester
Contact details: CWE121, Westminster Building, University of Chester, Parkgate Road, Chester CH1 4BJ
Keywords: co-operative inquiry, complaints, counselling training, higher education, training alliance
A co-operative inquiry: circumnavigating complex undercurrents within the training 'alliance'
Aim/Purpose: Counselling training literature tends to examine trainer challenges vis-à-vis students from a competence and/or gate-keeping perspective. The aim of this paper is to explore the multifaceted nature of implicit challenge and explicit confrontation within the training 'alliance', and to ask how trainers might be supported when faced with conflict and complaint.
Design/Methodology: A 3-year co-operative inquiry approach was used to develop insights into trainers' strategies for responding to critical incidents within the training dyad. The study involved five experienced counselling trainers working in a HE environment as well as the author of the paper as an 'early stage' trainer. Data from this and three additional workshops conducted with counselling teams produced 10 two-hour transcripts analysed using thematic analysis.
Results/Findings: Using examples from co-researchers' own experiences and highlighting the dynamic between trainer and student in multifarious training situations, the paper reveals a rift between the intensity of the trainer's experience and the support in place to contain that. One of the main themes for experienced counselling trainers relates to the entreaty; We're supposed to be relational. Why can't we try and work this through together?
Research Limitations: Co-operative Inquiry presents several logistical challenges to the research process: Recruiting enough people willing to commit to a process over time; regular attendance; and a willingness to explore and challenge. As a qualitative study, co-researchers perspectives may not represent experience at other higher education institutions although workshops mitigate this particular limitation. An open dialogue with co-researchers, in research supervision, and through maintaining a reflexive journal, helped mitigate the negative impacts of researcher subjectivity. A key task for the researcher also involved holding the research focus in the context of what became a supportive and transformative experience for co-researchers.
Conclusions/Implications: A multidimensional picture emerges of experienced trainers struggling to contend with challenges presented by some students. A number of important implications were found: Trainers can feel disempowered, disconnected, angry, and silenced vis-a-vis perceived antagonism. The recommendation is that a collaborative approach to critical incidents needs to be incorporated into training cultures. Otherwise the danger is alienation of some trainers from their students, with potentially serious consequences.
Presenter: Hsiu-Lan Cheng
Other Authors: Jamey Rislin, Susanna La & Jessica Lopez
Professional Role: Assistant Professor
Institution/Affiliation: Department of Counseling Psychology, University of San Francisco
Keywords: attachment anxiety, attachment avoidance, stigma, intentions to seek counseling, psychological distress
Intentions to seek counseling among distressed individuals in romantic committed relationships
Aim/Purpose: The purpose of the study is two-fold: (a) to examine how adult romantic attachment insecurities (i.e., anxiety and avoidance) are associated with help-seeking stigma (i.e., perceived stigma from romantic partners and self-stigma) among distressed individuals in committed relationships, and (b) whether the two stigma variables mediate adult attachment and intentions to seek therapy for emotional distress. The literature indicates that many people with mental health problems do not seek professional help, and stigma is the most frequently cited barrier to treatment (Corrigan, 2004). Although adult attachment theory has been applied to studying help-seeking attitudes and intentions (e.g., Vogel & Wei, 2005), it has not been applied to understanding help-seeking stigma in a romantic relational context.
Design/Methodology: We used a cross-sectional design. Data were collected via an online survey using the Experiences in Close Relationship Scale-Short Form, Perceptions of Stigmatization by Others for Seeking Help Scale, Self-Stigma of Seeking Help Scale, and Intentions of Seeking Counseling Inventory. Screening measures for depression and anxiety were also included. Obtained data was subjected to Structural equation modeling (SEM).
Results/Findings: A sample of 326 distressed college students who were married or in a committed relationship completed the survey. Scores indicated that participants met the cutoff for moderate to severe depression and anxiety. However, only 24.8% of them sought counseling/psychotherapy in the past 12 months. Perceived stigmatisation by a romantic partner and self-stigma mediated the relationships between attachment anxiety and attachment avoidance as respective predictors and intent to seek counseling as the criterion variable.
Research Limitations: Cross-sectional design could not infer causality. The sole use of self-report measures could have resulted in inflated associations among variables due to monomethod bias. Data were based on only one university sample in the United States, which limits generalisability.
Conclusions/Implications: Although attachment anxiety is generally associated with more favorable intentions to seek counseling than attachment avoidance, both forms of attachment insecurity may impede help-seeking by promoting anticipation of stigmatisation from one's partner for seeking help, which may further be internalised in the form of self-stigmatization. Prevention and intervention programs should attend to attachment and stigma processes when working with distressed individuals in current committed relationships.
Presenter: Sarah Conn
Professional Role: Counsellor/Psychotherapist
Institution/Affiliation: Metanoia, Middlesex University London
Keywords: phenomenology, cultural engagement, hierarchy of helping, personal attributes, situational conditions
To whom do international students of non-European backgrounds turn when struggling with the challenges of university?
Aim/Purpose: To explore the subjective experience of the help seeking behaviours and coping strategies of international students of Non-European backgrounds, when struggling with the challenges of university. The study was motivated by the distinct under-utilisation of traditional counselling services by such students.
Design/Methodology: Eighteen students of Non-European backgrounds from eleven countries, studying at three universities were interviewed. A phenomenological approach was used to capture the students' experiential knowledge. Interpretative Phenomenological Analysis was employed to address the research questions from a first-person perspective, helping to shed light on the sense-making of the students when confronted with challenge.
Results/Findings: Analysis of subjective experience revealed five key themes emerging as super-ordinates. Students identified the significant defining experiences as: Impact of Transition which characterised the early stages following arrival in the country; Living with Challenge – how they coped, drawing on an extensive repertoire of strategies; Seeking Help whilst Living with Challenge – who from, why and at what point, followed by Shifting Identities – self observations of how these experiences have affected who they are as persons and finally Enhancing Cultural Engagement – students' reflections on changes that may improve their overall experience. Two important findings were revealed by the study. Firstly, patterns of help-seeking typically followed preferential relationships, which the researcher termed hierarchy of helping. Secondly, it became obvious that a combination of personal attributes (e.g., resilience) and situational conditions (e.g., presence of local community groups) have a bearing on how well students cope with challenge and how this later influences actions/decisions around seeking help.
Research Limitations: The findings are not truth claims, nor do they purport to be representative of all students fitting the description of 'International Students of non-European backgrounds'.
Conclusions/Implications: The study highlights the need for a "helping community" of collaboration between services to increase safety and reduce risk, through better cultural engagement. Implications for practice include offering alternative entry points, e.g., psycho-social-educational groups for students; embedding cultural awareness training through staff development programmes; integrating cultural competency into all professional counselling training accredited by BACP; making available CPD options in cultural competency for qualified counsellors; facilitating contact between students of Non-European backgrounds and local students.
Elizabeth Crunk, Naomi J. Wheeler & Edward H. Robinson
Presenters: Elizabeth Crunk, Naomi J. Wheeler & Edward H. Robinson
Other Author: Pauline Flasch
Professional Role: Doctoral Student
Institution/Affiliation: University of Central Florida
Keywords: intimate partner violence, abuse recovery, intimate relationships, domestic violence, intimate partner violence survivors
Navigating new relationships during recovery from intimate partner violence (IPV): a phenomenological investigation of female survivors' experiences
Aim/Purpose: About half of U.S. women will be victims of IPV. It is essential that counsellors are prepared for working with IPV clients. Much research focuses on crisis intervention and fails to emphasise the recovery process of survivors. The purpose of this study was to better understand how female survivors of intimate partner violence (IPV) navigate through the process of new relationships after their IPV experience.
Design/Methodology: The current study utilised phenomenological methodology. Ten female participants were interviewed in four U.S. states regarding how they considered or navigated new relationships after their abusive relationship. Results were analyzed using phenomenological qualitative data analysis procedures.
Results/Findings: Survivors engage in internal and psychological experiences (IPE) as well as social and interpersonal experiences (SIE) as they consider or navigate new relationships post-IPV. IPE: (a) Reclaiming self through dating experiences, (b) Learning to trust self, (c) Difficulty trusting new partners, and (d) Facing other fears of dating. SIE: (a) Exploring dating with new partners, (b) Sexual exploration as part of navigating new partners (c) Negotiating boundaries and use of control with new partners, (d) Communication and support of new partner, (e) Modeling of healthy relationships by others, and (f) Caring for and protecting children.
Research Limitations: Limitations include potential researcher bias; participants may have chosen to withhold information due to the sensitive nature of the study; variations in IPV background.
Conclusions/Implications: Findings provide clinical/practice implications for working with victims and survivors, such as preparation in the crisis stage and recovery in the action stage. They also help survivors gain a better perspective of recovery expectations and dating, potentially minimising post-IPV dating trauma. Future research includes quantitative studies instrument development.
Elizabeth Crunk, Naomi J Wheeler & Edward H Robinson
Presenters: Elizabeth Crunk, Naomi J Wheeler & Edward H Robinson
Other Authors: Paulina Flasch, Dodie Limberg-Ohrt, Jesse Fox, Jonathan Ohrt & Sandra L Robinson
Professional Role: Doctoral Candidate
Institution/Affiliation: University of Central Florida
Keywords: altruistic caring, empathy, therapeutic alliance, qualitative study, outcome
A qualitative investigation of altruistic caring and client outcomes in counseling relationships
Aim/Purpose: Altruistic behavior has a direct positive effect on others (Andre, Louvet, & Deneuve, 2012). It is hypothesised that counselors, who are altruistic, consequently have a direct positive effect on their clients. We interviewed first-time counselors and their clients separately about their experiences of altruistic caring in sessions and examined client outcome measures, specifically the Outcome Questionnaire 45 [OQ-45] (Lambert, 2011), to hypothesise, at face value, whether themes and patterns of altruism in session could be qualitatively examined in relation to outcome measures.
Design/Methodology: We utilised phenomenological research methodology (Moustakas, 1994) to better understand the lived experiences of first-time counselors (n = 10) and their clients (n = 14) in relation to altruistic caring in counselling sessions. We recruited participants in clinical practicum in the university counselling center. As a second component, we gathered client OQ-45 scores and identified the pattern of improvement for each client to identify trends between the qualitative interviews and their scores.
Results/Findings: The following subthemes were identified as reasons for becoming a counselor: (a) Emotional/Relational, (b) Counseling vs. other helping professions, (c) Spiritual/Existential, and (d) Cognitive/Rational. Counselors also shared their experiences of altruistic caring with clients in sessions. Clients experienced the following subthemes related to the experience of care by their counselors: (a) Emotional/Relational/Attentive and (b) Cognitive/Behavioral. Initial trends seemed to suggest that clients whose OQ-45 scores indicated the most improvement used terms to describe close relationships with their counsellors.
Research Limitations: Research limitations include: (a) potential researcher bias, (b) localised sample, (c) social desirability.
Conclusions/Implications: By understanding caring-experiences by counselors and their clients in session, we can better pin-point the specific interactions and factors that were especially influential in creating a sense of care and altruism in the session. Furthermore, we can provide a springboard for further investigation on potential patterns between outcome and altruistic caring in session.
Presenter: Melissa DeSmet
Professional Role: FWO aspirant, PhD candidate
Institution/Affiliation: Ghent University (Faculty of Psychology and Educational Sciences); FWO
Keywords: depression, outcome research, first-person perspective, subjective experience, qualitative research
Acknowledging clinical heterogeneity in outcome research: the value of studying the first-person perspective
Aim/Purpose: One of the major critiques on outcome studies (RCTs) is that they lack external validity, potentially leading to a further dispersion between research and practice. The aim of this study is therefore to explore what a qualitative analysis of the experience (which we term as the first-person perspective) of depression can contribute to findings from outcome research on the psychotherapeutic treatment of this condition. Specifically we aim to 1) deepen the understanding of depression by focusing on its complexity by taking in account the patient's point of view, 2) investigate what this knowledge adds to the dominantly used conceptualization of depression in outcome research (i.e. DSM definition) and 3) outline the possible implications for understanding research findings concerning the process and outcome of therapy for depression.
Design/Methodology: A qualitative study was conducted using semi-structured interviews within a randomized controlled trial on the psychotherapeutic treatment of depression. For a group of 14 participants (all diagnosed with Major Depressive Disorder; MDD) we analyzed the interview data using thematic analysis. We explored 1) how adults with a diagnosis of MDD experience this condition and 2) what this knowledge contributes to the diagnostic criteria of the DSM definition as dominantly used within outcome research.
Results/Findings: Descriptions of patients' subjective experience of depression clearly transcend the criteria listed in the DSM. Complaints must be understood in regard to ones subjective position towards the diagnosis and situation, and within a specific societal, professional and relational context. An RCT symptom-approach ignores these fundamental subjective dimensions, which compromises its ability to map treatment outcome adequately.
Research Limitations: Due to the small sample size, we cannot claim generalizability. Bias in the given interpretations was limited by making the assumptions and ideas of the researchers explicit and the several research steps transparent.
Conclusions/Implications: Integrating the first-person perspective in outcome research could add additional knowledge to findings concerning the process and outcome of treatments as it deepens our understanding of the phenomena under study. By integrating clinical heterogeneity in outcome research we ultimately believe we can help to overcome the well-known dispersion between research and clinical practice.
Presenter: Leah Drewitt
Other Author: Andy Hill
Professional Role: Research Officer
Institution/Affiliation: British Association for Counselling and Psychotherapy
Keywords: counselling for depression, trainees experiences, practice, IAPT
Exploration of trainees' experiences of the Counselling for Depression model, implications for practice and working in IAPT
Aim/Purpose: Counselling for Depression (CfD) is a form of Person-Centred/Experiential therapy developed for implementation in the IAPT programme. Training in this model has been available across England since 2011 and the initial roll-out of the training was evaluated by Pearce and colleagues (2012). Several hundred practitioners have now completed training in the model and are practising CfD, mostly in IAPT services. Anecdotal evidence suggests that some find the training more challenging than others, with some therapists not being suited to training in this particular model. Further anecdotal evidence has suggested that some CfD practitioners experience difficulties in implementing the model due to service-related constraints. This study aims systematically to explore these issues by investigating practitioners' experiences of learning the model and implementing CfD in practice settings.
Design/Methodology: A mixed-methods design was adopted whereby data collection initially involved a questionnaire followed by semi-structured interviews. Participants were recruited by an email sent to a CfD Practice Research Network. Eighteen out of 53 qualified CfD practitioners completed the questionnaire which gathered demographic information, experience of becoming a CfD practitioner and impact on practice. One hour follow-up interviews were subsequently conducted with six practitioners.
Results/Findings: Descriptive analyses from the questionnaire indicate a positive experience of CfD training, with a mixed experience of challenges on the course and impact on practice, sense of self and skill set. Thematic analyses revealed 7 superordinate themes which concern CfD training experience, supervision experience (in training and in practice) and the CfD model in practice and within a service setting (IAPT).
Research Limitations: The questionnaire could not be sent to all practitioners who have completed the CfD training as participants were sourced from the CfD Practice Research Network only. Therefore, the small sample size, which may not be representative of all CfD practitioners, lacks generalisability of these findings.
Conclusions/Implications: Qualitative findings further support quantitative results of a mixed experience of CfD training and impact. These findings inform the recruitment of trainees to CfD training programmes and the training itself. Implementing the model was dependent on service setting and can be used to achieve greater congruence between the training and delivery of the model.
Presenter: Dr Lisa Fellin
Other Authors: Jane E.M. Callaghan, Esnath Banda & Nana Ankofuah Mintah-Afful
Professional Role: Research Director, Professional Doctorate in Counselling Psychology
Institution/Affiliation:University of East London
Contact details: Room AE.1.23, University of East London, Stratford Campus, Water Lane, E15 4LZ
Keywords: Black African/British parents, help seeking, barriers to seeking counselling, children and young people, thematic analysis
Black African/British parents' perceptions of barriers to seeking counselling for their children in the UK: a qualitative investigation
Aim/Purpose: In the United Kingdom one in five children is diagnosed with a mental health issue. Yet less than one quarter will access professional help. There is great concern particularly about the access of ethnic minority clients to healthcare and the treatment they experience. Black African/British parents' perceptions of barriers to seeking counselling for their children are a crucial but under-researched area. We aim at filling this gap by qualitatively exploring the barriers to seeking counselling as an intervention for mental health distress of Black children living in the UK.
Design/Methodology: Sixteen Black African/British parents of children with mental health issues participated to semi-structured in-depth interviews on their experience and perceptions of access to help.They were all residing in East Midlands and recruited through opportunity sampling by word of mouth within community centres and Churches. The audio-recorded interviews were transcribed and analysed thematically (Braun & Clarke, 2006).
Results/Findings: Themes include variation in understanding, perception and experience of mental health distress, counselling for their children, perceived barriers of help seeking. Another significant theme is the strong influence of family support systems and community structure. Participants also provide their perspective on alternative methods and coping strategies to address their children's mental health issues.
Research Limitations: The study involved only a limited population from specific geographical and cultural background and leave children's voices unheard. Further research is needed to expand our knowledge and plan accordingly. Moreover, our analysis was strongly influenced by our different ethnic and cultural backgrounds. Reflexivity played a major role as codes were compared and discussed by the research team. Throughout this process, careful attention was paid to the way we co-created the meaning in the analysis. This helped to identify our views in a process of 'investigator triangulation' (Denzin, 2001) enabling the building of consensus in the interpretation to enhance methodological rigour.
Conclusions/Implications: The study provides counsellors and other practitioners with insights regarding potential clients' perception of counselling in multicultural background. Several perceived barriers and directions for change of service delivery and therapeutic practice have been identified and will be critically discussed.
Presenter: Deanne Gardner
Professional Role: DProf student/Psychotherapist
Institution/Affiliation: University of Chester
Keywords: group process, Black women, psychotherapy/counselling training, qualitative, survival strategies
A phenomenological exploration of the experiences of Black women during group process on humanistic psychotherapy training courses
Aim/Purpose: Group process or personal development groups are an integral part of many counselling courses, (Mearns, 1997; Mearns 2003). The aim of this study was to explore the group process experiences of Black women during Humanistic psychotherapy/counselling training.
Design/Methodology: This was a qualitative study in which eight participants explored their experiences of being a Black woman within Psychotherapy/counselling courses in various training institutes in the UK. The participants included qualified and trainee therapists. Semi structured interviews lasting 60 minutes were recorded, and transcribed. The data was analysed using Moustakas Phenomenological research method (Moustakas, 1994).
