This research was conducted in the context of funding constraints across the FE and HE sectors alongside changes to the funding structures in HE, where, as of the 2012/13 academic year, central government funding of institutions will be considerably reduced and, for most subjects, will instead be linked directly to individual student registration.
In this uncertain economic climate, it is reasonable for budget-holders to look for evidence of the value that all university and college departments and services, including counselling, contribute to the institution and its main stakeholders, students. This research was an important step in developing an evidence base which demonstrates the contribution in-house counselling makes to both student and institution, by improving student academic outcomes and overall wellbeing.
What we already know
CORE IMS’ Benchmarks for Higher Education Counselling Services1 provide the main body of preexisting evidence for the contribution made by counselling in the sector. CORE IMS compared these benchmarks to equivalents at that time in primary care counselling.
The level of ‘caseness’ (that is the level and type of presenting problem) of students presenting for counselling in higher education counselling services was similar to patients presenting for counselling in primary care.
Impact on clinical outcomes
75 per cent of clients were either ‘improved’ or ‘recovered’ following counselling in higher education, compared with 71 per cent of clients in primary care counselling.
Finding 1: The average waiting time between referral and assessment in HE counselling was nine days compared with 63 days in primary care counselling.
Finding 2: The average waiting time between referral and first counselling session in HE counselling was 16 days compared with 84 days in primary care counselling.
Provision of timely counselling is particularly salient in the student population which, according to the Royal College of Psychiatrists’ report into the Mental Health of Students in Higher Education2, may be more vulnerable than other young people as they face: the challenge of adapting to a new environment and to the demands of their courses; potential isolation without usual social supports; peer pressure to misuse drugs and alcohol; and the additional stress of financial pressures and the need to work alongside study. This same report notes that ‘underachievement or failure at this stage can have long-term effects on self-esteem and the progress of someone’s life’ thus highlighting the importance of early intervention.
Recent research: the impact of counselling on academic outcomes
Research paradigm – why the student perspective?
When conducting research, it is important to choose a research paradigm which both reflects the philosophy of the enquiry and which allows the research question to be answered as comprehensively and usefully as possible. In this case our interest was in knowing about the impact of counselling on students and in particular, on their academic outcomes. There are a number of possible ways to investigate this, including the traditional positivist approach of measuring specific variables related to academic outcomes before and after a counselling intervention. However, as this is an area in which there is little pre-existing research on which to base hypotheses and in which the lack of relevant standardised measures would limit the variables which could be investigated, it seemed more productive, as a first step, to conduct exploratory research from within the interpretive paradigm. The interpretive paradigm privileges the individual experience or perspective, and thus is consistent with the person-centred philosophy which underpins much of counselling relationship theory. For these reasons, it was decided to ask students who had recently completed counselling with an in-house university or college counselling service, their views on the impact this had had on four specific academic outcomes. In order to increase understanding of the types of impact as well as the process by which this impact occurred, two qualitative questions allowed participants to describe the positive and negative aspects of their counselling experience in their own words.
This research involved gathering responses from students to four quantitative and two qualitative questions for one full academic year – September 2011 to July 2012 – regarding their experience of counselling in general and in particular its impact on their academic outcomes.
Students were asked to indicate, on a Likert-type scale, the extent to which they considered counselling to have helped them in each of four academic outcomes – retention, achievement, their overall experience of being at university or college (‘student experience’) and in developing employability skills (described by examples: ‘self-understanding, understanding of others, managing difficult feelings better, increased confidence, assertiveness’). They could choose from the following responses: ‘not at all’; ‘to a limited extent’; ‘one of many factors’; ‘an important factor’; ‘the most significant factor’; ‘this was not an issue for me’.
In all, data from 5,537 students from 65 UK universities and colleges was submitted for quantitative analysis using SPSS software. A smaller, but still significant subset of data from 1,263 students from 53 universities and colleges was included in the qualitative analysis using Grounded Theory. A real strength of this research was the high number and therefore likely diversity of the student respondents and the wide range of the institutions contributing data.
