Counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact such work has on the therapist

Introduction: This paper describes a qualitative study focusing on counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact this has on the therapist. Method: Semi‐structured interviews were employed and the constant comparative method utilised to analyse the data. Findings: Findings indicate that counsellors experience intense emotions in response to self‐harm including: shock; sadness; anxiety; anger; and frustration. Counsellors also struggled to manage the tension between multiple dualities, corresponding to professional opinions of a seemingly polar opposite nature. Although participants indicated a requirement to work in a client‐led way, they all had either an explicit or implicit agenda for change. These two conflicting states create a tension for a counsellor that is difficult to resolve. In addition there were various views of client progression, yet all participants agreed that progression was not simply about stopping self‐harm. Conclusion: There is a significant impact on the counsellor when working with clients who intentionally self‐harm and the complexity of the phenomenon appears to exacerbate their anxiety. Implications: Further research within the counselling field focusing on the ambiguous nature of the subject may increase understanding, which in turn may contribute to greater therapist efficacy when working with this client group.     

Toward the re‐enchantment of psychotherapy: Stories as container

Abstract

Storytelling by a therapist to clients may serve to increase clients’ ability to bear pain, to increase self‐complexity, and expand clients’ senses of the allowable. A model delineating the therapeutic impact of therapist storytelling in psychotherapy is proposed. Stories may change clients’ selves so that they may accommodate traumatic experiences and internal complexity. Stories increase clients’ capacity to tolerate painful experience and therefore serve as a container of tragic life experiences. The artistry of therapeutic story selection is defined as choosing stories consonant with clients’ strengths, rather than with the nature of the trauma. The power of story‐listening to alter consciousness in pleasant ways (storystoned) increases its usefulness as an intervention that is neither anxiety provoking nor re‐traumatizing.     

How individuals with self‐reported anxiety and depression experienced a combination of individual counselling with an adventurous outdoor experience: A qualitative evaluation

Background: Adventure therapy is a short‐term experiential psychotherapeutic approach that utilises adventurous activities and being in natural environments in order to facilitate therapeutic change in clients. The present paper examines how students with self‐reported anxiety and depression experienced participating in an innovative intervention that combined individual therapy with an adventurous outdoor experience. Clients participating in the Adventure Therapy Project received between 10–15 one‐to‐one counselling sessions prior to the outdoor experience, as well as ongoing counselling following it. Method: Interpretative Phenomenological Analysis was used in order to record and analyse the experiences of three male and three female students who presented at a major UK university student counselling service with self‐reported depression and anxiety. Findings: Twelve themes emerged which were categorised into four major domains: enhancing intrapersonal relationships; improving interpersonal relationships; providing an experiential outdoor venue for achieving therapeutic change; offering a secure, personal place for achieving inner healing. The intervention was perceived to improve the ways in which interviewees related towards themselves and other people. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing. Conclusions: Outdoor experiences offer an experiential venue for achieving personal change and, it appears enhance the therapeutic process. Prior and subsequent individual therapy increases the benefits of such experiences.     

‘Coming out’ in therapy? Perceived risks and benefits of self‐disclosure of sexual orientation by gay and lesbian therapists to straight clients

Primary objective: The study's primary objective was to investigate the experiences of gay and lesbian therapists, when considering self‐disclosure of their sexual orientation to straight (i.e. heterosexual) clients. This qualitative study set out to ascertain the key factors gay therapists take into account when considering this decision and to explore the effects this self‐disclosure may have on themselves, their clients and their therapeutic relationships. Research design: The research design was based on the use of semi‐structured interviews, undertaken with a non‐random, purposive sample of counsellors and psychotherapists (n=8) in current practice. The rationale for this method was to aid exploration of therapists' experiences of the process of self‐disclosure. Methods and procedures: Inclusion criteria were for therapists who self‐identified as being gay or lesbian, and who were experienced in clinical work with straight clients. Transcribed data was analysed using inductive thematic analysis. Main outcomes and results: Some therapists reported being confident with self‐disclosure relating to their own sexual orientation. However, a common theme related to the reportedly high levels of anxiety and vulnerability, which therapists identified. Key themes emerged around: respondents' fears of client judgement; a need for therapist self‐protection; self‐awareness of the potential impact of their own fears and prejudices on the therapeutic relationship; and the potential relevance of internalised homophobia, as an overall constraining factor. Conclusions: Self‐disclosure of their sexual orientation to straight clients is constructed, in this initial survey, as being potentially problematic and risky for some gay therapists.     

