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research conference 2006 index of presentations | abstracts part 1 2 3 4 | programme | evaluation Abstracts part 2 Professional Role: Counsellor, Trainer, MSc student. ABSTRACT: Poster Being a person-centred counsellor in a postmodern context: a qualitative study of the influence of postmodernism on person-centred counsellors Rationale: The work of philosophers who are associated with postmodernism has been influential in the social sciences in recent years and in some schools of psychotherapy. This study was conducted to expand on existing research by looking at the influence of postmodern ideas on a sample of person-centred counsellors. The study provides counsellors with possibilities of what they may take from postmodern ideas to use in their practice. Research design/sample: The study involved conducting semi-structured interviews with seven counsellors, including three academics, trained to at least Diploma level in the person-centred approach. All are practising counsellors except one of the academics who is a practising counsellor trainer. None identified themselves as practising postmodern therapy. Recruitment was through advertising in journals, email circulars, and three academics were approached individually. The aim was not to gain a representative sample, rather purposive sampling was necessary to identify counsellors who had reflected on issues related to the research question. In-depth questions included the participants' understanding of postmodernism, and how it had influenced their thinking about counselling theory and their practice. Interviews were transcribed, and stages of analysis, including immersion, categorisation and phenomenological reduction of the data completed. Findings: Themes included the significance of narrative, identity as socially constructed and awareness of how power is constructed and operates in society, as well as power within the therapist-client relationship. Participants identified the concept of the loss of grand-narratives as leading them to look beyond a particular counselling theory to explain how they work and what they believe counselling to be. The limitations of the study include sample size, and different understandings of postmodernism. Conclusions: The study enabled exploration of the impact of postmodern ideas on a small sample of counsellors' thinking and practice. Participants suggested that postmodern ideas lead them to re-think the place of theory in their understanding of their work. Possible areas for further research include focusing on the influence of postmodernism on counsellors who were trained in other schools of psychotherapy. Professional Role: Psychodynamic Counsellor ABSTRACT: Paper An exploration of the meaning of addiction through an analysis of the countertransference experience of psychodynamic therapists working with drug or alcohol addicted clients Background: Drug and alcohol misuse are grave social problems, yet preferred treatment modalities, such as substitute prescribing and relapse prevention education, are perhaps used in response to a need to alleviate the social costs of substance misuse. These then tend to focus largely on the symptoms of underlying psychological distress at the expense of an exploration of its causes. This qualitative research sought to consider the possible 'meanings' of addiction through an exploration of the experiences of psychodynamic therapists working with addicted clients. It was felt that such research could inform counselling practice with drug and alcohol addicted clients. Research design: Letters inviting participation in the research were sent to a purposive sample of 120 psychodynamic practitioners, selected from the registers of the UK Council for Psychotherapy and the British Confederation of Psychotherapists. 36 therapists responded with nine agreeing to participate in the research. Nine semi-structured interviews were tape-recorded and transcribed, and analysis was informed by the ideas of immersion, categorisation, phenomenological reduction, triangulation and interpretation (McLeod, 1994:89–90). Findings: Data analysis revealed several common themes in work drug and alcohol clients: relationship difficulties, use of primitive defence mechanisms, narcissistic vulnerability, and inability to cope with psychic pain. Common countertransference responses to work with this client group included a sense of meaninglessness about therapy, wishing to terminate therapy, and a sense of 'contamination' by the toxicity of the addicted clients' material. Conclusions: Several possible 'meanings' of addiction were revealed: drug and alcohol addiction as a defensive withdrawal from reality, a turning away from unsatisfactory relationships and an attempt by a weak ego to tolerate or avoid psychic pain. It is hoped that a greater understanding of the common psychological difficulties of the drug or alcohol addicted client, and the countertransference they may evoke, could enable practitioners to work more successfully with this growing group of consumers of counselling. Reference: McLeod, J. (1994). Doing Counselling research. London: Sage. Professional role: Reader in Counselling and Research and Senior Research