Result/Findings: Several overlapping themes emerged as a result of this research, these included; Identity, protection, language and facilitation. Black women became silent and were silenced within the group regarding issues of colour. Based on the expectation that Roger's (1957) core conditions would be offered in group process, there was an expectation the group experience would be different to that experienced in other settings. Finding it to be otherwise, participants reported using familiar survival strategies to protect themselves and their peers.
Research Limitations: The small numbers of participants were a possible limitation of this study. The interviewer shared the same cultural identity with participants and participants may have assumed that there was a shared experience of group process. Subjectivity of researcher might be questioned in this study, and was addressed by being mindful to be as neutral as possible when asking questions. Another researcher would bring a different phenomenological lens to the research, but this is in keeping with the methodological stance.
Conclusions/Implications: Personal development during psychotherapy/counselling training is encouraged and expected. Whilst group process remains an integral part of counselling training courses, this research suggest that facilitators, teachers and lecturers should seek to gain a greater understanding of the power held within predominantly white groups, and the silent impact this might have on Black female students. A clear explanation of the purpose for group process within psychotherapy/counselling training programmes would be beneficial at the outset of the course.
Presenter: Dr Shelley Gilbert MBE, PhD, PGDPM, PGDCP, Reg. MBACP (Snr. Accred)
Professional Role: CEO and Clinical Director of a Charity
Institution/Affiliation: Middlesex University; Metanoia Institute
Keywords: loss, grounded theory, bereaved young people, grieving process, emotionally based model
Good grief: a grounded theory study of grief and bereavement with young people prematurely bereaved
Aim/Purpose: This research aimed to gain a better understanding of the core processes that underlie the psychological and emotional experiences of parentally bereaved young people, whilst observing both the challenging and helpful aspects of support. There has been little research carried out which seeks to understand the meaning and complexity of the individual's world through the analysis of their personal account of events and experiences.
Design/Methodology: Eleven parentally bereaved young people aged twelve to sixteen participated in the study. They were identified principally in a secondary school in North London using purposeful sampling, having been bereaved over six months. Semi-structured interview questions, a nationally validated measure CORE-YP and a creative activity were used to elicit the responses of the participants. Grounded theory based on Charmaz's social constructivist approach was used to analyse the findings.
Results/Findings: Five superordinate themes were identified: Losses; Disrupted identities; Struggling to make sense of grief; Role of others; and Finding a new kind of normal. The researcher also identified two overarching themes: time and ambivalence. The research highlights the extent to which young people are affected by the premature death of a parent. The findings demonstrate that grieving is an individual process, yet there are common threads that can be drawn together in order to provide a framework for grief's trajectory. This involves an emotionally based theory, which searches for the feelings behind the behaviours.
Research Limitations: This is a small-scale individually based study, with no control group, which offers a psychotherapeutic approach to the interpretation of the data. It was limited in being qualitative and not quantitative and staying close to the data, principally confined to language and left deeper issues unexplored e.g. through the transference.
Conclusions/Implications: Bridging research and practice, recommendations are made on how best to support this often overlooked group of vulnerable young people using a multisystem model. This includes family support programmes at bereavement organisations, counselling support, a new information guide for bereaved young people, a model for bereavement support and a bereavement training programme for professionals. Recommendations are also made for further research and dissemination of information on best practice.
Presenter: Bettina Gross
Other Author: Robert Elliott
Professional Role: MSc student/counsellor
Institution/Affiliation: University of Strathclyde, Glasgow
Keywords: counsellor disconnection, counsellor incongruence, qualitative research
Investigation of counsellor experiences of moments of disconnection with clients
Aim/Purpose: The purpose of this study was to document and describe moments of counsellor disconnection from their clients, including their triggers, key counsellor experience during these moments, and the coping strategies counsellors use to overcome disconnection.
Design/Methodology: Four semi-structured interviews with qualified person centered counsellors (including seven moments of disconnection) were analysed using Grounded Theory Analysis. The categories obtained were also evaluated for frequency and expectancy (cf Elliott et al, 1994).
Results/Findings: Triggers for counsellor disconnection included client non-engagement, client repetitive narratives, and disturbing similarities between client and participant tragic life experiences. Even in a productive working alliance with the client, triggers for counsellor disconnection occurred without warning. We also found that counsellors experienced incongruence in moments of disconnection. By becoming congruent again counsellors were able to re-engage with their clients.
Research Limitations: This study had a small sample, making generalisability difficult. Also an investigation of moments of counsellor disconnection from different theoretical orientations and different levels of therapist experiences would have given a broader insight into the topic. Finally, the study did not directly explore the experience of clients.
Conclusions/Implications: Some moments of counsellor disconnection bear a resemblance to post-trauma difficulties, with counsellors being reminded of their own unprocessed fear or other painful feelings. Overall the results suggest that counsellor self-insight is a key factor to prevent or repair disconnection. An implication of this study for training courses might be to include discussions about the possibility of moments of disconnection. Students who have been made aware of such moments are more likely to be more self-aware of challenges in counselling.
Presenter: Jan Grove
Professional Role: Visiting Research Fellow
Institution/Affiliation: Newman University
Keywords: same-sex couples, seeking counselling, internet survey, descriptive statistics
Same-sex couples seeking therapeutic help
Aim/Purpose: To explore the ways in which same sex-couples access counselling, and identify potential differences within different identity groups such as bisexual or queer, drawing on Goffman's (1963) theorising of stigma.
Design/Methodology: An internet survey collected data of same-sex couple's experiences of seeking therapy for their relationship. Of the 63 responses, 55 were analysed using descriptive statistics, thus offering a way of describing the social world (Marsh, 1998).
Results/Findings: Participants sought professionalism and couple experience from their therapist, and they also wanted a reassurance that same-sex couples were recognised, reflecting an anticipation of stigma. Nearly 30% of those who rated therapist experience of Lesbian, Gay, Bisexual, Transgender or Queer (LGBTQ) clients as important attended counselling with someone who they believed to have no experience. In addition, certain groups such as bisexual or queer-identified participants, more often appeared to seek reassurance through the identification of LGBTQ counsellors, or counsellors who were recommended by others, potentially illustrating a fear of multiple stigmatisation.
Research Limitations: These results do not seek to show 'a cause and effect relationship or an association between variables' (Beals & Peplau, 2001, p. 2) nor can they be generalised to all same-sex couples seeking counselling. The participants formed a fairly homogeneous group, predominantly white, educated and middle class.
Conclusions/Implications: Same-sex couples seeking counselling are vulnerable to stigmatisation without the possibility of 'passing' to ascertain the views of others prior to coming out. As same-sex couples are both in a marginalised stigmatised group, and also consumers seeking quality services, there is a need for services to provide details of counsellors' couple experience, professional standing and awareness of diverse sexual orientations and ways of forming intimate relationships. This becomes increasingly important where additional stigmas may be experienced.
Peter Madsen Gubi
Presenter: Reverend Professor Peter Madsen Gubi, PhD, ThD, MBACP (Reg.Snr.Accred.)
Professional Role: Professor of Counselling and Spiritual Accompaniment; Programme Leader for the Doctor of Professional Studies (Counselling and Psychotherapy Studies / Psychological Trauma); PhD research lead in Counselling and Psychotherapy Studies
Institution/Affiliation: University of Chester, UK
Contact details: Division of Counselling and Psychotherapy, Department of Social and Political Science, University of Chester, Parkgate Road, Chester, CH1 4BJ
Keywords: reflective, group, clergy, support, wellbeing
Bishops' advisors' perspectives on the benefits and limitations of reflective practice groups for maintaining and supporting the psychological wellbeing of clergy
Aim/Purpose: Clergy often struggle with poor psychological wellbeing. This has elicited a concerned response in some Church of England (CofE) dioceses through the provision of Reflective Practice Groups (RPGs), which are facilitated by counsellors/psychotherapists who are trained in group facilitation. RPGs are increasingly recognised as supporting helping professionals. The purpose of this research is to ascertain how organisers of RPGs view their benefits and limitations in the CofE.
Design/Methodology: Forty-two CofE Bishops' Advisors (BAs) for Pastoral Care and Counselling, who are responsible for advising on strategies for enhancing psychological wellbeing in CofE dioceses, were surveyed to ascertain what RPGs ran in their dioceses. Eight BAs responded and were interviewed, using semi-structured questions to determine the value of RPGs for clergy, and the data were transcribed and analysed using Interpretative Phenomenological Analysis. Some BAs facilitated RPGs, and others organised them.
Results/Findings: Five superordinate themes emerged (Contextual issues; Formats; Benefits; Hindrances; theological understanding), along with forty-nine subordinate themes. This paper explores three of the superordinate themes (i.e. Contextual issues; Benefits; Hindrances) and provides an overview of the data from thirty-two of the subordinate themes.
Research Limitations: The research is limited by the small number of respondents, and by their vested interests in promoting the value of RPGs. The voices against RPGs are missing. However, interviewees provided useful counterpoints to the value of RPGs and gave a balanced picture of their lived experience of facilitating RPGs. The research is limited by the lens of the researcher. Another researcher might bring a different lens to bear on the data. However, universal claims are not made from this research, but 'pointers' are offered towards further research.
Conclusions/Implications: The research gives insight into the value and difficulties of facilitating RPGs. Many Counsellors/Psychotherapists are involved in supporting clergy, and will find the research relevant. Recommendations include greater provision of RPGs in supporting clergy, and the research enables greater awareness of issues concerned with facilitating RPGs for clergy, to be gained.
Mèl Halacre & Rahul Jalil
Presenters: Mèl Halacre & Rahul Jalil
Professional Role: Clinical Director/Counsellor
Institution/Affiliation: Spokz People CIC
Keywords: integrative treatment, disability, adults, psychological distress
The effectiveness of a holistic working approach for disabled adults: a service evaluation feasibility study
Aim/Purpose: Individuals with an injury, illness, or congenital condition resulting in an impairment require better access to services and tailored support that meets their needs for psychological therapies. Ensuring that disabled clients are treated as a heterogeneous group, a purpose-developed intervention model was subsequently implemented at Spokz People. The aim is therefore to consider the utility of this holistic approach that is designed to accommodate and thereby reduce psychological distress, and to inform future service evaluations, to effectively meet the need of this client group.
Design/Methodology: A one group pre and post-test design was employed on the retrospective routine collected data, for clients that were in receipt of 1-2-1 therapy. Fifty three of the 91 clients (58%) completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre and post assessments. Common presenting issues included symptoms of depression, anxiety, coping strategies, and spousal relationship issues. Data was subjected to descriptive analyses.
Results/Findings: At pre therapy, 91% (n=83) were categorised as within the clinical range; 52% were either classified as moderate (n=23) or moderate-to-severe level (n=24). A paired-sample t-test indicated a statistically significant difference in mean scores between pre and post CORE assessments. Thirty clients (57%) met the criteria for reliable change in a favourable direction (improved), with 19 of these clients (36%) having also met the criteria for clinically significant change (recovered). Twenty two clients (41%) remained unchanged in terms of clinical severity category, and 1 client (2%) deteriorated.
Research Limitations: Almost half of the sample did not complete a post-therapy assessment. These findings therefore offer limited generalisability given a relatively small sample size, the range of impairments across clients, and an unrepresentative demographic population within the study. Further, the use of CORE-OM for clients with an impairment raises concerns for administration/appropriateness.
Conclusions/Implications: A purpose-developed intervention model comprising an integrative treatment approach that is deliberately flexible has to some extent shown to reduce psychological distress in adult clients within this sample population. Ongoing data collection would however provide more conclusive evidence for this service evaluation.
Presenter: Imogen Harries
Other Author: Dr Sheila Spong
Professional Role: Family therapist, children's and young person's counsellor, supervisor
Institution/Affiliation: University of South Wales
Keywords: secondary school, counselling, environment, supervision, grounded theory
Counsellor supervisory needs in the secondary school context
Aim/Purpose: The purpose of this study was to investigate how the secondary school as a working environment for experienced school-based counsellors in the South West of England impacted on what they required from their supervision.
Design/Methodology: Seven secondary school counsellors participated in semi-structured interviews. Participants were recruited by contacting five counselling agencies and one counselling network. Criteria for participation were that counsellors should have had at least 1 year experience of working as a counsellor in a secondary school and have been qualified for a year or longer. Participants had 1 to 12 years of experience in secondary school counselling (m = 4.7), and 1 to 13 years post qualifying experience of counselling (m = 7). They were aged from 32 to 53 years (m = 44). Of the seven participants, three were male and four were female. All were white British. Methods of analysing interview transcripts were heavily influenced by Grounded Theory.
Results/Findings: From the analysis, counsellors identified four main requirements from their supervisors: a need to be external to the school, a knowledge and understanding of risk and child protection legislation, an understanding of the working context of the counsellor and how that impacts on their work, and a knowledge of how to work therapeutically with this age group.
Research Limitations: A small sample size was used, and from only one area of the UK. As a lone -researcher, though reflexivity was acknowledged, bias cannot be eliminated since the researcher had previously worked in secondary schools and had supervised secondary school counsellors.
Conclusions/Implications: The findings identify requirements that counsellors have from their supervisors which relate to the impact of working within the environment of the secondary school. This has implications for the training of supervisors who intend to work with school counsellors.
Presenter: Phillippa Harrison
Other Authors: Professor Gillian Hardy & Professor Michael Barkham
Professional Role: PhD Researcher
Institution/Affiliation:University of Sheffield
Contact details: Department of Psychology, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TP
Keywords: expectations, therapy, depression, client-therapy match, tailoring therapy
The development of a measure of expectations of therapy for depression
Aim/Purpose: To develop and validate a measure of pre-therapy expectations to facilitate client-therapy matching. Previous measures typically assess expectations of the therapy overall rather than specific methods and goals which make it distinct from other therapies. This measure was devised to assess these specific therapeutic components.
Design/Methodology: Two hundred and thirty nine participants completed an online questionnaire about their expectations of Cognitive Behaviour Therapy (CBT) and Counselling for Depression (CfD). They completed a 30-item questionnaire derived from the therapeutic components of three therapist adherence scales that represented CBT, CfD, and general facilitative conditions (FC): the Cognitive Therapy Scale-Revised (CTSR), the Person-Centred Experiential Psychotherapy Scale (PCEPS), and the Sheffield Psychotherapy Rating Scale (SPRS). Participants were asked to rate the credibility, engagement, and expectancy of the 30 components. These concepts were validated using the Credibility/Expectancy Questionnaire (CEQ) and Client Involvement Scale (CIS). Principal Component Analysis (PCA) was conducted on each of the credibility, engagement, and expectancy datasets to reduce the number of items to the most robust components.
Results/Findings: PCA revealed that credibility, engagement and expectancy items did not all create clearly distinct CBT, CfD and FC factors. Engagement items had the clearest factor structure, which displayed 4 CBT, 4 CfD and 4 overlapping FC items as 3 different factors. These items were used to create the Sheffield Engagement in Therapy Scale, a measure of pre-therapy expected engagement with different talking therapies.
Research Limitations: A key limitation is the use of a non-clinical sample which may reduce the generalisability of the findings to the intended clinical population. However, those who reported experience of depression did not significantly differ in their engagement from those without depression.
Conclusions/Implications: This study provides a measure to assess client expectations of the components of CBT and CfD, thereby providing a better means of matching therapy assignment to the client. Expectations of therapy have been shown to be associated with drop out from therapy so an assessment tool provides the opportunity to reduce attrition by assigning a therapy which corresponds with a client's perspective.
Presenter: Jeanette Hennigan
Other Author: Dr Stephen Goss
Professional Role: Lead School Counsellor/Psychotherapist at Berkhamsted Schools Group
Institution/Affiliation: Doctoral Candidate of Psychotherapy by Professional Studies at Metanoia Institute
Email: email@example.com; firstname.lastname@example.org
Keywords: online therapy, school counsellors, adolescents
UK secondary school therapists' online communication with their clients and potential development in this area
Aim/Purpose: A review of a Schools Counselling Service in 2011 (Hennigan, 2011) highlighted pupil demand for online support, as an adjunct to the current face-to-face (f2f) provision. This provided impetus for the current study which sought to understand i) UK secondary school counsellors use of computer technology to communicate with pupils as of March 2014, ii) the perceived barriers to it's further implementation and iii) expectations regarding school counsellors future use of online counselling alongside current provision.
Design/Methodology: A pluralist, mixed methods approach utilised quantitative and thematic qualitative analysis of an Internet survey of UK secondary schools, using non-probability convenience sampling.
Results/Findings: Of 3753 schools targeted, 246 responded. If 61-80% of UK schools have counsellors (Cooper, 2013), the total relevant sample size was 2289-3002 schools, thus the actual response rate was 8% - 11%. Of 246 respondents, 45% had no onine communication with clients and 52% were using various forms of online communication. 43% used online communication (mostly email) for administrative purposes and 9% for therapy via email, Skype and Facetime (3% did not respond to this question). The three main motivators for providing future therapeutic contact online were 'evidence of reaching pupils with psychological barriers to accessing face to face help', 'evidence of demand from pupils' and 'access to appropriate training'. The main perceived deterrents were: 'impact on the quality of the relationship', 'issues around confidentiality' and 'impact of lack of visual and auditory cues'. As these percieved barriers are all now resolvable with suitable preparation, these views may be based upon a lack of information or training.
Research Limitations: The low response rate and non-probability sampling limit reliability and generalisability. Future research could address these through a larger group of participants andor fuller sampling in smaller areas. Categories provided for responses in the survey may have been suggestive and more free text responses could have led to a wider variety of responses.
Conclusions/Implications: This study suggested that further development of online provision in schools is likely to be well received by a significant proportion of school counsellors, but more exposure to existing research literature, practical assistance and training specifically tailored to the needs of a school environment may be required.
Wendy Hoskins, Katrina Harris & Holly Thompson
Presenter: Wendy Hoskins, Katrina Harris & Holly Thompson
Other Authors: Brittnee Smith
Professional Role: Associate Professor in Counselor Education & IRCEP Ambassador
Institution/Affiliation: University of Nevada, Las Vegas
Keywords: counselor education, international counseling identity
International counseling identity relevance among graduate students
Aim/Purpose: The counseling profession accentuates the importance of cultural competency and encourages this to be a value of counselors-in-training. Successfully meeting professional expectations requires a willingness to educate oneself and enhance one's understanding of other cultures through engagement. This presentation reviews U.S. based standards for becoming a culturally competent counselor. Additionally, presenters will review the International Counseling Identity Model as an aid to direct counselors through their lifelong learning process of advocacy, professional identity development, and global and personal awareness. Finally, presenters will provide results from a mixed-methods exploratory study.