A cognitive‐behavioral model of anxiety disorders in children and adolescents

This study investigated a cognitive‐behavioral model of anxiety disorders in Japanese children and adolescents. Participants comprised 532 children from elementary schools and 751 adolescents from junior high schools as a community group, and 41 children and adolescents who fulfilled the criteria for childhood anxiety disorders as a clinical group. All participants completed three questionnaires about anxiety symptoms, self‐statements, and cognitive errors. While the clinical group showed more anxiety symptoms, negative self‐statements, and cognitive errors than the community group, there was no significant difference in positive self‐statements. Multigroup structural equation modeling found the presence of cognitive links for the community and clinical groups. Specifically, cognitive errors generated negative self‐statements, exacerbating a higher‐order factor (childhood anxiety) affecting six anxiety symptoms corresponding to the diagnostic criteria of psychological disorders. Mediated relationships were supported in only the community sample. Clinical implications for prevention and treatment of anxiety disorders in children and adolescents are discussed.     

Should psychotherapists disclose their own psychological problems?

Background: Self‐disclosures by psychotherapists can encompass a wide array of content, including information about the personal life of the psychotherapist. Aim: The goal of this study was to empirically assess reactions to psychotherapists disclosing their own personal problems to clients with similar problems. Methodology: This study explored participants' (n = 155) reactions to vignettes describing psychotherapists as either disclosing or not disclosing their own history of psychological problems to clients presenting with similar problems. Findings: Compared to otherwise identical vignettes featuring psychotherapists who did not self‐disclose, vignettes featuring psychotherapists who self‐disclosed were rated more positively in a variety of ways. Specifically, psychotherapists in the vignettes featuring self‐disclosure were perceived as possessing a higher level of favourable personal qualities and as more likely to establish strong working relationships with clients and achieve success in therapy. Limitations of the method and alternate explanations for the results are considered. Implications: Implications regarding the judicious use by psychotherapists of self‐disclosure regarding their own past psychological problems are discussed.     

Equivalence of serufuesutei‐mu (self‐esteem) and jisonshin in Japan

Most studies of Japanese self‐esteem have implicitly assumed that the concept of self‐esteem (SE) is indigenously meaningful. However, this has not been shown to be true. The present research investigated whether the indigenous Japanese word jisonshin is semantically equivalent to the English expression SE and, by implication, whether it denotes the same concept as originally delineated by Rosenberg, that of having a positive attitude toward oneself. Japanese participants (N = 234) responded to 11 pairs of statements about SE and several other items. Half of the statements contained the expression serufuesutei‐mu (self‐esteem), the other half the expression jisonshin. Participants independently judged the two expressions to be ‘basically’ synonymous, but endorsed some otherwise identical statements significantly more often when they contained the expression serufuesutei‐mu, suggesting that the differences were due to the foreign connotations of the expression serufuesutei‐mu.     

The good,the bad and the uncertainty: Trainees' perceptions of the personal development group

Background: Views about the purpose and role of personal development groups (PD group) in the counsellor training process are varied. Some argue they enhance self‐awareness, self‐exploration, the ability to be congruent and, ultimately, that they make for better practitioners. Others argue there is no clear evidence for such benefits and that they can actually be damaging to trainees. Aims: This study aimed to explore the beliefs of 25 trainees enrolled on counselling diploma or counselling psychology doctoral courses. It looked in particular at their perceptions of the purpose of PD groups and their expectations regarding support, difficulties and the scope of their participation. Method: Data was collected using open‐ended questions in an anonymous survey and was subjected to a thematic analysis. Results: Trainees appeared to hold mixed – and sometimes conflicting – views about the PD group. For some it was a positive endeavour that facilitated learning about self and clients, and helped in the processes of developing counselling skills and keeping the training group healthy. For others it was a feared space, which could elicit negative emotional experiences, and impact negatively on both learning outside of the PD group and the health of the group itself. Still others were unclear about its purpose. Hope/idealisation (of the process, the facilitator and course tutors) were also evident in the trainees' responses. Implications: Implications of these findings for counselling training are discussed.     