Fellow ABSTRACT: Paper Narratives of identity: from 'recreational drug user' to 'druggie' This paper addresses issues of identity construction among people who have misused drugs and invites counsellors, psychotherapists, researchers and workers in the drugs field to notice how traditional psychological and socio-cultural notions of identity formation (Erikson 1968; Mead 1934; Vygotsky 1978) might shape their responses to clients' life stories. The paper focuses on two of eight life stories gathered as part of an ongoing narrative inquiry. The inquiry was commissioned by a community based drugs project that provides free counselling for abuse/trauma survivors in recognition of the frequency of such histories among clients using the methadone, outreach and other drug services provided. It uses parts of the two life stories to address the question: what can we learn from a person's story about how they change their view of themselves as 'someone who occasionally would take drugs at the weekend', to being 'a druggie'. The stories are analysed using narrative analysis to show how narrative and identity are not separable but, instead, constitute one another, and how, by using narrative approaches, new identities can emerge as the teller moves actively between private and public, personal and cultural, past and present. It also adds to the growing awareness of the therapeutic value of qualitative (particularly narrative) methods for research. The work suggests that counsellors working in the drugs field who position themselves firmly within modernist notions of self and identity might miss opportunities to enable clients to re-story their lives in ways that can allow the emergence of healing connections between their historic childhood trauma and subsequent drug misuse. By focusing on the question 'Why?'- a question often discouraged during counsellor training - we can invite clients to make sense of their lives and drug misuse in ways that do not re-inforce internalised negative and stigmatising stereotypes based on concepts of identity as fixed and 'damaged'. Instead they can restore 'the valued sense of who they are, the preferred sense of identity or personhood' that Michael White (2004: 47) refers to as 'a sense of myself', which can then become 'the foundation for a rich story development of the person's life'. Other authors: Mick Cooper Robert Elliot Professional Role: Research Assistant ABSTRACT: Paper Development of a psychotherapy outcome measure based on Rogers' theory of therapy change Background: Current results from comparative outcome studies suggest the general equivalence of psychotherapeutic treatments based on different theories and techniques. One of the alternative explanations for this general finding of no difference in the outcome of therapy is that different outcomes do occur but are not detected by current research strategies. It is important, therefore, to develop research assessing humanistic therapy's specific effects using rating scales designed to assess dimensions beyond symptom intensity or global evaluations. Aims: To develop and test the validity of a psychotherapeutic outcome measure based on Rogers's theory of therapy change. This measure is entitled the 'Strathclyde Inventory'. Method: The instrument consists of 51 items developed according to Rogers' description of the 'fully functioning person', encompassing the dimensions of locus of evaluation, open-ness to experience, self-liking, existential living, acceptance of others and psychological adjustment. In the pilot phase of the development of the inventory, 121 subjects responded, they also completed a range of other instruments as a means of testing the validity of the measure. The discriminant validity was assessed by comparing it with CORE (Clinical Outcome and Routine Evaluation) and the Marlowe-Crowne Social Desirability Scale, and its convergent validity was assessed through comparisons with Behr's Stuttgart Emotional Experiencing Scale and Rosenberg's Self-Esteem Scale. Results: The instrument had a Cronbach's Alpha of 0.94 showing excellent item-reliability. Pearson Correlations with Rosenberg's Self-Esteem Scale and the subscales 'Accepting own Emotions' and 'Experiencing lack of emotions' of the SEE measure were 0.76, 0.69 and -0.60 respectively showing that the instrument has good convergent validity. However, the discriminant validity in relation to the CORE measure was poor (-0.63). The correlation with Marlowe-Crowne was 0.27 showing only a modest degree of social desirability bias. An exploratory factor analysis suggested two components identified as Congruence/Experientially Fluidity and Incongruence/Experiential Constriction factors. Conclusions: The instrument was found to have excellent item-reliability and showed good convergence with related measures. It was not substantially associated with social desirability, but showed greater than desired overlap with clinical distress. A revised version of the measure has been developed and is currently being tested. Professional Role: Clinical Director ABSTRACT: Work in progress symposium Employee Assistance Programmes: who is the customer? Background: For many people, access to counselling is through their Employee Assistance Programme (EAP). This potentially introduces a new dynamic into the counselling relationship and raises the question of the nature of the customer from a number of angles. The research question is 'who is the customer and what is s/he buying?' This question is addressed to both the employer (purchaser of EAP) and the counselling clients (user of EAP) Aim: The aim is twofold: firstly, to develop a clearer understanding of the identity and needs of the counselling customer from the purchaser and user perspectives, and secondly to identify the issues that users bring to sessions thus identifying the profile of service users. Research Design/Sample: All customers (employers) who use Right Corecare EAP services (n>200) were asked to complete a