Design/Methodology: A mixed method pilot study was designed to better understand Chi Sigma Iota (CSI) student members' perceived importance of being a culturally competent counselor and tenets of the International Counseling Identity Model (ICI). A 30-item survey (Likert scale and open ended items) was developed and 16 CSI members participated. Additionally, six CSI student members participated in a focus group that utilized 13 qualitative semi-structured interview questions. Interviews were analyzed utilizing field notes, transcripts, and emergent coding.
Results/Findings: Findings in the focus group and survey convey a perceived importance for being a culturally competent counselor. Research, collaboration and training were consistently rated as important ways of improving an international counselor identity (ICI). Common recommendations for improving cultural competency and ICI include; engage with other helping professionals and clients, participate in further training in the U.S. and abroad, and review and participate in culturally and internationally relevant counseling research.
Research Limitations: Given the small scale of the pilot study, generalizability is limited. Additionally, there is a lack of current research regarding the ICI Model to draw from.
Conclusions/Implications: Obtaining data/research on student beliefs helps inform counselor educators on current practice and needs. Encouraging a shift in counselor education beliefs regarding the importance of a global perspective may enhance curriculum and inform counseling practice. Recommendations include evaluating and revising the original survey items, conduct additional focus groups to further clarify and define meaning, expand sample size, and research components of the ICI model with international participants.
Other Authors: Andy Hill, Jo Pybis & Karen Cromarty
Professional Role: Research Officer
Keywords: practice research network (PRN), children and young people (CYP), routine outcome measures
An analysis of routine outcome measures collected as part of a practice research network (PRN) for counsellors working with children and young people (CYP)
Aim/Purpose: BACP's Children and Young People's Practice Research Network (CYP PRN) invites practitioners working in a therapeutic capacity with children and young people to pool anonymous client data and share good practice. The study therefore aims to outline the use of CYP PRN and provide information relating to client's demographic characteristics, the effectiveness of the interventions delivered and client satisfaction.
Design/Methodology: Following a successful pilot of the COMMIT system (a web-based client and outcomes management system) in 2014/2015, all members of the CYP PRN were offered the opportunity to use the system via a regular e-bulletin. Fifty-eight members (across seven services) expressed an interest and were signed up to use COMMIT. Data from 499 clients were collected on their demographic characteristics and the number of sessions undertaken. Services were also encouraged to collect a variety of routine outcome measures, such as the CORE-10 or YP-CORE, Goal-Based Outcome Measures (GBOM) and an Experience of Service Questionnaire (CHI-ESQ).
Results/Findings: The majority of clients were seen in a voluntary and community sector (VCS) service (n=431, 86.4%), were female (n=357, 71.5%), had an average age of 17.6 years (SD=3.9) and received an average of 6.06 sessions. There was a significant difference between CORE-10 scores at first and last session (t(210)=10.24, p<.001), and a medium effect size was observed (d=0.71). A statistically significant difference was also observed in YP-CORE data, however, the effect size was smaller (d=0.4). Thematic analysis suggested that young people receiving counselling are most likely to set goals relating to emotional issues, such as controlling or reducing anxiety, anger or feelings of upset. Young people expressed high levels of satisfaction with the service they received.
Research Limitations: These are secondary data collected by members of a PRN which limits the control the researcher has over the data collection process.
Conclusions/Implications: PRN's are a relatively cost-effective and easy method to collect data on a large scale. Routinely collecting data from CYP PRN members contributes to the evidence-base for counselling for children and young people across a variety of settings. CYP PRN proposes a model for data collection and analysis which could be replicated across other services, such as Employee Assistance Programmes (EAPs).
Hanne-Sofie Johnsen Dahl
Presenter: Hanne-Sofie Johnsen Dahl
Professional Role: PhD candidate/clinical psychologist
Institution/Affiliation: University of Oslo
Keywords: case study, process and outcome, APQ, adolescent, depression
Process and outcome in psychotherapy for adolescents: a portrait of a therapy of a young girl with depression
Aim/Purpose: Psychotherapy of various kinds works. However, we know little of how, why, and when talking becomes a treatment. The Psychotherapy Q-set (PQS, Jones, 1985) was developed to study process in psychotherapy of adults and has been used to study what works for whom. Recently the Adolescent Psychotherapy Q-set was developed (APQ; Schneider & Midgley, 2009), it offers means for describing the therapeutic interaction in a clinically meaningful way, which is also pan-theoretical. This study seeks to illustrate how outcome measures and the APQ may be used together to shed light on psychotherapy process and outcome.
Design/Methodology: This case is drawn among adolescents with major depression from the larger First Experimental Study of Transference - In Teenagers (FEST-IT), which is still in progress. Diagnostics based on structured interviews are presented, as well as the girls self-reported scoring on symptoms, interpersonal problems, and her evaluation of her closest relationship. In addition, evaluators ratings of her relational abilities, affect tolerance, insight, and problem solving capacity (PFS), and level of daily functioning (GAF) will be presented in order to examine change over time, from pre- treatment to one year after treatment. APQ is used to score process. Three sessions from the beginning, middle and ending sessions, that is, a total of 9 sessions is analysed with APQ
Results/Findings: At one year follow-up the girl reported that nothing had changed and if something had changed it was for worse. On the PFS she did not change either. However, on depression questionnaires and in diagnostic interviews she did not longer fulfil the criteria for depression, and GAF was higher. Hence, it is a gap between her experience and the objective measures. The APQ indicates that there is no explicit work with the transference, even when it is quite obvious that the patient has allusions to the therapeutic relation.
Research Limitations: The number of sessions coded is small; hence the results must be seen as tentative and exploratory.
Conclusions/Implications: This study is seeking to encourage mutual engagement and discussions of therapeutic process and its relation to outcome in adolescent psychotherapy, an underprivileged area of study.
Hans Ole Korsgaard
Presenter: Hans Ole Korsgaard
Other Authors: Torgersen S., Wentzel-Larsen T &, Ulberg R.
Professional Role: Chief psychiatrist
Institution/Affiliation: Lovisenberg Diakonale Hospital, Norway
Keywords: personality disorder, quality of life, adolescent, outpatient, treatment
Quality of life in adolescents with personality disorders
Aim/Purpose: Previous studies of adults have shown that the number of personality disorder (PD) criteria met is negatively correlated with a patient's quality of life. The present study investigated the prevalence of PDs in adolescents who were referred to a non-specialized mental health outpatient clinic, with particular regard to the correlation between the number of PD criteria fulfilled and quality of life.
Design/Methodology: The study included 153 adolescents. PDs were assessed using the Structured Interview for DSM-IV Personality. Quality of life was assessed using the Youth Quality of Life Instrument - Research Version. Axis I disorders were assessed using the Mini International Neuropsychiatric Interview.
Results/Findings: Results demonstrated that 21.6% of the adolescents met the diagnostic criteria for at least one PD. No significant gender differences with regard to the prevalence of each of the PDs were revealed. A significant negative relationship (r = -.48) between the number of PD criteria met and reduced quality of life was found. Adjustment for age, gender, and the presence of Axis I disorders did not appreciably affect these findings.
Research Limitations: The study was performed at a single mental health outpatient clinic that served patients from a defined urban catchment area. Although the catchment area included a varied socioeconomic and ethnic population, we do not know if the results can be generalized to other populations. A further possible limitation is the use of a single evaluator.
Conclusions/Implications: Diagnosing personality disorders in adolescents facilitates early intervention and possibly a more favourable long-term prognosis. The present study indicates that the relationship between PD symptoms and quality of life is the same in adolescents as in adults. This emphasizes the clinical importance of evaluating quality of life when focusing on early detection and treatment of PDs in adolescents.
David Murphy & Robert Elliott
Presenters: David Murphy & Robert Elliott
Other Author: Lorna Carrick
Professional Role: Programme Leader: MA Person-Centred Experiential Counselling & Psychotherapy
Institution/Affiliation: University of Nottingham, School of Education
Keywords: social anxiety, trauma, case study methods, person-centred therapy, emotion-focused therapy
Engaging socially anxious clients in trauma focused work: a case comparison study of good and poor outcomes in person-centred and emotion-focused therapies
Aim/Purpose: Trauma histories are often present in clients with social anxiety. The aim of this study was to identify therapist in-session variables and competences that facilitate socially anxious clients' engagement in trauma work the early stage of person-centred therapy (PCT) and emotion-focused therapy (EFT).
Design/Methodology: We used a version of Strupp's (1980) case comparison method, which uses matched good and poor outcome cases. We identified one good and one poor outcome case in PCT and EFT, thus creating a two by two case comparison. All four cases met the DSM-IV-TR diagnostic criteria for PTSD and were selected from the Social Anxiety data set of University of Strathclyde Research Clinic. Good outcome cases were determined using high and low residual gain scores from a set of five outcome measures, including the Personal Questionnaire and the CORE-OM, thus identifying clients whose outcomes were substantially better or worse than was predicted from their pre-therapy scores. Qualitative observations of the first three sessions along with a range of quantitative and qualitative data are being used to identify differences between cases.
Results/Findings: PCT and EFT share differences between good and poor outcome cases. Good outcome cases for both approaches indicated empathic reflection of both psychological states and personal agency in client experiences whereas poor outcome PCT had more empathic failures and poor outcome EFT showed poor empathic pacing (too rushed). For both approaches good outcome cases explicitly addressed traumatic experience, linked prior trauma to current social anxiety and supported the development of client insight. Poor outcome cases also developed client insight but contained more empathic failures. There were more helpful factors referring to therapists in EFT that PCT but more helpful factors referring to insights in PCT than EFT.
Research Limitations: The study is limited due to a small number of cases. Further research is required to validate these results. .
Conclusions/Implications: Both person-centred and emotion-focused therapists may be able to adjust their practice based on the findings of this study. Case comparison methods have potential for identifying therapist competencies and other effective treatment ingredients in a variety of client populations and therapeutic approaches.
Presenter: Kim Patel
Professional Role: Self-employed counsellor and Mindfulness Teacher
Institution/Affiliation: University of Chester; Private Practice
Contact Details: Ebb & Flow Counselling C/O 160 Chester Road, Wrexham LL12 8DS
Keywords: eye movement desensitisation and reprocessing, chronic pain, phantom limb pain, somatoform, headache
A systematic review of the use of EMDR in supporting people with chronic pain
Aim/Purpose: Chronic pain (CP) threatens the integrity of Self with burdens of loss. CBT and psychological approaches are effective in reducing disability, distress and catastrophising with negligible effects on pain intensity. Eye movement desensitisation and reprocessing (EMDR) is gaining recognition in the literature for altering cognitive, affective and somatic symptoms in pain.
Design/Methodology: An emerging investigative area, systematic reviews (SR) identify available evidence and intervention effectiveness. With literature relevant to musculoskeletal CP extremely limited, inclusion/exclusion criteria were modified including widening pain conditions: fibromyalgia, migraine/headache, somatoform, neuropathic, CP with and without traumatic element, and phantom limb pain (PLP).
Results/Findings: Eight papers identified standard protocol (SP) and pain protocol (PP) EMDR for a wide variety of CP conditions. Papers varied greatly in robustness consisting of case studies, case series and uncontrolled clinical studies. Both EMDR protocols demonstrated significant pain reduction/amelioration- maintained at follow-up. Compared to other CP participants, PLP participants demonstrated higher pain intensity pre-intervention and lower pain intensity scores post intervention.
Research Limitations: Representativeness and generalisability is questioned due to gender bias in the participants and the wide variety of pain conditions investigated. The findings of this study are inconclusive because of the heterogeneity across the studies relating to design, research protocol, and participant factors. Without standardisation and homogenous primary studies the validity of this systematic review is threatened.
Conclusions/Implications: EMDR may have a positive effect on pain intensity in PLP individuals. Too early to make claims for the effectiveness of EMDR PP in CP, this SR highlights gaps in an emerging research area, highlighting opportunities for counsellor researchers. Using EMDR counsellors may be better placed to manage CP. The impact of EMDR on affect, behaviour, neuroplasticity and memory offers clients alternative ways to process memories/issues of self and loss in CP. For therapists not using EMDR, knowledge/awareness of underlying mechanisms of EMDR and CP may positively impact upon practice.
Presenter: Giovanna Reitano
Professional Role: Psychological Therapist
Institution/Affiliation: Ethical approval granted by the University of Roehampton (Psychology Department/Research Centre for Therapeutic Education) for the MSc award in Counselling & Psychotherapy
Email: c/o email@example.com
Keywords: cancer care, medical settings, psychotherapists, health professionals, cancer clients, medical language
An exploration of psychotherapists' experiences in medically driven cancer care settings
Aim/Purpose: This research study looked at psychotherapists' experiences of counselling people diagnosed with cancer in medical settings. In particular, the researcher was interested in exploring the implications for psychotherapists, if any, of working in cancer care settings where the medical discourse is dominant.
Design/Methodology: This study implemented the qualitative research method of Interpretative Phenomenological Analysis (IPA). Data was collected using semi-structured interviews with five psychotherapists of different ages, gender and psychotherapeutic approaches, and with experience of counselling clients in cancer settings. IPA offered an opportunity to explore participants' subjective experiences and perspectives while also allowing the researcher's personal interpretation of findings.
Results/Findings: Research findings indicated that counselling clients in cancer settings was experienced as a challenge. Participants found that medical language was difficult to understand when communicating with health professionals within multidisciplinary teams. It emerged that in medical settings health professionals had an expectation that psychological therapists should have knowledge of medical language. Contrarily, for the interviewed therapists, focussing on clients' experiences and the therapeutic relationship was considered far more relevant than having knowledge of medical language.
Research Limitations: The limitations to this research are potential researcher's bias in data analysis and interpretation; a small sample size, which may not be representative enough of a group of people to whom results are generalised; potential influence of participants' approaches on their narratives and contributions towards the phenomenon explored; variables in the multiplicity of truths that could be found in discourses at different times and stages of the process of data analysis; and, lack of generalisability.
Conclusions/Implications: Findings seem to suggest that further research on psychotherapists' experiences of working in cancer settings is important. The question as to what extent, if at all, psychological therapists fit into the medical model, or language and discourses of truth and power within medical settings can impact the clients-doctors-therapists relationship remains open. This is considered an interesting topic to explore in future research.
Presenter: Jamesina Rooney
Other Authors: Dr Jill Hendron, Dr Karyn Stapleton & Dr Maggie Long
Professional Role: Counsellor MBACP (Accred) and PhD Research Student
Institution/Affiliation: Two agencies & Ulster University
Keywords: qualitative case studies, clinical practice, therapeutic connection, inner-experience, interpersonal communication
Therapeutic connection: exploring the inner-experience and interaction in the therapeutic relationship for client and therapist
Aim/Purpose: To bridge the divide between research and practice existing literature recognises the dyadic nature of therapeutic connection and the need to deepen understanding on the micro-processes involved in forming this bond and clients and therapists felt experience of it. Current research is typically captured retrospectively, from one perspective and based on quantitative methods of inquiry. This study aims to go to the heart of the therapeutic process and address this need by exploring how therapeutic dyads in clinical practice identify, experience and co-create therapeutic connection.
Design/Methodology: A multiple case study design with 6 counselling dyads is employed. Experienced therapists, also supervisors and/or trainers, were recruited from researcher networks in Ireland. Therapists invited one current client. Ethical approval was granted from Ulster University Research Ethics Committee (UUREC). Dyads audio-recorded a counselling session and were interviewed on an individual basis soon after. The interview involved listening to the counselling session and the Interpersonal Process Recall method was used creatively to inform the interview process. Participants identified moments of connection, which were noted, and subsequently analysed post-interview. After identifying each moment the participant inner-experience was explored. Analysis of moments comprised a fine-grained interactional and linguistic analysis drawing on a range of analytic tools combined with participant reflection on their inner-experience. Procedures to ensure credibility of research include; researcher reflexivity; adequate evidentiary support; triangulation; participant checks.
Results/Findings: Within consistently strong relationships various levels of connection were identified. Client and therapist in dyads experienced; deeper connection at the same time; 'same' moments experienced differently and client-only and therapist-only moments. Main features include; an intricate interpersonal 'dance' and delicate handling of client material; silence, emotional/sensitive or difficult material; authenticity/realness; freedom of expression, pacing/patience, importance of learning/insight. A distinct difference between client and therapist felt-experience is that typically the client's self process was central for clients, while for therapists deeper connection was in terms of the relationship.
Research Limitations: Therapist selection may make clients reluctant to report negative experiences. Being knowingly recorded may raise questions about participant performance. The study is in-depth and hence time-consuming to replicate.
Conclusions/Implications: Findings offer guidance to practitioners, trainees, supervisors on the internal felt experience and intricate interpersonal 'dance' involved in therapeutic connection.
Presenter: Karen Sarai
Other Author: Susan Hajkowski
Professional Role: Counselling and Psychotherapy student
Institution/Affiliation: University of Leicester
Keywords: older adults, residential care, counselling, transition, home
The ache for home: an investigation into the emotional responses of older adults moving into residential care and their awareness of psychological therapies
Aim/Purpose: Moving into residential care in later life can be a significant and life-changing event. The prevalence of late-life depression, particularly amongst those in residential care, remains a concern yet access to psychological therapies for older adults appears to be a continued challenge. This study aims to explore the emotional impact of moving into residential care for older adults and the ways in which they consider counselling may have been helpful.
Design/Methodology: The study is based within an individual care home and focuses on the experiences of a small number of older adults who had recently moved into care. Suitable participants were suggested by the Care Home manager, following which participant information sheets were shared and informed consent gained. In-depth qualitative interviews with six residents were carried out to explore the experience of transition and the psychological challenges it presents. Participant views on counselling and whether they may have found this helpful to support the transition were also sought. Thematic analysis of the data was used to identify key themes.
Results/Findings: Results indicate that the experience of moving into care was one of many significant transitions experienced by participants in later life, within which loss appeared to be a key feature. Participants reported a significant influence of outside factors in their decision to move and found it difficult to adjust to life in care. Awareness of counselling was limited and access to services appeared low. Many participants reported that they may have found counselling a helpful intervention.
Research Limitations: Limitations included the small sample, which was limited to the experience of residents in one individual care home. There was no reflexive loop with the participants and no triangulation of the data.
Conclusions/Implications: It is hoped the research will lead to a better understanding of the support needs of older adults in residential care, encourage a raised awareness of counselling amongst this group, and potentially lead to improved services for those making the transition in the future. It is also recommended that, as an evolving profession, practitioners take greater responsibility for encouraging and providing better access to hard-to-reach communities.