Well over three quarters of the 5,537 student respondents considered that counselling had been helpful in improving their academic outcomes. Only 5.4 to 7.8 per cent (depending upon the specific outcome) considered counselling to have had no impact on their academic outcomes.
54 per cent of all student respondents indicated that counselling was either ‘an important factor’ or ‘the most significant factor’, and another 27 per cent indicated that it was ‘one of many factors’ in helping them stay at university. Therefore, in total, 81 per cent of students considered counselling to have helped them stay at university or college.
50.6 per cent of all student respondents indicated that counselling was either ‘an important factor’ or ‘the most significant factor’, and another 28.4 per cent that it was ‘one of many factors’ in helping them do better in their academic work. Therefore, in total, 79 per cent of students considered counselling to have helped them do better in their academic work.
55.9 per cent of all students indicated that counselling was either ‘an important factor’ or ‘the most significant factor’, and another 26.9 per cent that it was ‘one of many factors’ in improving their overall student experience. Therefore, in total, 82.8 per cent of students considered counselling to have improved their overall experience of being at university or college.
59.9 per cent of all students indicated that counselling was either ‘an important factor’ or ‘the most significant factor’, and another 18.2 per cent that it was ‘one of many factors’ in helping them develop skills useful for obtaining future employment. Therefore, in total, 78.1 per cent of students considered that counselling helped them develop skills useful for obtaining employment.
Students were asked to describe how counselling helped and to comment on any ways in which counselling or any aspects of the service were unhelpful.
How counselling helps
Open and Axial Coding: There were many helpful factors identified. In the course of Axial Coding, which considers relationships amongst factors (open codes), processes by which counselling impacts and types of impact that it has, emerged. The Context was described as one in which the student found counselling to provide a safe space within the unfamiliar and challenging environment of their FE or HE institution. The Counselling Interventions which they most valued were emotional containment, understanding, and being offered new perspectives and new tools for coping. The main Impact of counselling was that students developed increased understanding and increased ability to cope. This then changed their Outlook to one which was more confident, more optimistic and more hopeful about the future.
Selective Coding: The Core Code or the central process that appeared to be at work when counselling was helpful for students in the further and higher education setting is illustrated in Figure 1. In this case, the central, most useful impact of counselling was that it increased students’ understanding of themselves and their problem(s). This resulted in improved ability to cope, which created increased confidence. These two continued to interact in a ‘virtuous circle’ to result in increased hope for the future.
Aspects of counselling identified as unhelpful
Only 16.8 per cent of the 1,263 respondents commented on unhelpful aspects of counselling, despite a direct request to do so. Therefore, there was not enough data to complete a Grounded Theory analysis and so a simple thematic analysis was conducted. The factors identified as unhelpful were largely characteristics of the service, specifically: insufficient number of sessions offered; waiting time to begin counselling too long (on average 15-20 days, so still on average only a quarter of the waiting time in primary care settings as identified in CORE IMS, 2010); insufficient early or late appointments to accommodate students working or living at a distance; length of each session too short (though invariably sessions were the standard 50-60 minutes in length); and location of waiting area too public. A few students identified unhelpful aspects of the counselling approach, specifically: not enough direction from counsellor; not enough focus on solutions or active coping strategies; not enough emotional containment at the end of sessions; too much ‘just listening’.
The positive impact of counselling
Different approaches to research produce different types of evidence. In order to maintain the integrity of any piece of research, it is important to make only those claims that can be supported by the findings and the research methodology that was employed. Interpretive research allows us to draw conclusions about the experience of the individuals and groups of individuals involved in the research.
So, what can we conclude from our findings in this research? First of all, based on the quantitative findings, we can conclude that over 75 per cent of students, who completed counselling within the 2011/12 academic year at the 65 institutions involved in the research, found that counselling:
- helped them stay at university or college
- improved their academic achievement
- improved their overall experience of being a student
- helped them develop employability skills.