questionnaire which included items identifying the reasons they had purchased an EAP. To date, responses exceed 50 but the survey is currently ongoing. In addition, a whole-sample (n= 5877) analysis was made of every client who had accessed face-to-face counselling in 2005 through Right Corecare's EAP programme. The quantitative methodology was the most simple – count every case and log each presenting problem. Results: Whilst this is research in progress, results continue to emerge. Perhaps unsurprisingly, relationships and loss featured highly in the issues that were presented. Organisational change was a feature in certain clusters but, interestingly, there were organisations which went through great changes without this being reflected in the counselling referrals, leaving a question about what leads change to become an issue in counselling. Conclusion: It is too early to be definitive about the conclusions of this research, but it is already emerging that there are differences between the employer as customer and the service user as customer. When we discuss the customer in counselling, it is often assumed that we are talking only of the service user whereas this research suggests we are meeting the needs of more than one customer, and understanding this is essential in developing services that meet the needs and expectations of all our customers. Audrey Gachen and Patti Wallace Professional Role: Psychological
Counsellor (AG) ABSTRACT: Paper The consumers' voice: feeling or not feeling respected during hospitalisation: what counselling and psychotherapy have to learn from the psychiatric-inpatient experience Aims: To explore individuals' experiences of feeling respected during psychiatric hospitalisation and to consider implications for outcome and for counselling/ psychotherapy practice. Background: This study is rooted in the researcher's own experiences of feeling/not feeling respected during psychiatric hospitalisation. Previous research has considered respect as one of a number of elements of care (eg, Rose, 2001); this study is the first UK qualitative research to focus specifically on the concept of respect. Research design: This qualitative study interviewed eleven individuals about their psychiatric inpatient-care. Data incorporated experiences in 17 hospitals/units, across 21 wards. Interviews were semi-structured and data were analysed using a model of Grounded Theory. Results: In line with Rogers' thinking (1965, as cited in Farson, 1977) the data indicate that an individual's perception of whether or not they feel respected communicates to that person a sense of their value as a human being. This in turn impacts on self-esteem and potentially on outcome. The environment of the ward, the quality of patient/staff interactions, and individuals' sense of involvement in their treatment emerged as key themes. Although experiences were predominantly negative, occasions on which individuals felt respected were reported as having an enabling and lasting impact. Conclusions: The psychiatric inpatient-unit is often perceived as an inappropriate arena for counselling/psychotherapy. Inpatient psychiatry, therefore, generally remains a disconnected realm to which we 'refer on', and yet, in reality, the seeds of extreme psychological disturbance can be present in our day-to-day client work. This study highlights the universality of human need and challenges the myth of an inpatient/outpatient divide. This research also highlights that a knowledge and application of basic Rogerian principals and fundamental psychodynamics by ward staff would significantly improve inpatient-experience. Areas for future research include closer links during psychotherapy training with inpatient-psychiatry, and training of ward staff in basic Rogerian and psychodynamic principles. References: Rogers, C. (1965). A humanistic conception of man. In R.E. Farson (Ed.), (1977). Science and human affairs. California: Science and Behavior Books Inc. Rose, D. (2001). Users' voices. London: Sainsbury Centre for Mental Health. Barbara Gerber, Donna Dunlop, Karen Smith, and Lorraine Conway Other author: Sandy Kemp Professional Role: Psychotherapist (BG) ABSTRACT: Paper A quantitative study into whether the use of CBT self help materials could lead to a reduction in stress and anxiety scores and development of coping skills in year 11 school pupils Background: Research has suggested that CBT self help materials are helpful in developing coping skills for anxiety. 24,000 teenagers are admitted to hospital each year having utilised unhelpful coping mechanisms; our aim was to see whether self help materials could help school pupils develop helpful coping mechanisms. Aims: This investigation explored whether the use of CBT self help material results in reducing anxiety and depression scores in Year 11 school pupils. Method: Renfrewshire Association for Mental Health (RAMH) provide counsellors in two of East Renfrewshire's seven secondary schools, a relatively high achieving area in the South East of Glasgow. We worked with one of these secondary schools. Sixty children from Year 11 were assessed before and after the experimental period. Half were randomly assigned to the control and half to the experimental group. We produced and presented four self-help booklets during four school periods. We utilised Beck's Anxiety and Depression Scales as our scoring tools. We scored before and after the experimental period. Results: We utilized a Wilcoxon Statistical test for related designs. The control group for both anxiety and depression scores suggested no statistical difference between