Domestic violence in primary care: The psychologist's role

This paper highlights the difficulties facing medical and mental health professionals in helping families in which there is violence. Emphasis is placed on how domestic violence presents in primary care medical settings. Physician and patient characteristics that interfere with domestic violence detection are reviewed. A role is outlined for psychologists in primary care settings to facilitate detection and treatment. Facilitative efforts include educating physicians through collaboration and serving as an on-site resource for information and consultation.     

Humanistic education: The challenge to the counsellor

Counselling has long been considered to be an ancillary service in American education, its general purpose being to assure that the student is free enough from personal concerns and emotional problems to concentrate upon the objective of education, which is the development of the intellect (or cognitive abilities). Humanistic education questions this goal, and proposes that the objective of education should be the development of the student as a whole person, or the development of self-actualising persons. Counsellors, ideally, have always held this as their goal. When education adopts it also, then counselling will not be an ancillary activity, but will be central to the educative process.     

The role of personal development groups in counsellor training: understanding factors contributing to self-awareness in the personal development group

Personal development groups (PD groups) are widely employed in counsellor training with the aim of developing the self-awareness of trainee counsellors, and the intention of this paper is to open a discussion forum of the use of these groups and understand their use more fully. A quantitative and qualitative approach was employed in this study, using focus groups with a cross section of 88 trainees of counselling, at different points in their training, to establish those factors that were felt to contribute to developing self-awareness in the group. A questionnaire was used to measure both trainees' perceptions of their own self-awareness and the extent to which the contributory factors were felt to be both present and helpful in their current PD group (this is referred to as the 'comfort fit'). Statistical findings, from the full cohort of 88 trainees, indicated that they were more comfortable in the PD group at the start of their training and less comfortable at the end, although there was no clear relationship between there being a better 'comfort fit' and increased self-awareness. These findings are discussed in relation to alternative methods of facilitating the self-awareness of trainees of counselling (such as mandatory personal therapy) alongside the associated complexities of undertaking research of this kind.     

The responsibilities of counsellor supervisors: A qualitative study

A study was carried out to investigate whether supervisors of counsellors considered themselves to be clinically responsible for the work of their supervisees, what responsibilities they considered themselves to have for the counsellors' work, and how they managed their responsibilities. The purpose of the study was to enhance the counselling profession's understanding of the responsibility of supervisors and of the supervisory relationship. The study was confined to supervisors working in private practice. Ten experts in the field of counselling and supervision were interviewed, using a semi-structured questionnaire. The interviews were analysed using the 'constant comparative method'. They revealed that the participants would not use the term 'clinical responsibility' to describe their responsibilities. There were mixed views about the nature of the responsibility of the supervisor when supervising counsellors practising independently. The participants indicated a preference to supervise only the most experienced counsellors, with whose practice they were already familiar and in whose work they already had considerable confidence. None of the supervisors interviewed considered themselves to be legally responsible for the counsellors' work. All the participants were aware that the risks associated with counselling in private practice could be considerable and had an acute sense of responsibility for the content of the work. Reluctance to take action against supervisees who were in breach of the code of ethics was expressed. There was scepticism about the requirement for them to have supervision for their supervisory work. Implications for the practice of counselling supervision and for the profession are discussed.     

The importance of case discussion in counsellor training

Case discussion is viewed as a central and integrating core of counsellor training, in that it brings together the 'theoretical', 'practical' and 'personal' components which form the basis of the training process. The aim of the trainer in case discussion is to help the trainee gain therapeutic understanding of the counselling relationship. This can be done at both micro and macro levels of analysis. An example is provided where a trainee was helped to view from a different perspective a counselling relationship that had become 'stuck'.     

Training teamwork in medicine: An active approach using role play and feedback

Recent reports in the field of medicine have recommended teamwork training as method of reducing human error. The current study evaluated a teamwork training protocol that used a lecture, several role plays, and guided discussion for feedback. Forty‐one medical residents participated in the training on 1 of 2 days (groups) and completed evaluation measures both prior to and immediately following the training program. Means for a situational judgment test (SJT) were higher for post‐training scores than pre‐training scores. However, mean comparisons with teamwork attitudes and learning goal orientation did not yield significant differences. An item analysis of the SJT responses indicated significant response shifts that corresponded to teamwork behaviors. Results suggested that teamwork training positively affected behavioral intentions for trauma room teamwork.     

The challenge of becoming an integrative counsellor: The trainee's perspective

Aim: Integrative therapeutic practice is commonplace within the UK. Counsellors and psychotherapists increasingly report working in this way and numerous training courses have developed which advocate such practice. Despite its popularity, researchers have paid little attention to the impact that such training has upon students. This study therefore explores newly qualified counsellors' reflections of undertaking professional training in integrative counselling. Design: Newly qualified counsellors were invited to take part in a focus group to discuss their training experiences. Two groups were held involving a total of seven people. The data generated was analysed using Grounded Theory. Findings: The core-category ‘The challenge of becoming an integrative counsellor’ was identified. Embedded within this were four sub-categories: (1) ‘training issues’, (2) ‘applied issues’, (3) ‘the development of an integrative theory and identity’, and (4) ‘the impact of integrative training post qualification’. Key findings include the willingness of trainees to tolerate theoretical ambiguity and the discomfort that surrounded not belonging to a pure paradigm community. Discussion: Recommendations are made that trainers and practice supervisors are mindful of the distinct struggles that integrative trainees encounter. Additionally, in response to the isolation that some trainees report, greater use of peer support networks is encouraged.     