These are significant findings in themselves. However, from the qualitative findings emerges an impact of perhaps greater significance; that is that the experience of counselling also improved students’ self-confidence and increased their hope for the future.
Can we generalise these findings beyond the students involved in this investigation? Well, the fact that these findings are based on the responses of over 5,000 students from 65 different universities and FE colleges across England, Scotland and Wales, makes this as powerful an argument for generalisation as is possible within the interpretive research paradigm. So, it is reasonable to conclude that in general, the majority of students who complete in-house counselling at universities and colleges will find it impacts positively on their academic outcomes, improves overall self-confidence and increases hope for the future.
Counselling approach and length of contract
It is important to note that in this research, the models of counselling and the number of counselling sessions completed varied across students and institutions, and so the positive impact is associated with counselling provision in general, not a particular model or number of sessions. This is important information for FE/ HE counsellors and those employing them, as these findings support the current position in which a range of counselling approaches and lengths of counselling contract are employed. Qualitative findings regarding what students found unhelpful in their counselling experience provide further information. However, they need to be considered with caution as they come from only a small percentage of the respondents. That said, it is worth noting that most of the negative experiences cited were from students who saw themselves as having complex and/or multiple problems and where counselling ended before the student felt ready, due to service-imposed limits on the number of sessions that could be offered. Where cited, the number of sessions provided varied between four and eight. This suggests that flexibility of length of contract to suit the individual student’s needs would be considered more helpful, particularly for students with complex needs. The main finding regarding counselling approach is supported by qualitative data on both positive and negative experiences of counselling. Many students commented positively on what would be termed more ‘active’ interventions – that is: ‘helping find solutions’, ‘offering tools and coping strategies’, ‘offering new perspectives’ whereas the few who commented on negative experiences of counselling wanted more focus on this type of intervention and less on ‘just listening’. This does not suggest that a particular counselling model is required but rather that a fairly active, interactive approach, with a focus on present coping rather than past problems, is what students find most helpful. In my experience, this is consistent with the service that is normally offered in FE and HE, and argues in support of in-house services provided by counsellors who understand the specific needs of this client group.
The views we have not heard
In the interests of good research practice, it is important to recognise that although we have heard from a large and diverse group of students, their views cannot be considered representative of all students. Participants in this research all completed counselling within the allocated time frame, but there will have been many other students who began but did not complete counselling. In addition, the students who completed the questionnaires may not be representative of all the students who met the inclusion criteria. Analysis of the institutional data shows that on average across all institutions, 64 per cent of clients who met the inclusion criteria for this research were asked to complete a questionnaire. Of those, 36 per cent returned a completed questionnaire. Therefore, across all institutions, respondents constituted 23 per cent of all students who met the inclusion criteria. This response rate varied considerably across institutions with as low as 5.4 per cent and as high as 70.6 per cent return rate for students who met the inclusion criteria. Arguably therefore, this research will have accessed more students likely to hold positive views of their counselling experience and fewer of those likely to hold negative views. This does not in any way discount our findings, but rather reminds us to be cautious in the claims we make and how broadly we apply them.
What began as the Lead Advisor’s and the AUCC executive’s question: ‘What is the evidence base for counselling in FE and HE?’, developed into an extensive project involving over 5,000 FE/HE students and 65 universities and colleges across the UK. We now have some robust evidence for the positive impact of counselling on academic outcomes. However, there is more already happening and more still to be done.
Counselling impact on academic outcomes
(CIAO) measure One of the very positive outcomes of this research has been CORE IMS’ interest in developing a measure of counselling impact on academic outcomes based on the research questions and findings. This measure was worked on collaboratively over the summer (by Nic Streatfield of CORE IMS, Denise Meyer and Nicola Barden of University of Portsmouth Counselling Service, and Patti Wallace, Lead Advisor, University and College Counselling) and is now available for use by all Corenet FE/HE subscribers. An important advantage of this development is that data will now be collected and analysed on an ongoing basis so that we can continue to build a robust evidence base for the impact of counselling in FE and HE.