the scores before and after. However, there was a significant reduction in both the depression and anxiety scores in the experimental group in this same period. The results supported our hypothesis 'the use of CBT self help materials could lead to a reduction in stress and anxiety scores on a rating scale, and lead to the development of coping skills in Year 11 school pupils'. Discussion: We believe the promotion of a universal school based CBT programme, designed to prevent depression and anxiety in adolescents could be effectively implemented in the school environment. This fits with the objectives of both the Children's Scotland ACT 1995, which provides for local authorities having a duty to safeguard and promote the welfare of children in need, and with NSF objectives. Professional role: Counsellor and Psychotherapist ABSTRACT: Paper Researching sensitive issues with vulnerable groups: shame in adolescence as an exempler Research Question: How can counsellors and psychotherapists conduct research on sensitive subjects with a vulnerable group? Research Rationale: Focus groups are cited as an effective approach in counselling and psychotherapy research, however, there is limited research that examines using focus groups for sensitive topics and the literature does not report on group dynamics. The aim of this study was to explore differences in reported shame between adolescent renal patients and a healthy group of adolescents (matched for age, ethnicity and gender) and consider these differences in focus group dynamics. Research Design: A questionnaire survey compared reported shame in the two groups (no modification was made to the pilot of the quantitative research protocol). The qualitative investigation, utilising interviews and focus groups, was designed to provide an in depth understanding of the aetiology of shame and how this influences individuals' behaviour during a focus group. No modification was made to the semi-structured interview schedule, however, a pilot of a focus group exposed flaws in utilising a moderator's stance with adolescents and the approach was modified. At the end of each session notes were made on the group dynamics and the audio taped discussions were transcribed, summarised then given to participants for feedback. A total of eleven participants aged 12- 16 years participated in two series of focus groups. Results: Shame is associated with being defined as part of an 'out group', which is brought into sharp focus in adolescent peer interactions. Focus groups are an appropriate means of enquiry with vulnerable clients, but only when the group leader has significant therapeutic skills. Conclusion: In this study it emerged that significant therapeutic skills were needed in order to support the focus group enquiry. All the participants remained keen group members but acted out shame. This raises the possibility that researching sensitive issues with vulnerable clients should be conducted by competent therapists who understand issues of transference and counter-transference. This study indicates that counselling and psychotherapy research is needed in order to explore how the moderator role in a focus group needs to be developed in order to examine sensitive issues with vulnerable clients. Professional Role: Lecturer in Counselling ABSTRACT: Poster Grasping anger by the tale: therapists (discussing their experiences as client) identify specific interventions which helped and hindered their processing of anger Research Question: Which specific counselling interventions supported the expression and processing of anger and which undermined that process? Research Rationale: I explored whether issues of anger and rage are helpfully supported by qualities of relationship and interventions which validate anger, encourage its expression and subsequently attend to, the often many, layers of unprocessed life experience which can lie beneath it; in contrast to the mainstream cognitive interventions, usually referred to as 'anger management' programmes. Research Design: Therapists participated in two un-facilitated reflecting teams lasting 2.5 hours and told stories about their personal and professional experiences with anger. The narrative research method reflects the researcher's belief that bringing the stories which lie beneath anger into a respectful relationship is efficacious. This was combined with the researcher's immersion in the process and data, a heuristic approach, which led to a creative synthesis in the form of four models for supporting therapeutic work with anger. Sample: Sixteen local therapists were approached who consider themselves to work at 'relational depth', seven volunteered to take part (six female and one male). Results/Findings: Interventions which facilitated anger being heard in a non-defensive way, especially when aimed at their therapist directly, emerged as important to all participants. The most common failing was therapist inability to hear their anger through practices of discounting, minimising, rationalising and, most unpopular of all, interpreting; 'cushion bashing' was found unhelpful by one participant. Four models emerged which tentatively exemplify 1) how a therapist's unresolved story around the issue of anger eclipsed work with a client; 2) some possible developmental stages in therapists' practice when working with client anger; 3) anger as a protection for other vulnerable feelings; and 4) some possible stages of anger surfacing in the counselling relationship. Conclusions: Research participants' therapists inhibited the healthy expression and processing of anger through unhelpful interventions. Where their therapists were non-defensive, listened to their anger and conveyed their empathy, participants identified that considerable healing occurred. Significant personal and professional development is implicated if therapists are to work successfully with anger and rage issues. Professional Role: Lecturer in Counselling/ESRC