The Impact of Trait Anxiety on Self‐frame and Decision Making

The present study investigated how trait anxiety influenced the formation of a self‐frame and decision making. Participants (N = 1044) responded to the Trait Anxiety Inventory. Those with trait anxiety scores ±1 Z score from the sample mean (N = 328) were recalled to respond to the self‐frame questionnaire. The results suggested that trait anxiety differences could result in differences in the editing of decision‐making information, thereby influencing the risky choice. Compared with the low trait anxiety group, participants from the high trait anxiety group showed a greater tendency to use negative vocabulary to construct their self‐frame and tended to choose conservative plans. Self‐frame suppressed the influence of trait anxiety on decision making. These results further confirmed the hypothesis that individual differences in personality traits might influence the processing of information in a framed decision task. Copyright © 2013 John Wiley & Sons, Ltd.     

Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

A meditation on the nature of self‐healing and personality change in psychotherapy based on Gendlin's theory of experiencing

Abstract

From a humanistic point of view psychotherapy is a creative transformational process in which therapists assist clients’ intrinsic self‐healing tendencies. However the nature of the self‐healing process is poorly understood. I briefly consider two theories of self‐healing, Rogers’ self‐actualization theory and dialectical theory, but focus on Gendlin's theory of experiencing as providing a more complete explanation. I consider the fundamentally implicational nature of change and portray personal change as “paradigm evolution” rather than paradigm revolution. I conclude with an examination of the self‐healing process in therapies that provide minimal prosthetic assistance to the client: client‐centered therapy, eye movement desensitization and reprocessing, and focusing‐oriented therapy. I conclude that the self‐healing/self‐change process occurs when intellectual, “top‐down” cognitive and self‐critical activity is interrupted, and when clients adopt a receptive, listening attitude towards inner experience.     

The gap that makes us desperate: Paths from language to mental health

Although past research provided some clues about the relation of language use with mental health, the mediatory functions of personality variables in this relationship have been ignored. This research examined the mediatory role of self‐concept clarity in the relationship between language use perceived by individuals and mental health indicators including anxiety, depression, and alexithymia. Based on the theoretical framework suggested by ?im?ek (2010), two studies sought to test two alternative structural equation models in data from university students in the first study (n = 250) and data from other groups in the second study (n = 331). The first model assumed that the relationship of language use with anxiety, depression, and alexithymia was mediated by self‐concept clarity. The second model tested the mediatory role of both anxiety and self‐concept clarity in this relationship. The results of the first study showed that the second model fitted better to the data than the first. Consistent with the first study, the results of the second study confirmed that the second model produced better goodness of fit statistics than the first model.     

Self‐confidence,anxiety, and post‐purchase dissonance: a panel study

This study proposes an integrated conceptual model of the antecedents of post‐purchase dissonance. Data were gathered via a two‐stage panel study among consumers who made purchase of technology items. Study results demonstrate that consumer chronic characteristics (i.e., trait anxiety and generalized self‐confidence) not only directly influence post‐purchase dissonance positively and negatively but also are mediated by consumers' temporary feelings (i.e., state anxiety and specific self‐confidence) toward a purchase situation, and then indirectly influence post‐purchase dissonance positively and negatively. Trait anxiety positively influences state anxiety and that generalized self‐confidence and specific self‐confidence negatively influence state anxiety. Furthermore, trait anxiety appears to negatively influence specific self‐confidence, and generalized self‐confidence appears to negatively influence trait anxiety and positively influence specific self‐confidence.     

Working adults’ well‐being: An online self‐help goal‐based intervention

An online self‐help goal‐setting and planning (GAP) intervention to improve working adults’ well‐being was tested using a longitudinal, randomized crossover design. The study sought to (1) test the effectiveness of the intervention relative to wait‐list controls; and (2) test the stability of effects over a 3‐month follow‐up period. Participants were recruited from the UK Civil Service and were randomized to either a GAP intervention or a wait‐list control condition. Wait‐list participants then crossed‐over to receive GAP. Relative to wait‐list controls (N = 149), GAP participants (N = 158) reported significantly higher levels of positive affect (PA) and flourishing, but similar levels of negative affect (NA) and life satisfaction immediately after the intervention. Longitudinal data were analysed for the whole sample (N = 307). Compared to the start of the intervention, participants reported an increase in PA and flourishing directly after the intervention and 3 months later. NA and life satisfaction showed no change by the end of the intervention, but had improved by 3‐month follow‐up. Completing more modules predicted post‐intervention improvements in well‐being, accounting for pre‐intervention well‐being levels. The online self‐help format allowed the intervention to be offered with minimal therapeutic support, enabling convenient access by a large group of employees. The study provides an example of a successful adaptation of a clinically proven well‐being intervention to make it accessible to working adults.