Irene Sclare & Daniel Michelson
Presenters: Dr Irene Sclare & Dr Daniel Michelson
Other Authors: Dr Tessa Crombie & Dr June Brown
Professional Role: Consultant Clinical Psychologist; Southwark CAMHS
Institution/Affiliation: South London and Maudsley NHS Trust
Contact details: Mapother House, Maudsley Hospital, De Crespigny Park SE5 8AZ
Keywords: teenagers, anxiety/low mood, school-based, CBT
The effectiveness of DISCOVER: a school-based CBT workshop intervention for emotional symptoms in 16-18 year olds
Aim/Purpose: The rationale for developing an open-access CBT service innovation for 16-18s who are 'hard to reach', with anxiety and low mood problems, will be presented, along with results from a recently completed RCT with 155 participants in inner-city South London schools, designed to evaluate clinical effectiveness and acceptability.
Design/Methodology: Participants were sixth form students who signed up for DISCOVER workshops at ten collaborating schools in south London. The majority had not previously received mental health help. Schools were randomly allocated in a 1:1 ratio to two study arms: intervention (DISCOVER workshop) or waitlist control in a cluster randomised controlled trial. Five schools received the intervention in the autumn term; the five waitlisted schools received this in the spring term, with follow up after 3 months. Researchers were blinded to treatment allocation. Outcomes were assessed using self-report measures including Mood and Feelings Questionnaire Revised Child Anxiety and Depression Scale and Warwick-Edinburgh Mental Well-Being Scale.
Results/Findings: The takeup from the schools was very good (n=155) and the follow-up rate at 3 months was 93%. Results were analysed using the ANCOVA with outcome at baseline as covariate, and the school as a random factor. Clinical outcome results were encouraging with the experimental schools showing improved depression, anxiety and well-being scores at 3-month follow-up, compared to the waiting list schools. Results of sub-analyses will also be reported. Qualitative data from teachers and students indicated DISCOVER was perceived positively by students and teachers, and identified features that sustained school partnerships, and motivated students to engage.
Research Limitations: Subgroup analyses concerning access and impact were limited by sample size and insufficient power. Participant follow-up at 6 and 12 months would have allowed consideration of longer term impact and service usage.
Conclusion/Implications: Experimental schools receiving the DISCOVER workshops showed reduced emotional symptoms and increased well-being compared with waitlist comparison schools, and the programme is acceptable to teenagers and teachers. DISCOVER could therefore complement existing clinic-based provision of CBT to this age group. School-based trials of DISCOVER are feasible. Further research will establish the effectiveness of these workshops in a definitive trial, and the key DISCOVER service uptake variables.
Presenter: Susan Scupham
Professional Role: Psychotherapist
Institution/Affiliation: Metanoia Institute/Middlesex University
Keywords: mixed methods, thematic analysis, suicide, counsellors/psychotherapists
Life after suicide: practitioners speak about their experiences of working with suicidal clients and the impact it has on them if their client dies
Aim/Purpose: Research indicates the suicide of a client is the greatest fear practitioners' experience. In light of this the study examines the impact of working with suicidal clients on the practitioner in order to prepare and support them in their clinical work.
Design/Methodology: The convenience sample was gathered from practitioners responding to an advert in Therapy Today and an email invitation. The study used a mixed method approach to examine practitioners' experiences. The first phase of the research was a quantitative survey in which practitioners' (n =110) provided information on their experiences of working with suicidal clients. The second phase of the study was qualitative and explored via interviews the effects of client suicide on practitioners (n =16). A narrative thematic analysis approach was used to analyse the interview transcripts.
Results/Findings: The findings identified that practitioners experienced strong feelings in response to the death of their clients along with thoughts such as failure, self-blame, disillusionment and a collapse of confidence. Practitioners identified changes in their behaviour such as noticing they were cautious or avoidant about working with suicidal clients. Practitioners reported the impact of the manner in which they had been informed about the death of their client such as being left a note on their desk or finding out in a team meeting. Practitioners struggled to recall significant preparation in their core training to prepare them to work with suicidal clients.
Research Limitations: Predominantly counsellors/psychotherapists responded to the survey so the experiences of other professionals were not well represented. By using a mixed methods approach a significant amount of data was produced but due to time constraints some areas had to be neglected.
Conclusions/Implications: Trainees and practitioners may benefit from having discussions around personal beliefs, a need for openness about their fears of working with suicidal clients, vigilance with regard to relational responses and demystifying the process of investigations into serious incidents within organisations.
Presenter: Marta Shepherd
Other Author: Dr Clare Symons
Professional Role: Counsellor
Institution/Affiliation: University of Leicester
Keywords: countertransference, blind spots, wounded healer
"It's like I'm sitting in front of myself": an exploration of therapists' experiences of countertransference when working with parallel client issues
Aim/Purpose: This study aimed to examine the impact of countertransference originating in personal history on both the therapeutic process and the therapist. It endeavoured to explore therapists' experiences of countertransference when the client's material touches on their personal issues. The study also investigated therapists' coping strategies.
Design/Methodology: The methodology employed was qualitative, using data obtained from individual semi-structured interviews. Nine therapists, of various theoretical orientations, participated in the study. Collected data were analysed using the grounded theory.
Results/Findings: The results indicate that working with a client whose material touches on the therapist's personal issues can be intense and challenging. Interviewees felt deskilled, anxious and guilty about their emotional struggle. Some risks of over-identification, such as boundary crossing, and those of dis-identification, like struggle to use basic counselling skills, emerged from the findings. Participants felt shocked at the return of their personal material. Interviewees reported doubting their emotional ability to continue working with the client; some therapists considered referring the person on to another practitioner. However, the findings suggest that counsellors struggle to admit that the work with a client could be "too close to home".
Research Limitations: Participants were of White British origin and they were mostly female. The topic could be experienced as sensitive. Participants' responses regarding the impact of their feelings on the therapeutic process could be skewed by the self-serving bias.
Conclusions/Implications: The findings help increase understanding on problematic countertransference related to practitioners' personal issues. It may require particular consideration and preparation from therapists, as well as additional support from supervisors. Counsellors could be alerted to a potential impact of such problematic countertransference on the work, which may sometimes have serious implications on clients' welfare. Supervisors could allow space for supervisees to explore more deeply the role that their personal material may play in the therapeutic relationship. Trainers could apply the findings by raising awareness among trainee therapists about challenges of over-identification and dis-identification.
Mair Elinor Sides
Presenter: Mair Elinor Sides
Professional Role: Lecturer in Counselling/Associate Counsellor
Institution/Affiliation: University of Chester/Shrewsbury College
Keywords: trainee, counsellor, inappropriate referral, placement, development
Exploring the impact of perceived inappropriate referrals from clinical placement on the trainee counsellor's professional development
Aim/Purpose: The purpose of this research was to explore the experiences of trainee counsellors who had worked with clients during their placement who they perceived to be inappropriately referred for counselling; and to uncover the impact of such experiences on their professional development.
Design/Methodology: The data was gathered using semi-structured interviews with four participants and was subsequently evaluated using Interpretative Phenomenological Analysis.
Results/Findings: The findings revealed three overarching super-ordinate themes that compressed a number of inter-related personal and professional issues for the developing trainee. Primary themes encapsulated an initially bewildering stance when engaging with clients, and this affected the participant's sense of themselves as therapists and consequently exerted pressure on their clinical practice. Subsequent themes uncovered a procession of growth-enhancing features that gave rise to more secure professional identities and improved capacity to tolerate the ambiguities involved in the practice element of counselling training.
Research Limitations: The study worked with a restrictive sample that was small, selected by criteria and all female; therefore limiting extrapolation. Furthermore, trainees who perceived their experiences to be unusual or particularly negative may have felt compelled to participate, and so their views may not be representative of others' experiences. The lack of conceptual homogeneity in defining inappropriate referrals adds to the need to negotiate meanings derived from the data.
Conclusions/Implications: The main conclusion drawn from the findings of this research is that work with clients perceived to be inappropriately referred invokes both negative and positive influences on the trainee's development. The research characterised some of the important tasks involved in the early stages of the trainee's professional development, and included the impact of early client experiences on the trainee. The research raises a need for more understanding of referral mechanisms, and advocates greater emphasis on clinical management in the training of counsellors who gain experience in placements.
Presenter: Carole Smith
Professional Role: Senior Lecturer
Institution/Affiliation: University of Huddersfield
Keywords: counselling training, personal development, Interpretative Phenomenological Analysis
How useful are personal development groups in counselling training?
Aim/Purpose: There are diverse definitions of personal development in counsellor training as well as varied methods of facilitating it. Added to this are interchangeable meanings between personal development and professional development. Searching the literature does not bring clarity and there is no universally accepted definition of what personal development is, whether a group process of facilitation is necessary or how counsellors use their learning from personal development (PD) groups in their client work. This qualitative study is an exploration of counsellors' critical experiences in their personal development training group with the ultimate aim of investigating how they transfer their learning into the client counsellor relationship.
Design/Methodology: This was a qualitative interpretative phenomenological analysis (IPA) study, using semi-structured interviews with 12 counsellors/psychotherapists. The recruitment criteria included a minimum of five years' experience of working as a counsellor/psychotherapist. Seven women and five men responded. The method of analysis was chosen in conjunction with the researcher's own phenomenological gestalt approach.
Results/Findings: Resulting themes demonstrate that counsellors/psychotherapists believe that the intense challenges of personal development groups, particularly on an emotional level, are vital to be able to work in a relational way with clients. Facilitator style and experience can also influence participants' learning and assimilation and experiences within the personal development group can be traumatic, although this does not necessarily obstruct learning.
Research Limitations: This was a small sample and does not claim to be generalizable. The sample is however, consistent with IPA's commitment to a detailed interpretative account of lived experiences.
Conclusions/Implications: There is little empirical research on post-qualified counsellors' experiences in the personal development group; this study offers insights into how positive and negative learning experiences are used in client work. Implications for future research include an in depth focus on reasons for trainees leaving counselling/psychotherapy training as It may be that personal development training groups have an influence on this.
Presenter: Vicki Smith
Professional Role: Senior Lecturer in Counselling Studies
Institution/Affiliation: University of Huddersfield
Contact details: Division of Psychology and Counselling, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH
Keywords: philosophy, existential, therapeutic practice, relationship
Philosophy in practice: an exploration of how existential therapists view the relationship between existential philosophy and their therapeutic practice
Aim/Purpose: To identify what existential therapists regard as the value of existential philosophy for informing practice and what they see as some of the associated challenges. A further aim is to elucidate aspects of the under-researched and complex relationship between theory and practice in therapy.
Design/Methodology: Existential therapists with entries on professional body websites were contacted by email. Five participants (one male and four female) were interviewed using semi-structured interviews. Transcripts were analysed using thematic analysis (Braun and Clarke, 2006) leading to identification of some initial themes.
(1) IDENTITY- the therapists demonstrated a strong commitment to existential therapy with their personal and professional identity being expressed through the approach. Allied to identity, some therapeutic concepts were clearly regarded as meaningful and valid and others less so.
(2) HARD TO CAPTURE- there seemed to be a consensus that existential therapy in practice is hard to pin down and that this is not a desirable thing to do. The reasons for this include the fact that there is no overarching theory to be applied; every therapeutic relationship is unique and the relationship between theory or philosophy and practice is a complex one.
(3) PARADOXES- a number of interesting paradoxes emerged, such as an expressed antipathy towards imposing theory while using clear philosophical assumptions to guide practice.
Research Limitations: Even though this is a qualitative study, the number of participants was smaller and less diverse than the researcher hoped to include comprising mainly white, middle class women. As a result, transferability of the findings is limited. Researcher reflexivity has been important in exploring and interpreting how the meaning of the findings has been shaped by the researcher's own existential perspective on the world. External scrutiny of the findings has yet to take place.
Conclusions/Implications: The findings demonstrate the complexity and inevitable paradoxes involved in understanding the relationship between theoretical concepts and therapeutic practice even amongst experienced therapists. Consideration of some of these challenges and paradoxes on training courses may provide additional insight into the theory/practice link.
Presenter: Rebecca Southall
Professional Role: Doctoral candidate; Clinical Director
Institution/Affiliation: University of Manchester; Prohealth UK
Keywords: online counselling; psychoeducation; wellbeing; adolescents
The impact of online interventions on empowering secondary school children to monitor and improve their emotional wellbeing
Aim/Purpose: The engagement of 250 adolescents (aged 11-18) using a Virtual Learning Environment (VLE), which is designed to promote positive "Knowledge, Attitudes and Behaviours" relating to emotional wellbeing, was evaluated. In order to create an engaging and relevant VLE for the schools a pilot study was undertaken to address: "What knowledge, attitudes and behaviours do adolescents have regarding improving and monitoring their own wellbeing?"
Design/Methodology: The study used action research via the Piggot-Irvine Problem Resolving model to heuristically analyse the current situation in eight schools. The researcher worked with a group of volunteer students, namely "Peer Wellbeing Champions" (PWCs), to collaboratively design and implement interventions, which included psycho-education and online counselling. Outcomes were evaluated using pre and post-intervention SDQ and CORE-YP measures, and supplemented with semi-structured interviews (with two students from each school).
Results/Findings: An understanding of engagement with the website content and the PWC interview data was undertaken utilising the interpretive phenomenological analysis method. Results are presented in narrative, tabulated, graph and spider-graph format. A discussion of the findings related to knowledge acquisition, change in attitudes and increases in wellbeing related behavioural outcomes for a sample of both the PWCs and the VLE users in the eight study sites is presented and compared to a proposed conceptual model of change.
Research Limitations: The attempt to reduce reliance on subjectively reported measures through triangulated data collection methods, generated a very large, rich body of qualitative data which fell outside of the scope of the original proposed analysis. Further analysis of the project data could be undertaken in future.
Conclusions/Implications: The study provides insight into engaging adolescents with self-monitoring of wellbeing and accessing online psychoeducation and counselling. The process of therapeutic change through the use of a VLE is mapped against a novel conceptual model which can be used as a resource for adolescents' emotional wellbeing.
Presenter: Sheila Spong
Other Authors: Rachel Waters, Janet Morgan & Chris Kemp Philp
Professional Role: Academic manager, Counselling and Psychotherapy
Institution/Affiliation: University of South Wales
Keywords: carers, expectations, change
Counselling for carers: a qualitative study of carers' beliefs and expectations
Aim/Purpose: This study aimed to identify whether, and how, carers thought that counselling might help with the difficulties associated with the caring role. Despite evidence of the poor psychological well-being experienced by carers, and of the helpfulness of counselling for carers, a community counselling service noted low utilisation by carers. Community co-researchers who were themselves carers queried whether carers typically had a good understanding of what counselling is and the ways in which it might help them. The intention of the study was to identify ways to reduce barriers for carers in accessing counselling.
Design/Methodology: A community-based participatory approach to research (CBPR) was developed in conjunction with local carers organisations. CBPR draws on the expertise of local community co-researchers, and adheres to a number of participatory principles including sharing power and achieving positive outcomes for the community under study. Community co-researchers including carers were involved throughout each stage of the research. Twenty semi-structured interviews were undertaken with carers exploring their caring experience and their beliefs about counselling. Most participants were recruited through carer co-researchers' contacts, using a snowball approach via carers' fora; in addition the carers were invited to participate though contacts with social services. Thematic analysis of the transcripts was undertaken by academic and community co-researchers.
Results/Findings: Carers' beliefs about the ways in which counselling might be helpful differed systematically according to whether or not they had personal experience of counselling. Frequently, carers without personal experience of counselling expressed the view that counselling could not help them if it did not alter the practical situation of their caring responsibilities. Carers with direct counselling experience described counselling as facilitating personal change which impacted on their experience of caring.
Research Limitations: This is a relatively small qualitative study undertaken in one geographical area, using a convenience sample. All participants were already in contact with carers' services or networks and this could introduce a source of bias.
Conclusions/Implications: Information about the purpose and practice of counselling could help carers to make an informed decision whether to use a counselling service to help with the difficulties associated with the caring role.
Presenter: Nicolena Theodorou
Professional Role: MSc Integrative Counselling & Psychotherapy graduate– Private Practice
Institution/Affiliation: Mediterranean College; University of Derby
Keywords: therapists accounts, forgiveness, sexual abuse
Therapists' accounts on the role of forgiveness with adult survivors of childhood sexual abuse (CSA)
Aim/Purpose:. The aim of this qualitative study was to discover how therapists experience working with CSA survivors and explore the role of forgiveness in a clinical setting. To determine how, when and with whom forgiveness may appear as an issue in therapy, how it occurs and how to facilitate the process of forgiveness. Research has largely focused on the efficacy of forgiveness intervention models, ignoring the process of forgiveness itself and leaving a gap in research.
Design/Methodology: A qualitative approach was used. Data was collected via semi-structured interviews, interviews were audio recorded, six therapists participated who worked with adult CSA survivors, interview average time was one hour and interpretative phenomenological analysis (IPA) was utilized.
Results/Findings: Four superordinate themes emerged. Superordinate themes: Impact of working with CSA, client's disclosure of CSA and the effects on therapists, coping strategies when working with CSA, conceptualization of forgiveness with CSA survivors.
Research Limitations: The findings are based on a small sample and cannot be extended to a wider population, even though the aim was to gather a rich detailed description. Research quality is reliant on the researcher's skills to bracketing preconceptions, although this subjectivity is important in IPA as it is used to construct meaning. Additionally, rigor ishard to maintain, assess and demonstrate.
Conclusions/Implications: CSA is a challenging experience for novice therapists. They lack awareness on the effects of working with CSA survivors and initial training in sexual abuse is limited. Further research is required in terms of, how working with CSA survivors affects therapists and how this can be resolved and prevented. Understandings have been provided on, how, when, with who forgiveness may appear as an issue in therapy, how forgiveness occurs, and how to facilitate the process. Forgiveness can develop as a therapeutic process and not as an intervention. It naturally unfolds by addressing the effects of abuse. Regardless that forgiveness has been advised against when treating sexual abuse; the study revealed that it is feasible, as it is utilized differently in the context of sexual abuse. This may reduce the reluctance in applying forgiveness with CSA survivors.
Presenter: Mhairi Thurston
Other Author: Kate Smith
Professional Role: Lecturer
Institution/Affiliation: Abertay University, Dundee
Email: c/o firstname.lastname@example.org
Keywords: pluralistic counselling, diabetes, task-list, integration, long-term conditions
The development of a practitioner manual for counselling people with diabetes
Aim/Purpose: The aim of this study was to explore the experience of training and engagements in a task-based practice handbook in pluralistic counselling. The objective was to further develop a competencies-based guide, with training recommendations for practitioners working therapeutically with diabetic clients. The research question was: 'Is the manual appropriate for use for training and guidance for practitioners working with diabetic client groups?'