Funded ABSTRACT: Paper An investigation exploring the potential challenges and opportunities that surround the development of online counselling services for young people in the United Kingdom Background: Services for young people should be relevant and accessible to those seeking support. Within the UK precedents for the provision of successful mediated youth counselling have been set by telephone services such as ChildLine. With these points in mind, and with the acknowledgment that the Internet is steadily becoming a 'majority technology', youth counsellors need to be prepared for a move to online counselling. Aims/Method: This study aimed to pool together the views of a small group of counsellors with an interest in online counselling to explore the perceptions that they held regarding the development of such services for young people. To do so an online asynchronous focus group was set up and hosted for a one-month period to create a dynamic dialogue regarding the topic. A grounded theory analysis of the forum transcripts was used to make sense of the data generated. Findings: Findings displayed that the participants in the study accepted the potential of the medium for offering therapy; this particularly related to reaching groups of young people who would not ordinarily use a counselling service. They also suggested that there is a need for online counselling services to be regulated and good practice to be promoted. Conclusion: The Internet has great potential for the development of easily accessible and relevant counselling services for young people. However, caution should be heeded before jumping headlong into such uncharted territory. This paper ends by raising a number of questions that potential service providers should consider when developing a service of this kind. It also discusses the challenges of regulating such a varied and dynamic medium. Some suggestions for the minimum requirements of counsellors working in this field are made. Professional Role: Senior Lecturer in Counselling ABSTRACT: Paper Developing an evidence base in counselling and psychotherapy: methodological issues encountered in a systematic review of counselling older people Research Question: What are key methodological issues in developing an evidence base for counselling and psychotherapy? Background: Central to the theme of the consumer and counselling research is the notion of evidence. All consumers view research findings as potential sources of evidence to shape policy and guide action. From the results of a systematic review of research into counselling and older people (Hill and Brettle, 2004) methodological and quality issues are discussed with reference to developing an evidence base in counselling and psychotherapy. Method: Six electronic databases were searched and 10 key journals hand-searched. Reference lists of relevant studies were searched to identify further relevant studies. Forty-seven studies met the inclusion criteria and formed the body of research to be reviewed. Each paper was critically appraised by two independent reviewers and a summary of each study agreed. The summaries were organised into a table to facilitate analysis and the results presented in a narrative report. Results: CBT was the most commonly-researched intervention. Of the 47 included papers only seven were studies carried out in the U.K., the majority being North American. Twenty studies were randomised controlled trials and a further 12 were pre- and post-test outcome studies. There were nine systematic reviews, one survey, one mixed-method study, one statistical analysis of case notes and just three qualitative studies. The process of critical appraisal identified a variety of methodological issues relevant to the question of what constitutes evidence in counselling and psychotherapy. Conclusions: To generate a viable evidence base there is need for research to be carried out by U.K. counsellors on U.K. populations, in U.K. health and social care settings and using routine counselling approaches. Rather than focus on 'laboratory-type' efficacy research, there is a need to generate practice-based evidence by researching the effects of counselling in naturalistic settings. Pragmatic research designs will be needed to meet the exigencies of such settings. As a consequence, systematic reviews which have to date used the RCT as gold-standard for good evidence will need to take a more pluralistic and inclusive approach to hierarchies of evidence. The paucity of well-conducted qualitative research suggests that these methods are under-recognised and could usefully contribute to the evidence base. Reference Hill. A., and Brettle, A. (2004). Counselling older people: a systematic review. Rugby: BACP. Professional Role: Counsellor ABSTRACT: Paper Telecounselling to Arran: a qualitative analysis exploring client experience Research Question: To explore the experience of clients engaging in person-centred therapy through the medium of telecounselling; the effect of the telecounselling environment on clients and how the telecounselling environment affects the therapeutic process. Research Rationale: Since 2003 videoconferencing has been used by Consulting and Clinical Psychology Services, NHS Ayrshire & Arran, to provide