The response-shift bias in a counsellor education programme

Student counsellors' pre-test, post-test and retrospective pre-test scores on the Counselor Evaluation Rating Scale (CERS) were used to investigate the presence of a 'response-shift bias', to estimate the overall effectiveness of training and to promote counsellors' continuing self-reflection on their work. Results from three groups of trainees spanning 3 years revealed the presence of a response-shift bias, confirmed the effectiveness of the training programme and demonstrated the students' continuing self-analysis of their own counselling skill.     

The counsellor as researcher: Boundary issues and critical dilemmas

Some of the ethical issues that emerged during a study of adult male survivors of childhood sexual abuse are reviewed Some cases where boundary issues became problematical, and the dilemmas faced in working within a person-centred, qualitative approach, are discussed. Considerations for counselling researchers and their trainers when undertaking research are examined     

Spirituality in counsellor education: a new course

This article describes a graduate course in spirituality in counselling with the hopes of encouraging and supporting other counsellor educators in preparing and offering their own courses in this area. Learning objectives, activities and assignments are outlined. Students' personal experiences of the course are shared through excerpts from their final reflective papers.     

Efficacy of a program to encourage walking in VA elderly primary care patients: the role of pain

Pain may be a barrier or a negative outcome of initiating and maintaining an exercise program in elderly patients. The purpose of this study was to examine the role of pain in a program designed to increase walking for exercise in 181 veteran primary care patients (60 - 80 years). Self-reported physical activity (min-walked per week) and pain were assessed at baseline, 6, and 12 months. Walking for exercise increased over time without significant changes in pain. Analyses suggested that baseline pain was not a barrier to initiating or maintaining a walking exercise program, nor did increased walking influence reports of pain. These results suggest that patients can be encouraged to engage in physical activity, even if they are currently suffering from pain.     

The experience of working with refugees: counsellors in primary care

The provision of counselling services for refugee and asylum-seeking patients is relatively new in the UK and their complex needs may present considerable challenges within primary care, where access to specialist support resources is often limited. As far as we know, no previous research has attempted to look at the experiences of the counsellors who do this work. We undertook in-depth interviews with 13 counsellors who provide counselling to refugees in primary care in north London. The findings of this study suggest that counsellors who work in a primary care setting find themselves conflicted, troubled and out of their depth by the experiences, narratives and distress presented by refugee and asylum-seeking patients. They also report an erosion of usual counselling boundaries. Thus, the problems presented by refugees seem to demand approaches which go beyond standard counselling practice and which create ambivalence and uncertainty. These counsellors express feelings of isolation and impotence. The paper concludes with implications for counselling practice and suggestions for further research.     

The counsellor and the GP: The gulf and the isthmus - or the dilemmas of difference

Research supervision in the field of counselling and psychotherapy is a fruitful area for investigation in view of the fact that the research supervisory relationship is powerful and highly charged, whether consciously acknowledged or not. Researchers trained as counsellors and psychotherapists possess the skills to facilitate the emergence of, and work creatively with, impasses and crises, both in the research itself and the supervisory relationship, as a result of their training and experience in dealing with crisis and catharsis in clinical work. This paper will demonstrate these points using a case vignette from my work as a supervisor of research dissertations undertaken by students on a Masters in Therapeutic Counselling course. Drawing on narrative analysis, clinical supervision theory and discursive analysis it will look at the strengths and weaknesses of a ‘psychotherapeutic’ approach to research supervision.     

The 'open circle' in counsellor education and training: Rationale and criticisms

The apparently simple open circle is described and five elements of a rationale are discussed: that it acts as a 'buffer'; contributes efficiently towards developing trust; highlights aspects of self-disclosure; enhances awareness of emotions, biases etc; and, most subtly, provides practice of feeling sympathetic but not 'rescuing'. In the final section, four criticisms of the open circle are countered: that it is pointless; artificial; taxing; and insensitive.     

An investigation into the validity of role play as a procedure for counsellor skill assessment

The aim of this study was to determine the validity of role play as a method for assessing counsellor skill. Video recordings of twelve counsellors' performance in both real and simulated counselling interactions were analysed. Skill assessment included molar ratings of eight skill areas and molecular measures of 28 behaviours. A comparison of counsellor performance between conditions indicated that there was little difference between the real and role-play situations. It is concluded that the modified extended role-play format employed in the present study might be a valid technique for assessment of counselling skills.     

The prophetic role in pastoral care

The Author argues that learnings in Clinical Pastoral Education may clarify the prophetic function of ministry and minimize the perenniel conflict between the prophetic and the priestly. He describes solidarity and confrontation in counseling and amplifies their meaning as regards the traditional functions of the prophet.