Design/Methodology: The establishment of a treatment manual using a pluralistic approach to practice drew on previous research findings. The manual is designed to provide guidance on aspects of the relationship between counsellor and client, which enable effective support along with a range of empirically verified tasks which may commonly be addressed by diabetic clients, each task being supported with a number of methods, drawn from counselling approaches. Prior to the evaluation of counselling which has been offered by practitioners using the manual it's utility as a basis for training is explored.Five practitioners engaged in a one-day training workshop and introduction to the training manual, with on-line support provided during a consolidation period of one month, and a follow-up workshop. Participants were subsequently interviewed to ascertain the utility of the manual, effectiveness of training, and additional support and intervention needs.
Results/Findings: Key themes included i. Aligning own assumptions with client tasks, ii. Understanding the condition and making sense of client experience, iii. Meeting client needs in an informed way, iv. participants expressed a need for trainees to fully understand the pluralistic model prior to training.
Research Limitations: This is a small-scale study representing a small step in the development of task-based intervention guidelines and results cannot be generalised. It addresses the question of training and manualisation in counselling for diabetes, and not the effectiveness of the counselling approach per se.
Conclusions/Implications: The effectiveness of training of pluralistic practice using a task-based manual, from the perspective of practitioners will be presented.
Implications for practice are that development of the manual, and future validation, will provide empirical evidence for the use of a Pluralistic integration model to counselling for people with diabetes.
Presenter: Ladislav Timulak
Other Authors: James McElvaney, Elaine Martin, Daragh Keogh & Leslie Greenberg
Professional Role: Director, Doctorate in Counselling Psychology
Institution/Affiliation: School of Psychology, University College Dublin
Keywords: generalised anxiety disorder, emotion-focused therapy, quantitative outcomes, qualitative outcomes
Developing emotion-focused therapy for generalised anxiety disorder
Aim/Purpose: Generalised anxiety disorder (GAD) is one of the anxiety disorders, which has the highest prevalence among mental health disorders. Just as with other anxiety disorders, cognitive-behavioural therapy (CBT), a form of psychological therapy, is the treatment that is routinely considered for GAD. Despite the proven benefits of CBT, it is also shown that not all clients benefit from it. This study is aiming at developing and testing efficacy of emotion-focused psychological therapy (EFT), for the treatment of GAD.
Design/Methodology: The study consists of 14 intensive case studies of up to twenty sessions of EFT for GAD. The clients were recruited from a public health primary care psychology service after being screened for GAD and then assessed using SCID-I and II. Any eligible client was offered opportunity to participate until the full sample was recruited. The cumulative quantitative and qualitative outcomes (post-treatment) will be reported here in the format of an open trial. The principal measures were GAD-7 and GADSS (Generalised Anxiety Disorder Severity Scale). Other measures were also used (CORE-OM, BDI, and Penn-State Worry Questionnaire). Qualitative outcomes (client perspectives) where gathered through the Client Change Interview (CCI).
Results/Findings: The preliminary pre-post analysis suggests large pre-post outcomes. Qualitative outcomes suggest that clients transformed underlying core painful emotional self-organisations. They report less anxiety, more resolution around chronic interpersonal conflicts and being hopeful about future. In general, clients specifically valued experiential, emotion-focused, tasks although they found them at times particularly challenging. No clearly negative outcomes or experiences were reported.
Research Limitations: The findings are presented in the form of an open trial, which means that there is no control group (just benchmarking against established treatments).
Conclusions/Implication: If preliminary analysis is confirmed, the results would suggest that further examination of EFT in an RCT against established CBT interventions would be warranted. Establishment of another treatment for GAD would widen the choice of therapy for the clients with GAD.
Els van Ooijen & Lesley Spencer
Presenters: Dr Els van Ooijen & Dr Lesley Spencer
Professional Role: Lecturer, Diploma in Consultative Supervision
Institution/Affiliation: University of Wales
Keywords: counselling, psychotherapy, training, supervision, practice
The enduring effect of supervision training on therapists' supervision and therapy practice
Aim/Purpose: The number of courses offering training in supervision has greatly increased in the last twenty years. However, to date, research into the long-term effectiveness of such training remains limited.
This was a follow-up to an earlier study, the results of which indicated that supervision training could affect practitioners' therapy and supervision practice positively and increase their awareness of organisational context, as well as the impact of differences, such as culture, gender or class. The aim of this qualitative study was to establish whether changes initiated by the training were being integrated into people's ongoing practice. The research question was 'What is the enduring impact of supervision training on new supervisors in terms of how they conduct their supervision practice?'
Design/Methodology: Four former students, representing the cohorts from the previous two years, took part in a focus group that was run by an experienced independent facilitator. The recorded data was transcribed and anonymised by a professional transcriber; the two researchers initially analysed the transcript separately using thematic content analysis (Burnard et al, 2008), following which the overall results were sent to the participants for their verification.
Results/Findings: The results suggest that people's professional confidence as therapists and supervisors had increased significantly as result of the training. The supervisory relationship was regarded as crucial; participants reported being more adaptable, not phased by challenge and more able to deal with complex group dynamics. There was an awareness of their educational responsibilities when supervising students, as well as the importance of supervision's restorative and normative aspects. The results also included a continued appreciation of the value of a framework or model, increased organisational awareness, and having become more proactive in their own supervision.
Research Limitations: This small study relates to one course only and did not elicit views from supervisees or clients
Conclusions/Implications: The results indicate supervision training can have an enduring positive effect on practitioners' supervision and therapy practice. Further research is required with larger groups of students and different types of courses, to discover whether these results pertain to supervision training generally.
Presenter: John Wilson
Other Authors: Lynne Gabriel & Hazel James
Professional Role: Senior Bereavement Counsellor & Trainer. PhD student.
Institution/Affiliation: Saint Catherine's Hospice Scarborough & York St John University
Keywords: bereavement, grief, assimilation, meaning-making, adaptation
Meaning-making in bereavement counselling: clients' assimilation of grief experiences
Aim/Purpose: Inspired by the work of Parkes (1971), Neimeyer (2001) and Attig (2001), who posit that grieving is a process of meaning-making and adaptation, the authors aimed to observe how clients make effective use of bereavement counselling.
Design/Methodology: Adopting a theory-building case study approach (Stiles, 2007), the authors began with a testable theory; that grief resolution requires learnt adaptation to loss, which in turn involves an observable process of assimilation. The authors suggest that this is analogous to constructivist learning seen in children (Piaget, 1952), a view supported by the psychology of personal constructs developed as a model of psychotherapy by Kelly (1963), and further investigated by Neimeyer (2009) and Janoff-Bulman (1992).
An observational protocol was devised which reconciled scientific positivism with relativist methodologies (Wilson, Gabriel, & James, 2014). The counselling sessions of five bereaved clients were recorded and transcribed. The transcripts, supported by the lead researcher's immersion in the session recordings, were subjected to assimilation analysis (Varvin & Stiles, 1999). Because the lead researcher was also the counsellor, inter-rater reliability measures were used to mitigate observer bias.
Results/Findings: The initial theory was borne out. Each client was observed assimilating his/her life changes. In collating transcribed extracts, three categories were identified: managing the grief, accepting the circumstances of the death, and developing a continuing bond (Klass, Silverman, & Nickman, 1996). Using Stiles' (2001) Assimilation of Problematic Experiences Scale as a template, the authors arrived at an eight point scale which described a sequence of adaptation to loss and grief.
Research Limitations: Whilst five case studies are inadequate to draw firm conclusions, a theory-building methodology allows each new case study to add a small degree of confidence to previous findings (Stiles, 2007).
Conclusions/Implications: A reliable and valid Assimilation of Grief Scale would provide evidence for psychological change and could be developed into an outcomes measure questionnaire. Bereavement work may be more effective if counsellors are trained to stimulate and foster assimilation of the client's post bereavement world.
Presenter: Michelle Wynn
Other Authors: Dr Clare Symons & Jon March
Professional Role:Trainee Psychotherapist
Institution/Affiliation: University of Leicester
Keywords: psychotherapy, discourse analysis, premature termination, therapist responses, latent content.
The silent goodbye: therapeutic discourse about client-initiated premature termination
Aim/Purpose: The ending phase is an important part of the therapeutic work, but is often cut short or missed out altogether when clients prematurely terminate therapy. This research set out to explore the ways in which clients communicate their intentions to stop therapy prematurely. The research explored how these communications were worked with, or possibly missed, in the brief remaining time in the work and the impact that this had on the dialogue that followed. Research question: What are therapists' responses to direct and indirect communications from clients about wanting to terminate therapy unilaterally and prematurely?
Design/Methodology: The study made use of data from a university-based counselling and psychotherapy research clinic with therapists from a psychodynamic modality. Ethical approval was granted to access this data. The study used transcripts of audio-recording for the final therapy sessions of seven clients who prematurely terminated therapy. Within these client-therapist pairings, there were five different therapists. Analysis of these transcripts was achieved through critical discourse analysis.
Results/Findings: No instances were found of clients explicitly stating that the therapy session would be the last that they would be attending; all identified instances of client communications were indirect. Therapists' responses to these communications range from: not addressing the communication at all, to probing and exploring what message the client is trying to impart. Concealed discourses are explored, thus allowing for overt consideration of hegemonic influences.
Research Limitations: It cannot be determined if the clients had decided whether or not they would return for further sessions at the point of what turned out to be their final session; this is a consideration regarding the lack of explicit communications in the transcripts.
Conclusions/Implications: That neither client nor therapist names the client's intention to drop out of therapy suggests that it is the elephant in the room and not legitimised as a valid topic for discussion. The research contributes to practitioners' understanding of how to work with a client who wants to drop-out of therapy and how to best support them with this decision in the remaining time.
Methodological Innovation Papers
Presenter: India Amos
Professional Role: Trainee counselling psychologist
Institution/Affiliation: The University of Manchester
ABSTRACT: methodological innovation paper
Keywords: interpretative phenomenological analysis, embodied interpretation, Gendlin, the lived body, body-based hermeneutic
Interpretative phenomenological analysis and embodied interpretation: integrating methods to find the 'words that work'
Background and introduction: IPA draws on the theoretical ideas of phenomenology, hermeneutics, and idiography. Within the development of phenomenology, a multiplicity of ideas pertaining to what is considered its central tenets are offered by varying authors within the developing conversation. This paper identifies one enduring and coherent strand within the phenomenological tradition which recognises the intertwined relationship between the life world and the lived body. Understood as the means to texturally experience the pre-reflective 'more' of the world, as well as offer reflection on the experience, the lived body is conceptualised as an essential source of meaningful understanding. In seeking to resolve an aesthetic tension, attendance to the researcher's bodily response to the research data is understood as enabling movement towards a fuller understanding of the phenomenon under examination, as well as facilitation of the production of 'words that work' for the participant, author, and reader alike.
Nature of the methodological innovation/critique being proposed: IPA is considered to be a systematic qualitative analysis, however is not prescriptive in its approach. Embodied interpretation has been developed in response to a growing trend towards an aesthetic phenomenology which aims to 'carry forward' the meaning of phenomena in all its complexity and texture. With the aim of facilitating the development of emotionally receptive forms of understanding, it is proposed that embodied interpretation can be successfully integrated into IPA, via the application of Gendlin's method of focusing. An application of the method is demonstrated, and its contribution is evaluated.
Conclusion and relevance to counselling and psychotherapy research practice: The process of incorporating embodied interpretation into more traditional scientific methods of analysis is deemed as offering a supplementary analysis phase which ensures the capture of both the structure and the texture of lived experience. Furthermore, within a research climate which continues to seek an appropriate evaluative criteria for qualitative research, the procedure is considered as effectively enabling an intricate experiential reference against which any critical explanation, or interpretation of the data set can be validated.
Tracey Fuller & Carol Holliday
Presenters: Tracey Fuller & Dr Carol Holliday
Professional Role: Associate Tutor and UKCP registered Psychotherapeutic Counsellor; Affiliated Lecturer and UKCP registered Psychotherapist
Institution/Affiliation: University of Sussex; University of Cambridge
Email: email@example.com; firstname.lastname@example.org
ABTRACT: methodological innovation paper
Keywords: phronesis, epistemology, embodied-judgement, contextual-model, particularity
Prizing the particular; re-imagining phronesis for counselling and psychotherapy research
Background and introduction: Ongoing and current debates in the field highlight a gap between practice and research. This is exacerbated by the climate of increasing managerialism, technification and instrumentalist rationality. It is therefore important to establish a warrant for undertaking research that is relevant to counselling and psychotherapy practice that reveals what practitioners actually do.
The nature of the methodological innovation/critique being proposed: The central argument we are making in this paper is that the concept of phronesis can provide an epistemological framework to progress our thinking about counselling and psychotherapy research. Phronesis is most often translated as practical wisdom. It is one of several intellectual virtues described by Aristotle as qualities of mind. Amongst these virtues, three are primarily types of knowledge; episteme, techne and phronesis. Recent scholars in the fields of sociology, education and others involved in professional practice have recently re-engaged with the idea of phronesis. In this paper we re-imagine phronesis for counselling and psychotherapy research. Our argument is predicated upon an up-to-date analysis of findings from a vast array of psychotherapy studies that leads to the conclusion that a Contextual Model (Wampold and Imel, 2015) of psychotherapy better fits the evidence than a Medical Model; together with an understanding of epistemology that suggests that the kind of knowledge that is required for the investigation and practice of excellent therapy is phronesis; and Flyvbjerg's (2012) reformulation of real social science.
Conclusion and relevance to counselling and psychotherapy research practice: We conclude that effective therapeutic practice is contingent, not formulaic, that one size does not fit all, that particularity is to be prized and that therapy involves making embodied judgements. Phronesis as a methodological approach has the potential to close the practice/research gap. The emphasis is on illuminating judgements in practice in order to make them visible for learning. We suggest that Phronesis may offer a research approach that allows for a more holistic examination of what it is that effective counsellors and psychotherapists 'do'.
Lynne Gabriel & Hazel James
Presenters: Lynne Gabriel & Hazel James
Other Authors: Jane Cronin-Davis, Zahra Tizro, Tanya Beetham & Sarah Hill
Professional Role: Associate Professor of Counselling and Reader in Counselling, Coaching and Ethics
Institution/Affiliation: York St John University
Contact details: Faculty of Health and Life Sciences, York St John University
ABSTRACT: methodological innovation paper
Keywords: children, research, relational, dialogical, ethics
Developing research conversations with children: an exploratory approach
Background and introduction: The paper identifies key features of designing research conversations with children and young people. It explores explore ethical, researcher and research process issues and generates ongoing debate on innovating qualitative research with children and young people
Nature of the methodological innovation /critique being proposed: Work with young people is increasing in the counselling professions, yet the evidence base for qualitative research methodologies is slim. The research team (including health psychologist, counsellors, forensic mental health specialist, child/youth work specialist) developed in-depth research conversations to elicit a young person's relational agency in a dialogical and intersubjective conversational space; a space which did not 'problematise' the child. We explored abuse, trauma and familial violence with young participants (Gabriel et al. 2016). Informed by Epston and White (1990) and Winslade and Monk's (2007) work, the researchers regarded the individual's worldview and life experiences as central. The research team developed an inquiry framework informed by social constructionism, pluralism and poststructuralist feminism (Tizro, 2012). The focus of this presentation is upon designing research conversations with children and young people.
The research design phase was supported by a partner with expertise in child/youth and a project steering group (which included a developmental psychologist and others bringing expertise of relevance to the project). The research team were affected by engaging with the children's harrowing stories. The iterative research and researcher processes were complex, powerful and challenging. Managing the nuances of exploratory research work with young people brought both relational and process challenges. Researcher reflexivity, embedding principles of self-care, beneficence and non-maleficence, became a crucial component and the research design was enhanced through active partnership work with the external agency partner.
Conclusions and relevance for counselling and psychotherapy research: A narrative-informed, relational approach to developing and undertaking research with children, can elicit agency and competence in young participants. We concur with Harris et al (2015) that researchers undertaking in-depth qualitative research work with children must develop child-centred techniques. We posit that in-depth research with children necessitates critically reflexive researchers, comprehensive child safeguarding, effective research supervision and, ideally, a steering group with expertise in the research topic.
Presenter: Mo Mandić
Professional Role: Lecturer, Regent's School of Psychotherapy and Psychology
Institution/Affiliation: Regent's University London
Contact details: RSPP, HASS Faculty, Regent's University London, Inner Circle, Regent's Park, London NW1 4NS
ABSTRACT: methodological innovation paper
Keywords: existential, phenomenology, hermeneutic, formal indication, experience
Existentially-focused enquiry: what matters in psychotherapy research?
Background and introduction: The predominant focus in qualitiative research on psychotherapeutic practices has been to articulate procedures and methodical paths by which researchers can arrive at findings that are meaningful and relevant. In so doing, the emphasis has, understandably, been on identifying the 'doing' aspects that researchers follow. However, the existential approach being proposed here also embraces a 'being'-oriented focus, which has been highly relevant to recent research conducted on the experience of care in the therapeutic relationship.
Nature of the methodological innovation/critique being proposed: Martin Heidegger's methodological approach to phenomenological investigations, namely, his hermeneutic, or interpretative, method of 'formal indication', will be introduced and elaborated, in order to demonstrate how an existential focus can be pursued in psychotherapy research. In brief, this refers to the researcher's engagement with the topic of enquiry as one of indicating, or provisionally pointing to, something rather than its being already transparent and obvious to us. It is also approached in its formal character, rather than a focus on its content, since the latter already presupposes, and therefore closes off to us, the phenomenon under study.
Conclusion and relevance to counselling and psychotherapy research practice: Drawing on illustrations and examples from recent research on the psychotherapist's care, as well as other investigations, the existential approach (based on formal indication) is a viable research approach that illuminates particularly important phenomena in psychotherapy. However, at the same time, in taking such an approach to research, it also invites consideration of the possible challenges and limitations that are found in such a form of enquiry. As well as this, it also challenges the limitations in prevailing methodologies used in psychotherapy. In the light of this, it is hoped that this paper will promote further debate and discussion about what matters, or really matters, in psychotherapy research.