person-centred counselling during the winter months to clients on the Isle of Arran. Although evidence suggests that it is possible to build therapeutic rapport and a working alliance when delivering CBT via this medium, there is a dearth of evidence concerning a person-centred approach. Since the client-counsellor relationship is the vehicle of therapeutic change in person-centred therapy, it is important to discover if there are elements of this distance technology which prevent relational depth. Research Design: A semi-structured interview format was used. The interviews were recorded, transcribed and analysed by the researcher using grounded theory methodology. The research design received ethical approval from the local NHS Research Ethics Committee and from the University of Abertay, Dundee. Sample: Ten (nine females and one male) of the 11 Arran clients who had engaged in counselling via telelink between September 2004 and April 2005 were interviewed by a research assistant regarding their experience of engaging in counselling via the medium of videoconferencing. Five had experienced a mixture of in-person and telecounselling and five had had an introductory in-person session followed by telecounselling. Results/Findings: The central category which emerged was 'engaging with the technology, a journey of transition'. Within this there were four major categories, each containing sub-categories: 1) wondering how this can work; 2) needing a safe space; 3) adapting to the medium; and 4) discovering that therapeutic process is unimpeded. Half the participants (n=5) felt that the medium itself reduced the discomfort of speaking of difficult matters. Conclusions: Despite its limitations, it would appear from this study that, provided a 'safe space' is created, it is possible to offer clients an engagement at relational depth through the medium of videoconferencing in an NHS setting and that the videoconferencing medium may be advantageous for some clients. Professional Role: University Lecturer ABSTRACT: Poster Coping strategies utilised by patients when undergoing and waiting for MRI scan test results Research Question: How do pituitary patients manage any stress related to their MRI scans? Research Rationale: In January 2005 the Department of Health produced a white paper "Supporting people with long term medical conditions". As part of this initiative an "Expert Patient Programme" has been introduced, with the intention of helping people living with long term or chronic medical conditions to become more knowledgeable and empowered regarding their condition and their interaction with the NHS. This research supports this initiative by looking at a patient group with a long-term condition who regularly undergo what can be distressing diagnostic tests known as MRI scans. Initial communication with pituitary patients reveal that they are eager to talk about how they cope with waiting for an MRI scan, undergoing the procedure and waiting for the results. The research will identify the counselling/psychotherapy options available to this particular group. Participants will also be asked how they have accessed counselling/therapy if appropriate, and if they have not, what alternative support systems they have used. The research will look at the accessibility and availability of counselling/psychotherapy services for this client group. Research Design: The research design will use ethnographic qualitative methodology and there will be a triangulation of research methods. Participants will be part of a number of national focus groups and there will also be national questionnaires. Sample: The sample is purposive in that a particular group - those with a pituitary condition who are part of a National Pituitary Organisation - have been approached for their participation. The National Pituitary Foundation has endorsed this research and has advertised for participants of the research via their conference, their website and their newsletter. Results/Findings: Through a thematic analysis of focus groups and questionnaires the researcher will identify how patients, and those close to them, cope with MRI scan procedures. The research intends to identify the most effective types of counselling/psychotherapy for this target population. Conclusions: Conclusions from the findings will identify how best the helping professions can support people who undergo tests, the results of which may alter their lives significantly. I will conclude from the findings what are the most effective ways of offering emotional support to this client group. Professional Role: Counsellor and Psychotherapist ABSTRACT: Poster Does psychotherapy/counselling help ex-cult members recover from an abusive cult experience? Background: There is virtually no reference to recovery from an abusive cult experience in the psychotherapy/counselling literature and ex-cult members (ex-members) report a lack of understanding by therapists. This raises questions as to the effectiveness of established approaches. Aims: To explore what helps ex-members recover, whether the participants sought psychotherapy/counselling and whether it helped. The researcher chose a phenomenological qualitative research design and conducted semi-structured interviews with a sample of eight individuals who identified themselves as ex-cult members. The size of sample was chosen because qualitative research emphasises processes, meanings and how reality is constructed, and is typically smaller in number to quantitative research. The research aimed to begin to give this consumer group a voice in the profession. Results: The data and