Practitioner points

• Well‐being interventions proven in clinical settings can be effectively adapted for use in workplace settings with only minor alterations.
• Brief, online self‐help interventions can improve working adults’ well‐being.
• Goal‐based interventions can improve working adults’ well‐being when focused towards goals that are aligned with personal values and have been chosen by the individual.

     

The Moderating Effect of Within‐Group Similarity on Change in a Strengths‐Based Programme for Incarcerated Young Men

Many youth who are incarcerated within juvenile correctional facilities experience mental health disorders, histories of victimization and suicide ideation. Strengths‐based intervention programmes are intended to enhance participants' resilience against such challenges. However, little is known about how the composition of intervention groups contributes to programmes' efficacy. This study addresses the impact of within‐group similarity on the success of a strengths‐based intervention for incarcerated young men (n = 141). Similarity was assessed in terms of self‐reported demographics and behaviours and belief systems. Youths' masculine ideology, caring and cooperative behaviours, ethnic pride and respect for differences, self‐efficacy regarding education and non‐violence, and attitudes about criminal behaviour were measured before and after intervention. Results indicate that participants' caring and cooperative behaviour increased during the intervention. However, their education‐related self‐efficacy was reduced, and the perceived benefits of criminal activity increased. These changes were moderated by group composition: less similarity between participants and their group members was associated with less negative change. In the context of juvenile corrections facilities, where staying the same may be a relatively positive outcome, perhaps the more relevant question is not which processes and characteristics of others better enable youth to change but which experiences help them retain positive aspects of themselves. Copyright © 2014 John Wiley & Sons, Ltd.     

Self‐Efficacy Among Adults in Substance Abuse Treatment: The Role of Religious Coping

In substance abuse treatment, general self‐efficacy and religiousness are factors that may support positive outcomes. The authors surveyed clients receiving substance abuse treatment (N = 121) and found that religious coping predicted general self‐efficacy scores. Clinical implications are discussed.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Should your lips be zipped? How therapist self‐disclosure and non‐disclosure affects clients

Is therapist self‐disclosure a therapeutic technique or a therapeutic mistake? Is it useful? Is it ethical? This study attempts to address this controversy among therapeutic modalities by asking clients about their perceptions of self‐disclosure and non‐disclosure. Eighteen people (16 women, two men), currently in therapy in two Canadian cities, generated 157 incidents of both disclosure and non‐disclosure. The incidents were first coded as helpful or unhelpful. Cross‐tabulation of the results showed that disclosures were more than twice as likely to be experienced as helpful; non‐disclosures were twice as likely to be unhelpful (χ² (3, N=157) = 14.439, p≤0.002). One‐quarter of these incidents was coded by two independent raters; inter‐rater reliability was high (Pearson corr. ranged from 0.755 to 1.0, p≤0.01). The data was then sorted, using the Constant Comparison method, into themes, starting with, but not limited to, the themes suggested by the literature. The greatest single effect was on the therapeutic alliance, both positive and negative. Clients’ perceptions of helpful disclosures and non‐disclosures generally supported therapists’ rationales. There was also some evidence that when clients found disclosures unhelpful, the reasons also supported theoretical rationales against disclosing. Rather than simply supporting either position in the controversy, this study suggests that skill, or lack of it, was the intervening variable that affected the perceptions of both techniques. Further research on the effects of skill on both disclosure and non‐disclosure are warranted. This study has implications for both researchers and practitioners.     

When does anxiety help or hinder cognitive test performance? The role of working memory capacity

Cognitive interference theories (e.g. attentional control theory, processing efficiency theory) suggest that high levels of trait anxiety predict adverse effects on the performance of cognitive tasks, particularly those that make high demands on cognitive resources. We tested an interaction hypothesis to determine whether a combination of high anxiety and low working memory capacity (WMC) would predict variance in demanding cognitive test scores. Ninety six adolescents (12‐ to 14‐years‐old) participated in the study, which measured self‐report levels of trait anxiety, working memory, and cognitive test performance. As hypothesized, we found that the anxiety‐WMC interaction explained a significant amount of variance in cognitive test performance (ΔR² .07, p < .01). Trait anxiety was unrelated to cognitive test performance for those adolescents with average WMC scores (β = .13, p > .10). In contrast, trait anxiety was negatively related to test performance in adolescents with low WMC (β = ?.35, p < .05) and positively related to test performance in those with high WMC (β = .49, p < .01). The results of this study suggest that WMC moderates the relationship between anxiety and cognitive test performance and may be a determinant factor in explaining some discrepancies found in the literature. Further research is needed to fully understand the mechanisms involved.