Presenter: Julia McLeod
Other Author: John McLeod
Professional Role: Lecturer in Counselling
Institution/Affiliation: University of Abertay
Contact details: School of Social and Health Sciences, University of Abertay, Dundee, DD1 1HG
ABSTRACT: methodological innovation paper
Keywords: client strengths, cultural resources, interviews, scales, social capital
Social capital and psychotherapy: a review of data collection methods for investigating social and cultural resources used by clients
Background and introduction: Although it is widely acknowledged that "extra therapeutic" factors make a major contribution to therapy outcome, there have been few attempts to conceptualise this dimension of therapy, or develop methods for investigating it. Among the perspectives that are relevant to understanding tis phenomenon can be included: cultural resources, strengths, life events, social support, and social capital. Further attention to these domains may have the potential to enhance the social relevance and effectiveness of therapy.
Nature of the methodological innovation/critique being proposed: The present paper offers a brief overview of approaches to conceptualising social capital and allied constructs, before presenting a review of methods that could be used in research on the role of social capital (and related factors) in therapy. The review identifies a number of questionnaires/rating scales and interview schedules that have been used in research in allied disciplines, such as mental health and health education, and discusses their relevance for use in studies of counselling and psychotherapy. The paper concludes with recommendations regarding research instruments likely to be most suitable for research in counselling and psychotherapy, and suggests some research questions that might be explored using these techniques.
Conclusion and relevance to counselling and psychotherapy research practice: Inclusion in studies of measures of social capital can enhance the perceived credibility of research into the effectiveness of therapy, by demonstrating that the research community has paid serious attention to the possible influence of social factors on therapy outcomes. This line of research also provides ways to incorporate social justice values in therapy research, and to promote inter-professional collaboration.
Presenter: Jean Penman
Other Authors: Erica Cook & Gurch Randhawa
Professional Role: Clinical Lead Psychosexual Counselling
Institution/Affiliation: Cambridgeshire Community Services NHS Trust; University of Bedfordshire
ABSTRACT: methodological innovation paper
Keywords: practice-based evidence, realist service evaluation, reflexive, psychotherapy case study, therapist-researcher
Developing a reflexive insider-realist service evaluation (ri-RSE): the systematic and ethical examination of contextual psychotherapy process and outcome
Background and introduction: It is both questioned and evidenced that outcomes of protocol-led psychological therapy interventions are not necessarily evaluated as effective for practice in situ (Fonagy, et al., 2005). Therapists in the real-world can find that 'Evidence-Based' practices (EBP) fall short of the complexities of individual psychotherapy relationships. An inclusive research/evaluation methodology for the development of Practice-Based Evidence (PBE) from inside naturalistic service delivery using qualitative and quantitative data is needed for Therapist-Evaluators.
Nature of the methodological innovation/critique being proposed: An exploration of Realist Evaluation (RE) methodology (Pawson & Tilley, 1997), showed a logic of enquiry that supported the development of PBE concerning engagement between the therapist and 'patient' within healthcare delivery. In this instance, a valid exploration of context, process of engagement and outcomes with sufferers of persistent physical symptoms (PPS) became possible. Essential to this RE adaptation was the engagement of the insider-realist evaluator. A realist synthesis of the literature followed by a realist service evaluation facilitated further understanding of a contextual engagement with PPS and outcomes. Guidance from McLeod and Cooper's (2011) Systematic Psychotherapy Case Study protocol was incorporated at depth case exploration within the service setting. The exposure of the Therapist-Evaluator's positioning and the core reflexive function is found as integral to transparency and reduction of bias in the design, implementation, analytic decision-making and evaluation outcomes. A mechanism of external consultation at each stage of the evaluation and validated measures of change addressed Pawson & Tilley's (2004) concern for the balanced insider-outsider perspective on the generation of realist findings.
Conclusion and relevance to counselling and psychotherapy research practice: The pragmatic use of realist principles for the development of PBE applicable to psychological therapies validates this ethical and relevant reflexive insider-Realist Service Evaluation (ri-RSE). In this instance, ri-RSE enables knowledge development in alignment with current healthcare policy to reduce particular professional and service delivery silos relating to mental and physical health (DoH, 2011). It also results in conceptual guidance for practice. Future therapist-evaluators engaging with this methodological innovation can have confidence that the ri-RSE process and findings will complement the Systematic Psychotherapy/Pragmatic Case Study (Fishman, 2000) with the potential to impact policy, practice and service development.
Femke L. Truijens
Presenter: Femke L. Truijens
Other Authors: Shana Cornelis & Mattias Desmet
Professional Role: PhD Candidate
Institution/Affiliation: Ghent University, Belgium
ABSTRACT: methodological innovation paper
Keywords: epistemic validity, test validity, evidence based treatment, psychotherapy research, evidence based case study
Validity in times of measurement: on the epistemic validity of test validity in psychotherapy research
Background and introduction: In psychotherapeutic research on Evidence-based Treatments (EBTs), treatment efficacy is operationalized as the numerical mean of individual treatment successes. In psychotherapy research, efficacy numbers are derived in randomized controlled trials by symptom measurement with validated symptom measures. 'Validity' refers to the test validity of such measures - i.e. to the adequacy of a measure as a means to satisfy its proposed end - which is taken as vital for the validity of the research procedure. However, this paper argues that test validity is principally insufficient as a means for overall epistemic validity of psychotherapy research.
Nature of the methodological innovation/critique being proposed: In psychological methodology, validity is strictly bound to instruments, such as the Beck Depression Inventory (BDI) that has detection of depression symptoms as its end. However, in application the measure becomes a means towards an epistemic end, which may differ from the end of the measure itself. Consequently, the test validity of a symptom measure is only part of the epistemic validity of the operationalization of treatment efficacy per se. In this paper, epistemic validity are discussed both on conceptual and operational level, given that the conceptual level is meaningless in psychotherapy research without its operationalization, yet the operationalization implies multiple validity questions that reach beyond test validity, which implies a paradox in the validity of applied measures in psychotherapy research. This paradox is discussed via an empirical case study from our mixed method psychotherapy study. Two interpretations of its idiosyncratic treatment success are sketched, in which the application of measures implies different conclusions on the test validity given a difference in operationalization of 'treatment success' - which substantiates the need for a concept of validity that goes beyond test validity in psychotherapeutic epistemology.
Conclusion and relevance to counselling and psychotherapy research practice: In this paper, the clinical relevance of 'epistemic validity' in psychotherapeutic methodology is highlighted by discussing it within idiosyncratic data. As individual data forms the basis of aggregated data that is used to derive EBTs, which in turn is translated back to individuals in clinical practice, it is vital to understand the epistemic validity of 'the evidence' in Evidence Based Treatments.
Presenter: Cirecie West-Olatunji, Ph. D.
Other Author: Jeff Wolfgang, Ph. D.
Professional Role: Associate Professor
Institution/Affiliation: Xavier University of Louisiana
ABSTRACT: methodological innovation paper
Keywords: research, multiculturalism, hegemony, emancipatory, methodology
Multicultural competence in cross-national research
Background and introduction: While multicultural counseling scholars have asserted the need for cultural competence to enhance clinical efficacy (Sue & Sue, 2013), assessment (Alexander & Suzuki, 2001), and ethics (Ridley, Liddle, Hill, & Li, 2001), less discourse has focused on multicultural competencies in research methodology (Sue, Ivey, & Pedersen, 1996). Further, it has been asserted that many researchers base their practices on Eurocentric ideologies and assumptions (Chilisa, 2012) and are prone to poor conceptualization and interpretation in their research due to inculcated cultural biases. Eurocentrism in research has been evident in sampling bias (Rogler, 1999; Sue, 1999), use of deprivation theories (Foster, Lewis, & Onafowora, 2003), and culturally encapsulated methodological approaches (Dillard, 2006). For cross-national studies, the methods developed have been insufficiently applied (Davidov, Schmidt, & Billiet, 2011). Issues of construct, method, and item bias and the subsequent implications for the comparability of data (construction, metric, or structural equivalent) are of concern.
Nature of the methodological innovation/critique being proposed: To address the cultural hegemony prevalent in research methodology, qualitative methodology has been offered as an alternative (Fine, 1994; Guba & Lincoln, 1988). Later, mixed methodology was presented as a more pragmatic paradigm for conducting research (Johnson & Onwuegbuzie, 2004). Yet, critical scholars have asserted that these alternative paradigms insufficiently address issues of cultural bias in research protocols (Author, 2014; Tate, 1997). Emancipatory methodologies, including indigenous (Walter & Anderson, 2013), endarkened feminist (Dillard, 2006), and transformative research (King, 2005), have been suggested, reflecting qualitative and quantitative paradigms.
The researchers assert that it is necessary to bridge the gap between clinical multicultural competence and the hegemonic research methodologies that predominate research involving non-White populations. Counselors need to employ emancipatory methods to give voice to marginalized communities and facilitate transparency in the research process.
Conclusion and relevance to counselling and psychotherapy research practice: It is recommended that the multicultural counseling competencies be expanded to focus on increasing: awareness of how researchers bring their biases into the research process, knowledge about emancipatory methodologies, and research skills that minimize cultural hegemony and ultimately improve the lives of culturally diverse clients.
Presenter: Sarah Cantwell
Other Authors: Dr John Rae, Dr Joel Vos & Professor Mick Cooper
Professional Role: Doctoral researcher and counsellor in a community counselling service
Institution/Affiliation: University of Roehampton
Keywords: pluralistic therapy, working collaboratively, conversation analysis, personalization
Exploring the interactional challenges of working collaboratively and pluralistically with clients
Relevance of the workshop to counselling and psychotherapy research: This workshop explores the practical implications of findings that psychotherapy works optimally when it is personalized (e.g. Norcross & Wampold, 2011; Horvarth et al., 2011). In particular, the workshop focuses on pluralistic therapy, which aims to achieve personalization through collaborative discussion with the client regarding their goals and preferences (Cooper & McLeod, 2011). This involves exploring the client's views regarding what might be therapeutically helpful. However, clinical experience indicates that such discussions can be challenging for clients to engage in (Cooper et al., 2016) and therapists also report finding it difficult to translate pluralistic theory into real-world therapeutic practice (Thompson & Cooper, 2012). As an observational methodology, Conversation Analysis (e.g. Madill, 2015) can develop our understanding of the interactional difficulties involved in collaborative discussions and how these can be managed.
The aims of the workshop: To explore how Conversation Analysis can be used to investigate therapists' management of interactional difficulties in collaborative discussions about what might be therapeutically helpful.
How the workshop will be structured:
• Workshop materials are derived from the presenter's doctoral research which uses Conversation Analysis to identify recurrent interactional practices in 42 audio-recorded sessions of pluralistic therapy, across 7 client-therapist pairs.
• Using a version of the Conversation Analytic Role-Play Method (Stokoe, 2014), participants will be presented with transcribed examples of interactions. The examples will be presented one at a time and in segments, so that participants can react to the interaction as it unfolds.
• Participants will then be asked to comparatively discuss different interactional practices.
Key points for discussion: The nexus of interactional and institutional considerations negotiated by therapists when attempting to elicit clients' views on what might be helpful e.g. 1) designing questions which are more/less assuming 2) whether and how to pursue a response from the client.
Who will benefit from attending the workshop? Practitioners and researchers interested in exploring the concrete practice of working collaboratively and/or pluralistically with clients.
Colette T. Dollarhide, Darcy Haag-Granello & Paul Granello
Presenters: Dr. Colette T. Dollarhide, Dr. Darcy Haag-Granello & Dr. Paul Granello
Professional Role: Associate Professor, Counselor Education
Institution/Affiliation: The Ohio State University
Keywords: counsellor professional identity, qualitative, quantitative
Professional counsellor identity evolution: researching counsellor knowledge, attitudes, and skills
Relevance of the workshop to counselling and psychotherapy research: Professional identity of counsellors can be understood as the culmination of professional knowledge, attitudes, and skills. Each presenter has conducted studies in these domains: cognitive development (knowledge), identity development (attitudes), and rigor of field experiences (skills). Using these three studies as examples, participants will discuss ways to explore these domains using various research methodologies.
The aims of the workshop: To facilitate participants' ability to research the professional identity evolution of counsellors in these three domains using various research methodologies.
How the workshop will be structured: First, an overview of professional identity will be offered and questions posed to the audience. Each of the three studies will be presented and connected to professional identity. How does this structure (knowledge, attitudes, skills) capture counsellor development? Focusing on methodology, what future studies can expand on this understanding?
Key points for discussion:
(1) What is professional identity? What was your professional identity development process? What was your greatest learning experience? Why was that so meaningful for you? (5 minutes)
(2) How is professional identity developed: changes in knowledge, attitude, and skills. Each study will be shared in 5 minutes maximum focused on research methodology that was designed to fit the construct being measured, either quantitatively or qualitatively. (15 minutes)
(3) Participants will be asked to each write a research question focusing on professional identity development. What methodology would fit those questions? Depending on how many participants attend, either small or large group discussion will allow presenters to talk with groups who are interested in their particular methodology. (40 minutes)
Who will benefit from attending the workshop? Advanced professionals, counsellor educators
Géraldine Dufour & Julieta Galante
Presenters: Géraldine Dufour & Julieta Galante
Other Author: Peter Jones
Professional Role: Head of University Counselling Service
Institution/Affiliation: University of Cambridge, BACP senior accredited psychotherapist, member of BACP Universities and Colleges Division
Contact details: University Counselling Service, 2-3 Bene't Place, Lensfield Road, Cambridge CB2 1EL
Keywords: mindfulness, counselling, university, research, collaboration
Researcher and practitioner collaboration: a successful synthesis of complementary roles
Relevance of the workshop to counselling and psychotherapy research: Research is essential to expand the frontiers of knowledge, to show proof of effectiveness and to facilitate the commissioning of psychotherapies. Many clinicians understand this, but few make the transition to undertaking research themselves. In this workshop the presenters will focus on developing understanding and confidence in setting up researcher-practitioner collaborations.
The aims of the workshop: By outlining their partnership and stimulating discussion the practitioner and the researcher aim to help promote ethical collaboration and counselling-in-practice research, inspiring others to start their own collaborative research projects, and advancing knowledge and understanding about psychotherapy and its provision.
How the workshop will be structured: The workshop will start with a short presentation from the Practioner and the researcher on their experience of setting up a joint project researching the usefulness of mindfulness in increasing resilience in university students. This will be followed by small group discussions where participants will be encouraged to explore their own potential research projects and collaborations, followed by a larger group discussion. The session will finish with a summary of the group learnings and key action points, giving participants practical tips and advice on how to set up collaborations.
Key points for discussion: Share research good practice; think about potential collaboration between researchers and practioners thereby increasing the evidence-base for psychotherapy.
Who will benefit from attending the workshop? Practitioners. Psychotherapy academics and students. Researchers. Those with a special interest in mindfulness and/or student counselling.
Presenter: Robert Elliott
Professional Role: Professor of Counselling
Institution/Affiliation: University of Strathclyde
Contact details: School of Psychological Sciences and Health, University of Strathclyde,
40 George Street, Glasgow, G1 1QE
Keywords: outcome, individualised, measurement, psychometrics, psychotherapy
The Personal Questionnaire: a hands-on workshop on an individualised outcome measure
Relevance of the workshop to counselling and psychotherapy research: The Personal Questionnaire (PQ) is a client-generated individualized outcome measure with many different uses in counselling and psychotherapy, including treatment planning, outcome assessment and monitoring, clinical assessment, and case formulation within a wide range of theoretical approaches. Elliott et al. (2015) documented detailed and wide-ranging psychometric evidence supporting the PQ, showing it to be an evidence-based form of clinical assessment.
The aims of the workshop: The aim of this workshop is to introduce the PQ to counselling researchers, allowing them to learn about it and to experience it for themselves.
How the workshop will be structured: The workshop will open with a brief overview of PQ, including its history, the procedures for creating and using it, and supporting evidence. Participants will then be guided through the process of creating their own PQ form. We will conclude with a group discussion of the varied uses, advantages and limitations of the PQ.
Key points for discussion: What did you learn from the process of putting together your own PQ? What uses does the PQ have? What are its strengths and weaknesses? Where and how might an instrument like the PQ fit into your practice?
Who will benefit from attending the workshop? Counselling researchers interested in outcome or case study research. Counsellors, psychotherapists and psychologists interested in clinical assessment, case formulation, and individualised treatment planning and outcome monitoring.
Lisa Fellin & Jenna Goodgame
Presenters: Dr Lisa Fellin & Jenna Goodgame
Professional Role: Research Director Professional Doctorate in Counselling Psychology
Institution/Affiliation: University of East London
Keywords: adoption, fostering, attachment, narrative, systemic, creative
Creative techniques in research and therapy with adoptive and foster families
Relevance of the workshop to counselling and psychotherapy research: Notwithstanding a considerable body of clinical and research work on adoption and fostering, families still face many difficulties in relational adaptation, and placement breakdown (Woolgar & Scott, 2013). Most clinical research focuses on the psychological impacts of these relational difficulties (Woolgar & Baldock, 2014) and issues related to early attachment disruptions, neglect or abuse. However, many clinicians and researchers have underscored the centrality of self-narratives difficulties associated with adoption and fostering, and have linked these problems of conflicting identities and belongings to psychological and relational difficulties and, ultimately, to placement breakdown. Two narrative-creative tools developed for research and therapeutic work with adoptive and foster families will be presented.
The aims of the workshop: Participants will:
• gain an overview of the body of evidence for current treatment options related to adoption and fostering
• familiarise with the current debate around support for carers and adoptive parents learn the use of two creative tools for research and practice through discussion of applied case examples from our sample
• participate to the discussion of issues related to research and clinical application
How the workshop will be structured:
PowerPoint delivery of research data
Presentation of creative work from our research sample
Questions and comments
Key points for discussion: Drawing on the intersection of two therapeutic models -Creative Expressive Therapy and Systemic Family Therapy- an integrated model of looking at creating novel narratives with adoptive or foster families is presented. Through case studies materials, family and self-narratives and images constructed by the integration of two graphical-creative tools, i.e. the Double Moon (Greco, 1998) and the Tree of Life (Ames, 2008; Ncube, 2006) will be illustrated. Limitations of this model, possible integrations and future perspectives for both research and clinical practice will be addressed too. The workshop will be delivered in a collaborative style. Participants will be invited to discuss creative materials based on the case studies. There will be time for questions and comments following the group discussion.
Who will benefit from attending the workshop? Psychotherapists, family therapists, counsellors, play therapists, CBT therapists, Creative Therapists, Teachers, Social workers, Learning mentors, researchers.