findings were split into two sections; internal processes and contexts in which recovery occurs. These findings provide valuable insight into the recovery process from an ex-member's point of view. A number of themes emerged including; education about the cult experience; reconnecting with pre-cult personality; learning to trust again; relationship - an antidote; and reconnecting with 'normal' life. The findings highlight that specialist work is needed with ex-members. Conclusion: Whilst a number of therapies were mentioned (including Gestalt, Psychoanalytic, Person-centred, Cognitive, Crisis intervention, Family Therapy, Pastoral Counselling and Psychiatric) it was clear that they were only marginally helpful in aiding recovery if the therapist did not regard the cult experience to be an issue. The outcome of the research is, therefore, a challenge to the profession to include this consumer group. I propose that further research into specialist therapy approaches and services needs to be developed to meet their needs, as well as training for therapists and specialist supervision. Professional Role: Counselling Psychologist,
Co-ordinator of Counselling Services ABSTRACT: Paper The therapeutic relationship in primary care: using client accounts to inform debates of how to enhance the delivery and practice of counselling Research question: Can client accounts inform debates of how to enhance the delivery and practice of counselling? Research rationale: Counselling is included in NICE guidelines as a treatment of choice in primary care for those experiencing mild to moderate symptoms of depression and/ or anxiety. Whilst there is a literature that focuses on evidence-based practice, this study seeks to explore client accounts of primary care counselling in order to inform debates of how to enhance the delivery and practice of counselling. Research design: Following ethical approval, 23 clients were interviewed by the researcher some months after completion of their counselling. Individual semi-structured interviews were analysed using a thematic analysis. Sample: Participants had been referred in one of two managed primary care counselling services, covering 17 GP practices, which offered structured/ brief counselling. Counsellors were accredited, or of accreditable standard, and had undertaken training in differing therapeutic approaches. Results/ Findings: Clients disclosed a wide range of life issues that had preceded their referral for counselling, and their experience of a variety of counselling interventions. Clients also spoke of their appreciation of the ability to negotiate the spacing and ending of the counselling sessions, the perceived competence of the counsellor, and the physical location of the counselling. Eleven of the 23 had also received therapeutic interventions in other settings. They offered contrast narrative to illustrate helpful and unhelpful factors. Conclusions: The findings suggest that no one form of counselling will suit all clients and, therefore, to offer only a single approach will inevitably fail to meet the needs of some clients. It is suggested that counselling provision in this setting needs to be flexible in its approach and that counsellors need to be able to offer interventions from a range of therapeutic approaches. Other issues are discussed, such as recognising and addressing counsellor-client 'fit', and the timing of the counselling in the client's life process. This paper is based on PhD research funded by ESRC at Cardiff University. Professional Role: Primary Care Counsellor ABSTRACT: Paper Do the benefits of time-limited counselling endure? Background: Time-limited primary care counselling is now widely available. With the advent of routine clinical audit systems like CORE it is possible to monitor and report on the effectiveness of such services. The data shows substantive evidence of the benefits of counselling based on pre and post measures; but how well does this endure? Aim: To follow-up clients known to have gained reliable and clinically significant improvement from time-limited counselling (6-12 sessions) to investigate 'durability of benefit' in the medium term. Method: 108 ex-clients of an NHS primary care counselling service are followed up 9-16 months after completion of counselling. A CORE-OM and a custom questionnaire are used as dual, repeated measures of outcome. The follow-up measures are compared with previous pre/post data gained at the time of therapy. The project was approved by the local NHS ethics committee. Results: The mean pre-therapy CORE-OM score of 64 had fallen to 21 by the end of counselling; the study found that at follow-up, the mean level had risen to 30. ANOVA testing found the rise to be significant although still well below the nationally established benchmark for clinical cut-offs (i.e. 41 for men & 44 for women). 72% of cases remain below the cut-off. Effect size between pre and follow-up was found to be large (ES=0.73). The custom questionnaire found clients' perception of 'durability of outcome' was good, and strongly associated with the CORE-OM follow-up measure. In those that relapsed, no association could be found with amount or type of therapy, clinical issue, time to follow-up, age or gender. Conclusions: Durability of outcome was found to be good and in agreement with clients' own perception of lasting benefit to them. In the minority that relapsed, no specific factors could be identified. The research was hosted by West Sussex Health & Social Care NHS Trust and supervised by Roehampton University. |
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