Laying mother to rest: Working with grief-related nightmares through exposure therapy and imagery

Cognitive behavioural therapy of unresolved grief is usually presented as a fairly rapid approach for reducing psychological problems. The present case study shows how behavioural cognitive and symbolic approaches can be integrated to foster griefwork at several levels. The counselling adopted a behavioural exposure technique specifically for eliminating a significant anxiety-provoking obstacle to mourning, namely the experience of recurrent death-related nightmares that surfaced every time the bereavement was recalled in depth. The client was also encouraged to explore the symbolic meaning of the dream images and in drawings modified these images in ways that helped to alleviate her feelings of long-standing guilt. Drawing as well as verbal representation could also be regarded as an effective form of exposure therapy, helping the client to stay with the anxiety-provoking death-related images. The client once relatively free of nightmares could mourn the loss of the mother more deeply in subsequent less directive counselling sessions.     

Use of Morita Therapy in Shyness Counseling in the West: Promoting Clients' Self-Acceptance and Action Taking

The author discusses the practical application of Morita therapy philosophy and techniques in shyness counseling in the West. Shy clients in Morita therapy are encouraged to recognize the self-actualizing meaning of social anxiety instead of regarding it as abnormal and becoming preoccupied with attempts to control anxiety symptoms. They are challenged to reevaluate their maladaptive cognitive processing of shyness and their unproductive behavioral passivity. The didactic, confrontational, and supportive messages used in Morita-based counseling are presented. Cross-cultural issues are discussed, and the positive reinterpretation technique and the behavioral instructional method are illustrated.     

Applying REBT to workaholic clients

This paper draws attention to the use of rational emotive behaviour therapy (REBT) in counselling clients who are workaholics. Essential REBT theoretical tenets can help to reveal and explain the causes of workaholic behavior, while REBT techniques can be used effectively in assisting workaholic clients to cope with their cognitive, emotive and behavioural biases. Having explained the general characteristics of workaholism, this paper utilizes a case illustration to demonstrate the basic tenets and techniques of REBT that can be used to help a workaholic client.     

Counselling children and young people: A review of the evidence for its effectiveness

This paper summarises and presents the results of a BACP commissioned systematic scoping review on the research evidence on counselling children and young people. The methodology was based on a structured, hierarchical, systematic approach to searching and reviewing the research literature. Inclusion criteria defined the scope of the review in relation to a range of issues in counselling children and young people: behavioural problems and conduct disorders; emotional problems including anxiety, depression and post‐traumatic stress; medical illness; school‐related issues; self‐harming practices and sexual abuse. Four groups of counselling approaches were examined: cognitive‐behavioural; psychoanalytic; humanistic; and creative therapies. The findings indicate that the four therapeutic approaches are effective to a greater or lesser degree in relation to the range of issues. Although the findings show that there is little or no evidence for the effectiveness of some therapies for particular issues, this may not reflect the lived experience of children and young people engaged in counselling in a range of community and institutional settings. Instead, the absence of evidence is likely to reflect a lack of published studies that fit the inclusion criteria for this review.     

Examining process constructs of narrative career counselling: an exploratory case study

The present article examines how the five process constructs of reflection, connectedness, meaning making, learning and agency are operationalised in a constructivist approach to career counselling, specifically a storytelling approach. This article reports on an exploratory case study of a Black South African female university student. The case study provides examples of how a career counsellor enacts these constructs and facilitates their development in a client, as well as examples of how they are evident in client dialogue and action. Insight into the process of a storytelling approach to narrative career counselling is demonstrated, from which tentative suggestions are made about how to facilitate the process constructs of reflection, connectedness, meaning making, learning and agency.     

Training for paraprofessional counsellors: Evaluating the meaning and impact of a common factors approach

A group of 12 people participated in a short (40 hours) counselling training programme for paraprofessional counsellors, which emphasised the importance of common factors in accounting for therapeutic effectiveness. The general framework, language and skills of a brief, solution‐focused approach was used as a means of translating the theoretical/conceptual ideas of the common factors model into specific counsellor behaviours and also to provide structure and focus for counselling sessions. A pluralist methodology was employed to assess the personal meaning of the training for participants and the impact of the training on the development of counselling skills and awareness. Results indicated the training impacted positively on the development of counselling skills and ability to handle difficult client behaviours but less so on personal values and ability to deal with process issues. The majority of participants believed the training contributed positively toward their personal development.     

Revisiting a meta-analysis of helpful aspects of therapy in a community counselling service

This small scale mixed methods study examines helpful events in a community counselling setting, categorising impacts of events according to Timulak’s [(2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: A qualitative meta-analysis. Psychotherapy Research, 17, 305–314] meta-synthesis of significant events research. Comparisons were made between the types of impacts reported as helpful by clients receiving cognitive behavioural therapy (CBT) or relational integrative counselling. Seventy-five clients identified 291 significant events on 216 Helpful Aspects of Therapy (HAT) forms. The findings broadly reflect all nine impacts identified by Timulak (2007). The study also suggests that a potential new category, ‘voicing’ may exist. Differences between the types of impacts reported as helpful by clients in CBT and integrative therapy showed a higher percentage of CBT clients reporting ‘behavioural change/problem solution’, ‘reassurance’ and ‘client involvement’ as helpful. Differences in other categories were not statistically significant.     