Presenter: Leigh Gardner
Professional Role: Counsellor, Supervisor, Researcher, Trainer
Institution/Affiliation: University of Salford
Keywords: action research, education, young people, practitioners as researchers
Action research – encouraging the counsellor in education to take reflection into research
Relevance of the workshop to counselling and psychotherapy research: Exploring action research as a methodology that can be used by both practitioners and researchers will encourage practitioners to use research as a tool for reflection, evaluation and reporting. Counselling in education has been undergoing cuts and threats to funding for some time so research to show its effectiveness is a vital part of its survival.
The aims of the workshop: Participants will take away a clear understanding of the purpose, benefits and potential barriers to using action research as a possible method to evaluate the effectiveness of a counselling service in an educational setting. Action research is social research, used widely (but not exclusively) in schools to help staff take 'action' to resolve issues. Counsellors and psychotherapists are reflective practitioners and this workshop will encourage practitioners to take the reflection further, into relevant research, to help demonstrate the effectiveness of a counselling service. Action research consists of a balance of research, participation and action (Greenwood, Levin 1998). The practitioner is the researcher and participates with the stakeholders to determine what action is required; the practitioner is in a strong position in a school to notice issues – such as a rise in presentation of self-harm. The workshop will look at the advantages and some of the criticisms of action research using relevant literature.
How the workshop will be structured: A short presentation will explain what action research is and how an action research project is put together. In small groups we will then explore some of the issues that could be looked at through action research and develop some Enquiry Questions (questions that explore the relevant issues) then share them in the large group. A short presentation of findings from a recent project with a Year 8 group working on social skills and behaviour will demonstrate action research in action and its value, followed by group discussion about the benefits/ criticisms of action research.
Key points for discussion: Action research methodology, reflective practice/reflective research.
Who will benefit from attending the workshop? Therapists working in education and with young people; researchers interested in action research.
Presenter: John McLeod
Professional Role: Professor of Psychology
Institution/Affiliation: University of Oslo
Contact details: Department of Psychology, University of Oslo, Postboks 1094, Blindern, 0317 Oslo, Norway
Keywords: professional knowledge, research-informed practice, therapist development, training
Using research to inform practice: multiple points of contact
Relevance of the workshop to counselling and psychotherapy research: Studies of therapy practitioners have reported that they seldom read research articles, and do not regard research as a significant influence on practice. The existence of a research-practice 'gap' has been widely regarded as a barrier to the development of effective therapy services.
The aims of the workshop: The aim of this workshop is to promote creativity and innovation around the integration of research findings into the working lives of therapists, based on two key ideas: (i) the notion of multiple points of contact between research and practice, and (ii) an appreciation of the nature of professional knowledge. Multiple points of contact encompass a diverse range of activities, such as: reading research papers to keep up to date with new ideas; using an outcome measure to collect routine progress data from clients; drawing on research findings to justify your approach to counselling.
How the workshop will be structured:
1. Brief introduction: Evidence for the existence of a research-practice gap. Strategies for closing the research-practice gap. The idea of multiple points of contact. Experiential activity that invites participants to identify research-practice points of contact within their own work role.
2. Key features of professional knowledge: experiential exercise and discussion. The experiential activity will invite participants to explore the intersection of multiple sources of knowledge in relation to one issue that has arisen in their work setting.
3. Closing review and discussion
Key points for discussion:
What are the implications of this framework for counsellor and psychotherapist training and professional development?
What are the implications for the role of the researcher, and the way that research is disseminated?
Who will benefit from attending the workshop? The workshop is intended to be relevant for three groups of participants: (a) practitioners who are interested in ways of using research knowledge to enhance their competence; (b) tutors and lecturers on therapy training programmes; (c) researchers seeking to investigate the role of research in relation to practice.
Rita Mintz & Jeanne Broadbent
Presenters: Dr Rita Mintz & Jeanne Broadbent
Professional Role: Senior Lecturer in Counselling, MA and PhD academic supervisor, Chair of Departmental Ethics Committee
Institution/Affiliation: Division of Counselling and Psychotherapy, Department of Social and Political Science, University of Chester
Keywords: researcher, academic supervisor, participant, qualitative research, tensions
'The space between': an exploration of the complex relational dynamics existing between researcher, academic supervisor and participant within the context of a qualitative PhD study
Relevance of the workshop to counselling and psychotherapy research: If research in counselling and psychotherapy matters, as the title of this conference suggests, then attention needs to be given to an aspect of research that remains somewhat invisible: that of the intersection between researcher, participant and academic supervisor (Kottler, 2010). This workshop will open up areas for discussion related to this triadic relationship in order to heighten awareness of the complex dynamics of the ethical and professional issues involved.
The aims of the workshop:
• To provide a structured context within which to explore the dynamics of the interrelationship between researcher, participant and academic supervisor within the context of a qualitative research study.
• To critically examine the multiple roles of the academic supervisor and the tensions that may result (Lee, 2008).
• To consider the wider implications of this triadic relationship and its contribution to the research process.
How the workshop will be structured: A short introduction will be given, drawing on the presenters' personal experiences of researcher and academic supervisor within the context of a PhD study that investigated the highly sensitive area of therapists' personal traumatic bereavement and its impact on their professional identity. This will be followed by an experiential, small group or pair exercise in which attendees will (i) share and explore their own experiences in relation to the presentation; (ii) discuss how the tensions and complexities of roles are managed, and (iii) reflect on the impact on their current and future research. Feedback from attendees will be taken and used to inform a whole group discussion.
Key points for discussion:
• How is the triadic relationship perceived and experienced by supervisor and supervisee?
• What are the tensions and complexities in the supervisory relationship, and how are these managed?
• How do the issues in the triadic relationship impact the research process as a whole?
Who will benefit from attending the workshop? Anyone interested in research would benefit from attending, but particularly those currently engaged in research studies as a researcher, academic supervisor and/or research tutor. The workshop will offer the opportunity for attendees to share experiences and learn from others in an interactive and reflective context.
SYMPOSIUM A - Celia M.D Sales
Presenter: Célia M.D. Sales
Professional Role: Researcher
Institution/Affiliation: University of Porto
Contact details: Centre Center for Psychology at University of Porto, Faculty of Psychology and Education sciences, University of Porto, Rua Alfredo Allen, s/n 4200-135 Porto, Portugal
ABSTRACT: symposium A overview
Keywords: individualized outcomes, psychometrics, clinical utility, routine outcomes measurement
Would you trust individualized outcome measures? Evidence on the psychometric properties and clinical utility of the PQ and PSYCHLOPS
The aims of the symposium: Our aim is to present evidence on the measurement properties of two individualized outcome measures, the Personal Questionnaire (PQ) and the Psychological Outcomes Profiles (PSYCHLOPS). These are case-tailored outcome measures, where items are proposed by each patient, according to his or her needs and priorities.
Contribution of each symposium paper to the overall theme: We will present two studies that explore the psychometric properties of the PQ (paper 1) and PSYCHLOPS (paper 3), using multi-national samples. Paper 2 describes the clinical utility of PQ in real clinical settings, as viewed by an international sample of therapists enrolled in an on-line survey. How is it, to use PQ in real therapy? Is it feasible? Useful? Do therapists adapt the PQ administration procedure due to practical constrains? What are, if any, the suggestions therapists provide regarding the use of PQ in routine clinical practice? Finally, paper 4 aims to shed light into the kind of information patients provide in individualized measures, since they are invited to formulate the questionnaire items in their own words. Specifically, what are the contents of PSYCHLOPS free text items? Are they similar to the dimensions assessed by pre-set standardized measures (CORE-OM and PHQ-9? Or do they cover other topics that are relevant for the patient, and that otherwise would be missed in the outcome assessment?
Implications of the symposium theme for counselling and psychotherapy theory, research and practice:The study of the psychometric properties of individualized measures is a challenge that requires adapting methods of conventional psychometrics, and in that sense, this Symposium is innovative from a methodological point of view. It is also relevant for clinicians to consider using individualized measures in their clinical work.
Name of the symposium discussant: Célia M.D. Sales
SYMPOSIUM A - Robert Elliott
Presenter: Robert Elliott
Other Authors: John Wagner, Celia Sales, Brian Rodgers, Paula Alves, & Maria Café
Professional Role: Professor of Counselling
Institution/Affiliation: University of Strathclyde
Contact details: School of Psychological Sciences and Health, University of Strathclyde,
40 George Street, Glasgow, G1 1QE
ABSTRACT: symposium A paper 1
Keywords: outcome, measurement, individualized, psychometrics, psychotherapy
The Personal Questionnaire: an international study of its psychometric properties
Aim/Purpose: The aim of this paper was to study the reliability and validity of data generated by the Personal Questionnaire (PQ), a client-generated individualized outcome measure.
Design/Methodology: A large five-sample replication design, collected in three countries, was used to assess a wide range of psychometric parameters, followed by a meta-analytic approach in order to derive overall estimates of these parameters.
Results/Findings: Overall pre-therapy mean internal consistency (alpha) across clients was .80; within-client alphas averaged .77; clients typically had one or two items that did not vary with the other items. Analyses of temporal structure indicated high levels of between client variance (58%), moderate pre-therapy test-retest correlations (r =.57), and high session-to-session lag-1 autocorrelations (.82). Scores on the PQ provided clear evidence of convergence with a range of outcome measures (multi-level within-client r = .41). Mean pre-post effects were large (d = 1.25). The results support a revised caseness cut-off of 3.25 and a reliable change interval of 1.67.
Research Limitations: The main methodological limitation of the data stems from its multilevel nature, involving extensive nonindependence of observations. We were able to document the nature of this nonindependence in our analyses of temporal structure; however, owing to the complexity of the data (especially the varying numbers of items across and within clients) we were only able to implement fully multilevel statistical analyses for the convergence analyses.
Conclusions/Implications: PQ data meet criteria for evidence-based, norm-referenced measurement of client psychological distress for supporting psychotherapy practice and research.
SYMPOSIUM A - Celia M.D. Sales
Presenter: Célia M. D. Sales
Other Authors: Rita Antunes & Robert Elliott
Professional Role: Master's student
Institution/Affiliation: University of Évora
ABSTRACT: symposium A paper 2
Keywords: individualized measures, clinical utility, acceptability, feasibility, generalizability
The clinical utility of the PQ from the psychotherapist perspective
Aim/Purpose: The demand to implement routine outcome monitoring (ROM) in mental health care calls for appropriate measures, but instruments with robust psychometric properties might turn out to be inadequate in daily clinical practice. Therefore, it is crucial to explore the clinical utility, which addresses the ability of an instrument to be effective in the clinical setting. This research aims to study the clinical utility of a client-generated measure, the Personal Questionnaire (PQ), from the psychotherapist perspective.
Design/Methodology: A systematic method to assess the PQ's clinical utility was developed, based on a review of literature and the inputs of a panel of experts (therapists with experience of PQ administration). A self-report questionnaire was designed to explore significant dimensions of clinical utility (study I). This questionnaire was administered on-line to an international sample of psychotherapists (study II). An e-mail message inviting participation was sent to the Society for Psychotherapy Research (SPR) server list, as well as to centers, teams and individuals who were known to have used the PQ. A sample size of 25 participants was obtained.
Results/Findings: The participants demonstrated high adhesion to the PQ procedures and perceive the PQ as having high value for practice. The clients' receptiveness is considered high and it tends to increase from the first application to the subsequent. The therapists consider that the PQ can be used routinely with more than 50% clients and is considered very appropriate to the majority of the therapeutic approaches. Finally, the PQ administration is considered easy or very easy for 57% of the clinical settings.
Research Limitations: There is a relatively small base of PQ users available for this survey, making data collection difficult and limiting sample size. Moreover, inclusion criteria restricted the sample to professionals that used PQ, which in itself may result in a baised pool of participants, more positive concerning clinical utility of PQ.
Conclusions/Implications: Preliminary results suggest PQ presents relevant clinical utility in routine clinical practice.
SYMPOSIUM A - Celia M.D. Sales
Presenter: Célia M.D.Sales
Other Authors: Luís Faísca, Mark Ashworth & Daniel Guerra
Professional Role: Clinical and Health Psychology Msc Student
Institution/Affiliation: University of Évora
ABSTRACT: symposium A paper 3
Keywords: PSYCHLOPS, psychometrics, meta-analysis, individualized outcomes, client-generated measures
The psychometric properties of PSYCHLOPS
Aim/Purpose: To deepen the understanding of the psychometric properties in client-generated outcome measures (CGOMs) in general, and in PSYCHLOPS in particular. PSYCHLOPS is a self-reported client-generated outcome measure, one-page long, developed specifically for mental-health services usage. It measures three domains of psychological distress (problems, function, and well-being), and contains four items.
Design/Methodology: The comparison between PSYCHLOPS and a nomothetic outcome measure (CORE-OM) was carried out in order to assess how valid, reliable, and responsive PSYCHLOPS is as an outcome measure. Even though there were differences regarding data collection procedures and eligibility criteria between samples, data analysis procedures were common to all samples, having been combined using meta-analytical procedures. Six samples were used, from four different countries, comprising a total of 718 subjects enrolled in talking therapies. One data set was collected in the UK (n=110), two from Portugal (n=80 and n=95), one from Poland (n=208), and one from Iceland (n= 225). Data comes from distinct settings, ranging from hospital psychiatric services, to primary care, and including a therapeutic community.
Results/Findings: Overall, pre-therapy mean internal consistency (Cronbach's alpha) across participants was .82 for PSYCHLOPS, and .94 for CORE-OM. Construct validity was assessed through the correlation between CORE-OM and PSYCHLOPS; overall, correlation between both instruments was moderate (r = .63). Correlation between change scores for PSYCHLOPS and CORE-OM was used to assess responsiveness and an overall value of r = .67 was found.
Research Limitations: The multiple research designs and methodologies in data gathering make data analysis and generalizability difficult. Also, the absence of specific statistical models that fit client-generated outcome measures makes interpretation of results difficult.
Conclusions/Implications: Although PSYCHLOPS internal consistency indicators were good, the interpretation of alphas is dubious in CGOMs due to the non-equivalence of items across subjects. Hypothesis regarding correlation values for construct validity and for responsiveness were not completely satisfactory due to lower than expected correlation values. Low correlation values may be a consequence of the possibility of CGOMs to assess multiple constructs within and across subjects. Nonetheless, suitability of current psychometric analysis to study CGOMs is debatable, either because psychometry needs to evolve, or because CGOMs need to be adapted.
SYMPOSIUM A - Inês Neves
Presenter: Inês Neves
Other Authors: Célia Sales, Paula Alves & Mark Ashworth
Professional Role: Research Assistent
Institution/Affiliation: Faculty of Medicine, University of Lisbon
Contact details: Institute of Preventive Medicine and Public Health, Av. Egas Moniz, 1649-026 Lisbon, Portugal
ABSTRACT: symposium A paper 4
Keywords: individualized measures, patient-generated measures, personalized outcome measurement, personalized assessment, patient involvement
Is it worth listening to the patient? What we gain with the personalized assessment of talking therapy
Aim/Purpose: Understand the extent to which items indicated by patients completing PSYCHLOPS added qualitative information which was not captured by standardized outcome measures.
Design/Methodology: A cross-sectional observational study was conducted. The study used a sample of 107 patients attending a psychiatric service of a general hospital and centers for treatment of drug and alcohol misuse in Portugal. All patients completed PSYCHLOPS questionnaire and two standardized measures, CORE-OM and PHQ-9.
Results/Findings: A total of 279 patient-generated items were identified and categorized into 51 sub-themes using thematic analysis. "Work-related problems" was the most common sub-theme identified by 26% of patients as relevant to assess their clinical process. Of the 51 sub-themes, 17 (33.3 %) did not feature in the CORE –OM items and 43 (84.3 %) did not feature in the PHQ -9 items. Most patients reported at least one response that did not map to a CORE-OM and/or a PHQ-9 item.
Research Limitations: The quality of items in PGOM (Patient-Generated Outcome Measure) may be a limitation. Only 31% of the items generated by patients were considered 'well-formed' and the implications of this are unknown. Further studies are needed at the level of the item-generation process using 'think-aloud' testing to explore the issues related to freetext response quality.
Conclusions/Implications: The discrepancy found between the PSYCHLOPS and the two structured instruments included in the study reinforces the importance of capturing data on the issues of greatest concern to patients. It is important to recommend that PGOMs are included in routine outcome measurement and validated nomothetic instruments should more clearly be aligned to the issues of concern identified on PGOMs.
SYMPOSIUM B - Stephen Buller
Presenter: Stephen Buller
Other Authors: Susan Hajkowski & Barnie Proctor
Professional Role: Director and Senior Consultant
Institution/Affiliation: Psychotherapy Foundation
ABSTRACT: symposium B overview
Keywords: short-term psychodynamic psychotherapy, process, outcome, effectiveness, ego capacity
Effectiveness and process research in short-term psychodynamic psychotherapy (STPP)
The aims of the symposium: There is growing empirical support for Short-Term Psychodynamic Psychotherapy (STPP) across a wide range of patient populations and treatment settings. This symposium will present some recent research focusing on the effectiveness and process of STPP primarily informed by Intensive Short-Term Dynamic Psychotherapy (ISTDP), which is a sub-set of STPP incorporating latest developments in evidence-based technique.
Contribution of each symposium paper to the overall theme: Dr Stephen Buller will examine the effectiveness of STPP for patients with severe and complex psychiatric disorders in the context of a frontline, mental health assessment service. Data is derived from a clinical trial of STPP with technical developments for the target population. Results suggest statistically significant improvement on all measures, with good effect size, in a relatively small number of sessions. Barnie Proctor will present a cognitive-behavioural perspective on STPP using a single case design. This will illustrate theoretical differences, strengths and limitations of each approach. Data is derived from the STPP treatment of a patient by a trainee clinical psychologist within an NHS Tier 4 service, supervised by an advanced practitioner of the model. Results of analysis of outcome and process measures will be presented, and trends in the data discussed. Susan Hajkowski will present a qualitative, ethnographic study focusing on an in-depth examination of process issues. The development of process rating for the evaluation of ego capacity in STPP, through observational rating of video recorded clinical practice, is described. Results demonstrate how experts make phenomenological observations, and how these observations are utilised in making decisions about moment by moment evaluations of ego capacity in practice.
Implications of the symposium theme for counselling and psychotherapy theory, research and practice: Findings in these studies, using a range of methods, uncover potential clinical benefits for training, theory and practice in STPP. It appears from a new clinical trial that STPP can be effective in the treatment of severe and complex disorders. Additionally it appears possible to identify and address through single case study challenges in learning and applying STPP from a trainee perspective. An application of qualitative methods, specifically ethnographic approaches, show how core processes and change mechanisms can be identified in the practice of STPP experts.