In order to ensure that AUCC members who do not have access to Corenet are also able to collect and analyse data on the impact of counselling on academic outcomes for reporting on their own service outcomes, an Excel spreadsheet with embedded calculations has been developed on behalf of BACP (by Jo Pybis, Research Facilitator and Patti Wallace, Lead Advisor, University and College Counselling). This has been distributed via the AUCC member mailbases for use by all members.
A range of stakeholders within the FE/HE sector have expressed interest in these findings. Following my presentation of the first stage of these findings at the BACP Research Conference in May 2012, the findings were picked up and reported by the Times Higher Education (THE)3. Since then, I have been invited to speak at three National Union of Students (NUS) conferences in England, Wales and Scotland, in October and November 2012, and at the National Association for Managers of Student Services in Colleges (NAMSS) Conference in March 2013. I am also hoping to have the opportunity to present at an AMOSSHE CPD event in the coming year.
I see this research as the first step in developing and maintaining a robust evidence base for counselling in the FE/HE sector and a contribution to the evidence base for counselling more generally. The next steps will need to involve ongoing collection, analysis and reporting of data similar to the current research as well as new research using alternative, perhaps more robust, methodologies.
Ongoing data collection
In order to achieve the first of these, CIAO and the BACP spreadsheet have been designed in such a way that data from both can easily be combined so that further sector-wide analyses of the impact of counselling on academic outcomes will be able to be conducted and reported on a regular basis. In addition, an updated AUCC survey spreadsheet for the 2012/13 academic year has been developed (by Tina Abbott of Cardiff University and Mary Dailey of Bradford University) to allow for the collation of descriptive data from services for use in service reporting by all participating counselling services in the sector. These are significant steps in integrating research into daily clinical practice, something which in my view is necessary if we are to develop and maintain a robust and up-to-date evidence base for counselling in the sector.
To me, the next obvious step is to conduct a randomised controlled trial (RCT) of counselling in the FE and/or HE sector as RCTs constitute the ‘gold standard’ test for the effectiveness of an intervention by the National Institute for Health and Clinical Excellence (NICE). I have submitted a proposal for funding to BACP for a small-scale RCT, based on one recently completed into the effectiveness of schools counselling. Should funding be awarded, the research would be conducted in the 2013/14 academic year.
We, as a sector, can feel pleased that many of our members have chosen to actively engage in this research to support our profession. We can feel even more pleased that the research findings demonstrated that most students found counselling to have a positive impact on their academic outcomes. Perhaps most pleasing of all is the finding that counselling helped students feel more self-confident and more hopeful for their future, attributes which are likely to impact directly on their future success and wellbeing. My hope is that this positive experience will encourage AUCC members to continue their engagement in high quality evaluation of their own services and their participation in sector-wide research in the future.
In the tradition of the interpretive research paradigm, I wanted to let our students and research participants have the last word.
‘Counselling helped me gain strength and confidence in myself and be able to look forward to the future with optimism.’ (Cl136)
‘Counselling has been the best thing I have ever done. It has given me a fresh, positive outlook at a very difficult and challenging time in my life.’ (Cl687)
‘Counselling has helped me turn my life around for the better.’ (Cl422)
‘It has helped me through some very tough times – probably lifesaving!’ (Cl715)
‘It has given me a very optimistic outlook on my university experience and indeed life.’ (Cl1143)
‘Counselling, through unconditional support and understanding, provided me with the confidence and self-esteem to stride forward into the rest of my life.’ (Cl1012)
‘The results have been priceless. I have been given hope for my future life and career.’ (Cl989)
Patti Wallace, Lead Advisor, University and College Counselling
1 CORE IMS. Benchmarks for higher education counselling services. CORE IMS. July 2010 (available online).
2 Royal College of Psychiatrists. Mental health of students in higher education. College report CR166. Royal College of Psychiatrists. London: September 2011.
3 Grove J. It’s good to talk: poll points to wise counsel. Times Higher Education. 13 May 2012.