Counselling adults who were abused as children: Clients' perceptions of efficacy, client-counsellor communication, and dissatisfaction

Despite the amount of clinical material relating to adults who were abused as children, there is a dearth of research which has examined the effectiveness of counselling such clients. In order to examine the perceived efficacy of counselling with this client group, a total of 53 in-depth interviews were undertaken with a sample that included adults abused as children who had received counselling, counsellors working with this client group, and counselors-who-were-abused-as-children. The findings indicate that there are many similarities in what abused clients and the general client population judged to be helpful and unhelpful factors in counselling. However, certain aspects of the counsellor-client relationship appear to have specific impacts and meaning for an abused client group, especially when they have little prior knowledge or experience of counselling. Data are presented relating to clients' evaluations of counselling. These illustrate clinically relevant issues in relation to communication and experiences of dissatisfaction. One conclusion from the study is that in terms of their responses to counselling, it is simplistic for adults who were abused as children to be categorisied as a unitary group. Nevertheless, there are certain aspects of counselling with such clients which do merit particular attention if practitioners are to minimise the possibility of counselling being ineffective, unhelpful or, at worst, re-traumarising.     

Effects of focus of attention on physiological,behavioural, and reported state anxiety in repressors,low-anxious,high-anxious,and defensive high-anxious individuals

Abstract

Discrepancies between physiological activity, behavioural anxiety, and self-reported anxiety were examined when focus of attention was manipulated in a public speech task for four groups of individuals: repressors, low-anxious, high-anxious, and the defensive high-anxious. They were exposed to self-focus (when their behaviour was socially evaluated) and other-focus (when their behaviour was not socially evaluated) conditions. Repressors had consistently the lowest level of self-reported anxiety, but had consistently greater physiological activity in all conditions and greater behavioural anxiety in the self-focus condition. The high-anxious showed the opposite pattern, i.e. their self-reported anxiety was greater than their physiological and behavioural anxiety, and this finding was significant in the self-focus condition. No significant pattern of discrepancy was found for the low-anxious or defensive high-anxious groups. The findings are discussed and interpreted within the framework of recent cognitive models of anxiety.     

Cognitive-Behavioral Treatment of Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) can be treated effectively with cognitive-behavioral therapy. When working with clients who have GAD, therapy can focus on four central areas that help to promote therapeutic change. The initial focus of therapy is on developing a sound therapeutic alliance and educating the client about anxiety symptoms. Skills training focuses on relaxation training and cognitive changes that can help clients confront their worries in a constructive manner. Then, exposure to internal and external aspects of the anxiety can help clients test and refine their coping skills. Finally, because of the chronic nature of GAD, relapse prevention strategies can be used to help maintain treatment gains over time. These strategies allow a broad but flexible treatment plan that can be adapted to the unique needs of each individual client.     

Explanation and Causality in Counselling: Consequences and Alternatives

Despite calls for counselling to take greater cognizance of the social context in which we live, it remains primarily monadic in its approach, focusing on individual pathology rather than on contextual links. This is explored in a discussion of behavioural, cognitive, and humanistic approaches to counselling which — despite their differences — exhibit remarkably similar features when viewed from a perspective outlining patterns of causality. A systemic approach is presented which attempts to provide a framework for describing human behaviour that acknowledges the interaction between intrapsychic dynamics and patterns of communication. The likely consequences of the traditional and systemic approaches are then discussed within a framework of 'self-fulfilling prophecies' .     

The effect of group psychological counselling in Greek university students’ anxiety,depression, and self-esteem

Objective: During the last decades there has been a marked increase in both the number of students with severe psychological problems on campus and the number of students seeking counselling services. The present study measured the effect of a group psychological counselling program on university students’ anxiety, depression, and self-esteem. Design: Data were derived from six separate groups and a total of 53 participants (19 male, 34 female). The intervention was based on Cognitive-Behavioural Group Therapy (CBGT) and included cognitive and behavioural techniques in eight, two-hour weekly sessions. The quasi-experimental longitudinal study used a pretest/posttest group design. The participants completed the Spielberger's State–Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Rosenberg Self-esteem Scale (RSE) before and after the intervention. Data were analyzed using t-tests. Results: The results indicated the existence of meaningful differences in terms of state and trait anxiety, depression and self-esteem from pre-treatment to post-treatment. Conclusion: The program was effective in decreasing significantly participants’ anxiety and depressive symptoms, as well as increasing their self-esteem. These are encouraging results demonstrating an effective form of the intervention on student population.     