Name of the symposium discussant: Professor Ken Levy
SYMPOSIUM B - Stephen Buller
Presenter: Stephen Buller
Other Author: Susan Hajkowski
Professional Role: Director and Senior Consultant
Institution/Affiliation: Psychotherapy Foundation
ABSTRACT: symposium B paper 1
Keywords: short-term psychodynamic psychotherapy, outcome, severe, comorbidity, personality disorder
A clinical trial of short-term psychodynamic psychotherapy (STPP) as a frontline treatment for severe and complex disorders
Aim/Purpose: To examine the effectiveness of Short-Term Psychodynamic Psychotherapy (STPP) for patients with severe and complex psychiatric disorders in the context of a frontline assessment team in a UK, secondary public mental health service.
Design/Methodology: This is a naturalistic, pre-post, case series, clinical trial of an empirically supported STPP with developments for the target population. A range of patient reported and clinician reported outcome measures were used to study the implementation of a manualised STPP treatment, integrating the latest developments in clinical technique. In this design, as a naturalistic effectiveness clinical trial, the study does not include a control. Measures (CORE-OM, PHQ9 & GAD7) were used at each session enabling pre-post outcome analysis and case tracking.
Results/Findings: All patients in the sample (n=27) fulfilled criteria for a formal diagnosis of personality disorder with comorbidity. Results from analysis of pre-post data suggest that there has been statistically significant improvement on all measures (p<0.01), with good effect size (d>1.00), in a relatively small number of sessions (x¯ =10.22). A comparison of within-group analyses offers a critical perspective of both Jacobson-Truax (JT) and Percentage Improvement (PI) methods, with >75% of patients recovered and improved.
Research Limitations: Large effect sizes are not often recognised as typical in psychotherapy research. It can be argued that high initial scores on outcome measures, typical of severity and complexity in disorder, inevitably lead to large initial gains, little or no deterioration, and large overall effect sizes. This is a feature of the usual effect size calculations, such as Cohens d, particularly when initial scores are tightly clustered in the high range. An assumption might be that it is difficult to get worse if things are already as bad as they can be.
Conclusions/Implications: These results give cautious support for the use of STPP with the target patient population. Consideration of different methods of data analysis, and adoption of session-by-session recording of outcome measures indicate potential to elaborate change mechanisms from process-outcome findings. Preliminary findings add to the growing body of evidence for the effectiveness of STPP particularly when implemented for patients with severe and complex disorders.
SYMPOSIUM B - Barnie Proctor
Presenter: Barnie Proctor
Professional Role: Trainee Clinical Psychologist
Institution/Affiliation: Trent Doctorate in Clinical Psychology, University of Nottingham
ABSTRACT: symposium B paper 2
Keywords: Intensive Short Term Dynamic Psychotherapy (ISTDP), single case design, CBT, change mechanisms, trainee perspectives
A cognitive-behavioural perspective on intensive short term dynamic psychotherapy: a single case illustration
Aim/Purpose: This paper critiques an individual piece of Intensive Short Term Dynamic Psychotherapy (ISTDP) from a cognitive-behavioural (CBT) perspective to illustrate the theoretical differences in assessment, formulation and intervention and strengths and limitations of each approach.
Design/Methodology: A client referred for NHS Tier 4 psychotherapy received a course (15+ sessions) of ISTDP provided by a trainee clinical psychologist, supervised by an advanced practitioner of the model. The Generalised Anxiety Disorder Questionnaire (GAD), Patient Health Questionnaire (PHQ), Clinical Outcome and Routine Evaluation Outcome Measures (CORE-OM) and Inventory of Inter-personal Problems (IIP) were administered at baseline and at regular intervals during therapy. Measures were analysed for reliable and clinically significant change. The model of intervention encompasses an on-going clinician-assessment of the client's ego-capacity.
Results/Findings: Quantitatively, the client improved across all measures. The client achieved reliable and clinically significant change on the GAD and PHQ, and a non-significant decrease on the CORE-OM. There is an initial increase in distress before a decrease, which will be discussed. Qualitatively, the client's ego-functioning and anxiety tolerance greatly improved. They were able to drop iatrogenic defences and experience previously unconscious feelings towards attachment figures in the past and in the present. An alternative CBT formulation, whereby client defences are reinterpreted as core-beliefs driving negative affect and behaviour is considered.
Research Limitations: Although a single case methodology may be appropriate for exploring and contrasting theory-practice links, it is limited in contrasting the two approaches with regards to efficacy.
Conclusions/Implications: ISTDP and CBT are both clinically effective methods of ameliorating psychological distress; however there is divergence on their therapeutic techniques and purported mechanisms of change. Theoretical differences and similarities and clinical benefits and limitations between the approaches will be discussed. Challenges in learning and applying the two models in healthcare settings from a trainee perspective will be outlined.
SYMPOSIUM B - Susan Hajkowski
Presenter: Susan Hajkowski
Professional Role: Lead Practitioner in Psychotherapy
Institution/Affiliation: Derbyshire Healthcare NHS Foundation Trust
ABSTRACT: symposium B paper 3
Keywords: short-term psychodynamic psychotherapy, ego, ethnographic, process-rating, video
Developing process rating for the evaluation of ego capacity in short-term psychodynamic psychotherapy
Aim/ Purpose: The concept of 'ego capacity' is central in Short-Term Psychodynamic Psychotherapy (STPP). Accurate moment-by moment evaluation of ego capacity is required to determine choice, pace and application of clinical interventions. This evaluation enables accelerated treatment by working at the optimum level of a patient's ego capacity at any one time. Theoretical underpinnings suggest change and improvement in ego capacity are expected during and at the end of treatment. There is currently an absence of process rating procedures to evaluate change in ego capacity. This research investigates how ego capacity is currently evaluated or 'rated' by expert practitioners in practice, and how this may translate into a tool for process rating.
Design/Methods: A qualitative ethnographic enquiry is adopted, utilising a three stage observational interview method. A group of four expert practitioners act as informants in the micro-analysis of video recorded clinical sessions. Inter-Personal Process Recall interviews are adapted through the development and implementation of a template for process rating. Sessions from the beginning and end of treatment are reviewed to uncover processes used by experts in evaluations of ego capacity.
Results/Findings: Preliminary results demonstrate the use of a focussed ethnographic method in embedding enquiry in the culture of an expert group. Results demonstrate how experts make phenomenological observations and ways in which processes are constructed and rated, including commonalties and shared understandings. The enquiry uncovers the use of implicit knowledge, conscious focus and conceptual understandings in undertaking moment by moment ratings of ego capacity and the development of a preliminary tool for process rating.
Research Limitations: Limitations of the research are consistent with those inherent in qualitative and ethnographic enquiry. These include the challenge of recognising and managing subjective processes of the researcher, and in devising and undertaking enquiry that truly uncovers and represents the lived experiences of the other.
Conclusion/Implications: This study aims to enhance knowledge about processes involved in evaluations of ego capacity, and begin to construct ways these processes may be rated. A rating tool may have value in clinical use, and in identifying mechanisms of change.
SYMPOSIUM C - Felicitas Rost
Presenter: Felicitas Rost
Professional Role: Research Psychologist
Institution/Affiliation: Tavistock and Portman NHS Foundation Trust
ABSTRACT: symposium C overview
Keywords: refractory depression, treatment outcome and process, patient's perspective and differentiation, long-term psychodynamics psychotherapy
Understanding and treating chronic refractory depression
The aims of the symposium: Individuals who experience long-term, relapsing and complex forms of depression are highly disadvantaged due to the current shortage of research evidence guiding their clinical management. There is a considerable lack of a satisfactory understanding of both the nature of the condition as well as its treatment. The aim of this symposium is to present how the Tavistock Adult Depression Study (TADS) addressed this paucity by integrating a pragmatic randomised controlled trial with formal qualitative investigation and outcome-process research.
Contribution of each symposium paper to the overall theme:
Paper 1: You Zhou and Aneliya Merolla present the main outcome findings of testing the effectiveness of 18 months once-weekly psychoanalytic psychotherapy for treatment-resistant depression compared to receiving treatment-as-usual according to UK national guidelines (TAU).
Paper 2: Thomas Booker provides a deeper insight into some of the mechanisms involved in receiving psychoanalytic therapy. He explores the adherence to three psychotherapy prototypes as well as examines the interaction structures between therapist and patient during the beginning, middle and end phases of the treatment, and how these relate to outcome.
Paper 3: Felicitas Rost explores how pre-treatment depression characteristics impact differentially on treatment process and outcome, providing preliminary validity for her newly developed Anaclitic Introjective Depression Assessment (AIDA), as well as important insight into responsiveness and non-responsiveness to psychoanalytic psychotherapy for depression.
Paper 4: Sara Holloway addresses the importance of the patient's perspective. This final paper explores how severe depression is described and made sense of by the participants of the TADS. She presents the findings of a qualitative investigation into the patients' experiences and their views of the problems and difficulties that brought them to the study.
Implications of the symposium theme for counselling and psychotherapy theory, research and practice: Together, these papers make an important contribution to both a deeper understanding of complex forms of chronic depression and its treatment though psychoanalytic therapy. Insights were gained through a successful dialogue between three complementary research modalities.
SYMPOSIUM C - You Zhou, PhD & Aneliya Merolla
Presenters: You Zhou, PhD & Aneliya Merolla
Other Authors: Peter Fonagy, Felicitas Rost, Thomas Booker & David Taylor
Professional Role: Psychotherapy Researcher
Institution/Affiliation: Tavistock and Portman NHS Foundation Trust
ABSTRACT: symposium C paper 1
Keywords: psychoanalytic psychotherapy, treatment-resistant depression, long-term follow-up, evidence-based treatment, delayed treatment effect
The outcome of treating chronic, refractory depression with long-term psychoanalytic psychotherapy: a randomized controlled trial (RCT)
Aim/Purpose: This study aims to examine the effectiveness of long-term psychoanalytic psychotherapy (LTPP) in patients with treatment-resistant depression.
Design/Methodology: The Tavistock Adult Depression Study (TADS) is a pragmatic RCT of the effectiveness of 18 months once-weekly LTPP in comparison with treatment as usual (TAU). Patients (n = 129) with chronic major depressive disorder and a minimum of two failed treatment attempts were recruited from primary care and randomly allocated to either of the two treatment conditions. In total, 22 senior psychotherapists carried out the LTPP. The main outcome measure was the Hamilton Rating Scale for Depression (HRSD-17, Hamilton, 1976), which was administrated at 6-monthly intervals during the treatment and two-year follow-up. Complete remission was defined as a HRSD-17 score ≤ 8 and partial remission as a score ≤12. Recovery rate of complete remission and partial remission were examined within and between the two groups. Treatment differences and changes over time were analysed using mixed-effect models.
Results/Findings: Complete remission was found to be infrequent in both groups at treatment termination and at the end of follow-up. The groups did not differ with regards to partial remission at the end of treatment, however, differences began to emerge and became statistically significant during the follow-up period. Overall, 44% of those receiving LTPP no longer met criteria for major chronic depressive disorder diagnosis at the end of the follow-up compared to 10% of those receiving the NHS treatments currently provided for.
Research Limitations: Whilst the study has high ecological validity, it has several limitations. These include amongst others not allowing masking of patients to treatment allocation, which may have led to expectation bias. Furthermore, the study was conducted by a single provider organisation, which may limit the generalisability of the findings.
Conclusions/Implications: The study found that LTPP has been beneficial in improving the long-term outcome of chronic, treatment-resistant depression. Those receiving LTPP were much more likely to maintain their improvements after treatment termination compared to those receiving TAU. The inclusion of a long-term follow-up is pivotal to show effects of LTPP, which appear to manifest gradually over time.
SYMPOSIUM C - Thomas Brooker
Presenter: Thomas Booker
Other Author: Felicitas Rost
Professional Role: Researcher
Institution/Affiliation: Tavistock and Portman NHS Foundation Trust
ABSTRACT: symposium C paper 2
Keywords: psychotherapy process and mechanisms, Psychotherapy Process Q-set (PQS), interaction structures, treatment-resistant depression
The 50-minute hour: identifying interaction structures and treatment fidelity in individual sessions of psychoanalytic psychotherapy
Aim/Purpose: This paper examines the interaction structures within the treatment sessions of the TADS patients and how these relate to outcome. It looks at treatment adherence to different prototypes of treatment modalities: cognitive behavioural therapy (CBT), Psychodynamic therapy (PDT) and Interpersonal therapy (IPT) (Ablon and Jones, 2005).
Design/Methodology: The TADS treatment consisted of approximately 60 weekly psychoanalytic psychotherapy sessions. Psychotherapists (n = 22), with an average of 17.45 years of experience, took part and all sessions were audio-recorded. Three randomised sessions from the early, middle and end phases of 62 patients' treatment were rated using the Psychotherapy Process Q-set (PQS, Ablon and Jones 2005). Inter-rater reliability was assessed in a sub-sample of 90 sessions and was excellent (average intra-class coefficient was 0.87). Raters were blind to treatment outcome, as well as prior information about the patient or the therapist.
Results/Findings: The sessions correlated significantly with the PDT prototype in 82.2% of the sessions. Moreover, a significant correlation with the CBT prototype was found in 17.8%. Surprisingly, the correlation with the IPT prototype failed to reach statistical significance. Items were furthermore classified into three groups: therapist behaviours, patient behaviours and therapist-patient interactions. Item means were calculated across all sessions to find the most characteristic and uncharacteristic items in each group, eventually forming a narrative description aggregating all the ratings into one 'prototypical' representation.
Research Limitations: Only three sessions per patient were rated, which forms a minority of the overall number of sessions attended.
Conclusions/Implications: Whilst adherence to the psychoanalytic prototype was confirmed, the adherence to the CBT but not to the IPT prototype is interesting. Results will be discussed with particular reference to the treatment approach needed for patients suffering from such severe forms of depression. PQS items can offer an accurate description of measurable processes that take place in the therapy hour. The interaction between patient and therapist can thus be analysed over the whole course of treatment, offering useful data with clinical implications for the therapy process.
SYMPOSIUM C - Felicitas Rost
Presenter: Felicitas Rost
Other Authors: Peter Fonagy & Patrick Luyten
Professional Role: Research Psychologist
Institution/Affiliation: University College London; Tavistock and Portman NHS Foundation Trust; Society for Psychotherapy Research (SPR)
ABSTRACT: symposium C paper 3
Keywords: anaclitic, introjective, severe depression, Q-sort methodology, differential treatment response
The anaclitic introjective depression assessment (AIDA): exploring differential treatment effects
Aim/Purpose: The two-configurations model developed by Blatt and colleagues offers a conceptual and empirical framework for understanding depression (Blatt, 1974). It states that patients struggle with either issues of relatedness (anaclitic depression) or self-definition (introjective depression) at different developmental levels. Patients not only differ in terms of early life experience, personality, and adaptation to life stressors, but also considerably in how they respond to treatment and manifest therapeutic gain (Blatt. 2008). The aim of this paper is to explore whether differential treatment effects occurred amongst the severely depressed sample of the Tavistock Adult Depression Study (TADS), using and testing the validity of a newly developed clinical assessment tool of anaclitic and introjective depression.
Design/Methodology: 128 of the TADS Patients (n = 128) of the TADS were rated with the Anaclitic-Introjective Depression Assessment Q-sort (AIDA), developed by the presenter. Q-Factor analysis yield a more maladaptive group situated at a lower developmental level and a less maladaptive group situated at a higher developmental level within each configuration. The four empirically identified depression factors were compared on measures of depression severity and global functioning at the end of treatment and end of follow-up. A series of regression analyses were carried out to test whether changes in outcome where moderated by depression configuration and interacted with having received the long-term psychoanalytic treatment (LTPP) or treatment-as-usual (TAU).
Results/Findings: Findings reveal important differential treatment effects, which, like the main TADS outcome findings, become significant only during the long-term follow-up. Those anaclitic and introjective depressed patients situated at the higher developmental level were found to benefit from LTPP, whereas those situated at the lower developmental level showed no significant improvements. Moreover the anaclitic depressed patients at this level did better in the TAU group.
Research Limitations: The preliminary nature of the findings need to be stressed as the study was designed to assess the initial validity of the newly developed measure.
Conclusions/Implications: Having provided some empirical support for important sub-dimensions of severe depression, important emerging differential treatment effects may have been identified as well. If replicated, this may have important implications for future conceptualisation, diagnosis, and treatment of severe depression.
SYMPOSIUM C - Sara Holloway
Presenter: Sara Holloway
Other Authors: Manuel Batsch, Felicitas Rost & Nick Midgley
Professional Role: Assistant Psychologist
Institution/Affiliation: Tavistock and Portman NHS Foundation Trust
ABSTRACT: symposium C paper 4
Keywords: patient's perspective, qualitative research, treatment-resistant depression
"It's like there's a battle inside my head", the TADS participant's sense-making about their problems and difficulties
Aim/Purpose: The aim of this paper is to present the patient's perspective on and experience of their severe depression.
Design/Methodology: This qualitative study uses the Private Theories Interview (Ginner, Werbart, Levander & Sahlberg, 2001), a semi-structured interview designed to elicit patients' understanding of problem formulation and ideas of pathogenesis. The transcripts of ten participants of the Tavistock Adult Depression Study (TADS) were randomly selected, with the aim of gaining a rich phenomenological picture of how they experienced their difficulties that brought them to the study. The data were analysed using a systematic thematic analysis embedded within the Consensual Qualitative Research Framework (Hill, Thompson, Williams, 1997).
Results/Findings: Results yield that the TADS patients described their problems and difficulties in multiple ways. We captured these in three main themes: 'internal obstacles', 'external assaults' and 'an uncertain personality', which comprised a total of ten subthemes. These will be outlined and illustrated with participants' quotes and discussed in light of - and in contrast to - the particular psychiatric diagnosis they have been given, that of "treatment-resistant" depression.
Research Limitations: Although randomly selected, only ten participants' interviews were included in the analysis of this study, which restricts the generalizability of the findings to the whole sample. The risk of researcher bias and lack of rigour found with all qualitative methods was minimised by the fact that the data analysis was performed using a consensual method, in which the researchers regularly interrogated each other's interpretation of the data; it was further reduced by regular discussions of the findings with two supervisors.
Conclusions/Implications: Historically, most psychotherapy research considers primarily the clinician's perspective (Henkelman & Paulson, 2006). Theories of therapeutic action and problem formulation and ideas of pathogenesis have largely been built on the researchers and therapists views. Thus, recognition that authority can be given to patient's perspective is not only crucial in terms of gaining a deeper understanding of the phenomena under study, but also in terms of making a real difference to our clinical practice.