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

Une comparaison des apports des modèles de la construction de la carrière et de la construction de soi au life designing counseling

Recent developments in Western societies and transformations in work organizations have made the vocational issues that people face more frequent, complex, and puzzling. With the individualization of the life course, people now more than ever before need to reflect and deliberate as they design their lives. To assist individuals cope with difficult issues in life-designing, counselors have devised a new approach to counselling dialogues that differs from traditional information and guidance interventions. This article briefly presents the theoretical model for life designing counseling and then compares two distinct life-designing intervention approaches. Both of them share the epistemology of social constructivism and concentrate on the client and counselor's co-construction of meaning. Each approach provides a rigorous and systematic foundation for counselling interviews yet they differ in the ways they tackle meaning-making. The major difference is that the first approach presents a highly-structured form of life-designing interview that highlights the counselor's role in reconstructing a client's meanings, identity, and intentions. In contrast, the second approach presents a form of life-designing interview that highlights the client's role in self-construction of meaning, identities, and future prospects.     

The influence of personality and theoretical models on applicants to a counselling psychology course: A preliminary study

We examined whether personality variables in prospective condidates for a postgraduate program in counselling psychology were associated with an interest in models of counselling or therapy. The models were classified as directive models or non-deiective models of counselling. Using the Millon Index of Personality Styles we found that subjects who expressed an interest in the directive models of counselling (e.g. cognitive behavioural therapy) scored higher on scales measuring interpersonal boldness, systematizing and conforming in comparison to subjects who expressed an interest in non-dieective counselling (e.g. psychodynamic) who scored greater on intuitiveness (a perference for intangible, unstructured and symbolic). Implication for training and future research in this area are discussed.     

Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults

Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments. However, little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults. Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were randomly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment. After controlling for cognitive ability at pre-treatment, cognitive behaviour therapy resulted in significantly greater reductions, than waitlist, on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition. Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period. In contrast no significant differences were found between groups on measures of worry and well-being. In conclusion, group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric populations and gains maintain for at least three months.     

Integrating theory and practice in counsellor training

A training programme for counsellors, based on the principle that counselling is a behavioural skill, is described. The programme aimed to improve client-centred skills, though the methods used could also be applied to other approaches to counselling. The pre- and post-course measures of skill were based on (a) a 45-minute recorded interview with a client, and (b) recorded responses to simulated clients, using a language laboratory. During the programme the skills were practised, with feedback on progress, using a behaviour category language. This enabled trainees to become more sensitively aware of others, to become aware of the discrepancies between their intentions and their actions, and to monitor their own progress in learning the skills. Striking changes were observed between the pre- and post-course measures. The results are discussed in relation to counselling training.     

A narrative social constructionist approach to therapeutic empathy

The concept of empathy has been a centrol conceptual element in approaches to counselling and psychotherapy that emphasise exploration of meaning in the context of a facilitative relationship. However, the existing literature on therapeutic empathy lacks theoretical coherence. a narrative social constructionist perspective represents a theoretical approach that enables the integration of diverse strands of clinical observation and research into the creation of empathic understanding in counselling. From a social constructionist position, therapeutic empathy can be understood as a relational process, a step-by-step co-construction by counsellor and client of the life-narrative of the client. In this paper, the Barrett-Lennard (1981) cyclical model of empathy is used as a fremework for examining the counsellor and client actions, strategies and tasks that constitute empathic engagement around the task of emploring and re-authoring life-narratives. Constructionist analysis of the cultural origins of the concept of empathy suggest some limitations of this way of conceptualising what happens in therapy. The implications of these ideas for theory, training and research are discussed.     

Outcomes in clients transitioning from in-person counselling to telehealth counselling with trainees

The onset of the 2020 COVID-19 pandemic necessitated a rapid transition of mental health services from in-person to telehealth counselling. Despite the far-reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in-person services delivered (i.e. pre-pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra-pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self-reports would be generally equivalent across in-person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in-person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training.     

An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety

Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89–97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230). Although research supports the overall efficacy of transdiagnostic cognitive behavior therapy (CBT) for anxiety disorders (Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice and Training, 45, 214–226), the effect of diagnostically mixed group composition on individual outcomes is less clear. This study investigated the relationship between group composition and treatment outcome within diagnostically heterogeneous groups with the purpose of determining if diagnostic heterogeneity differentially impacted treatment outcome for 84 individuals during a 12-week transdiagnostic cognitive–behavioral group anxiety treatment program (Norton, P. J. (2012a). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford). The diagnostic makeup of the treatment group was examined at the beginning of treatment and at the end of treatment, and the results indicated that the diagnostic makeup of the treatment group had no significant impact on individual treatment outcome. These findings have direct implications for the delivery of transdiagnostic treatments, and are discussed in terms of their global implications for the transdiagnostic approach to the treatment of anxiety disorders.