Introducing SYPRENE: An International Practice Research Network for Strategic and Systemic Therapists and Researchers

SYPRENE, a new international Systemic Practice Research Network (PRN), has been established to fill the gap in practice-based research on the effectiveness and efficiency of strategic therapies. This article presents the rationale for the creation of SYPRENE and describes data collection methods, and the encoding system implemented within this PRN. More developments are expected in the recruitment of practitioners, the types of data collected, findings, and the implementation of SYPRENE in supervision, trainings, and professional schools.     

Short versus longer term effectiveness of an outreach program for the homeless mentally Ill

Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking. This research was supported in part by a grant from the National Institute of Mental Health, #H87 MH44373, to the Michigan Department of Mental Health.     

The Art Therapy Practice Research Network: Hurdles,pitfalls and achievements

Aim: This article gives an overview of the setting up of the Art Therapy Practice Research Network (ATPRN) in 2000, amidst a culture resistant to research. The authors discuss their experiences in changing this culture and encouraging art therapists to become practitioner/researchers. They identify learning points that may be helpful for other professionals who want to form new practice research networks (PRNs). Context: The research and practice context contemporary to the ATPRN foundation is outlined and identified as a significant influence on its inception and development. Key events in the 14 years of the PRN's life and articles on art therapy and psychotherapy research published at the time of the ATPRN foundation are used to illuminate the historical context. ATPRN newsletters and symposium reports were consulted to identify themes and issues across 14 years of development and growth. Learning points: Several learning points are identified and listed as useful factors to address when setting up and maintaining a PRN and include: shape the culture from the start; review and revise; get practical together; encourage members' presentations; build synergy with professional body; embed the ATPRN around all aspects of research publication. Conclusions: Successful PRNs depend on making practitioners feel included from the start by acknowledging fear and anxiety about research. Providing practical projects helped practitioners to feel less isolated by being part of a meaningful and productive network. Maintaining and developing PRNs is an iterative process that demands constant reviewing and revising.     

Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.     

School‐based humanistic counselling for psychological distress in young people: A practice research network to address the attrition problem

Aims: School‐based humanistic counselling (SBHC) is a common psychological intervention for young people, particularly in the UK. However, studies have tended to suffer from high attrition rates, such that effects may have been over‐estimated. This paper describes a low budget ‘star topology’ practice research network (PRN) outcome evaluation of SBHC in a sample where attrition rates were minimised. Design: A practice‐based longitudinal study in a small PRN compared levels of psychological distress at first and last session from session‐by‐session data. Multilevel regression modelling was used to identify predictors of outcomes. Methods: Eight counsellors working across 11 schools agreed to use session‐by‐session self‐rating on the Young Person's CORE (YP‐CORE) yielding data from 256 young people aged 11 to 17. Predictors of outcomes were analysed using multilevel regression analysis. Results: Mean levels of distress on the YP‐CORE reduced from 18.29 (SD = 7.32) at baseline to 9.10 (SD = 6.19) at endpoint, giving a baseline to endpoint effect size of 1.26 (95% CI = 1.06–1.46). Lower levels of psychological distress at endpoint were associated with male clients, younger age groups, greater rates of attendance at counselling, and bereavement as a presenting problem. Conclusions: This ‘star topology’ PRN focused on a single study and demonstrated that such a system can provide relatively low cost, high quality data. The data showed that SBHC is associated with large reductions in psychological distress, and that this cannot be attributed to the high attrition rates of previous datasets.     

Does Receiving Genetic Counseling Impact Genetic Counselor Practice?

This study was an investigation of whether genetic counselors have received genetic counseling and if so, how they believe it affects their practice. One thousand genetic counselors were mailed surveys about the nature of genetic counseling services received, impact on their clinical practice, frequency and reasons for disclosing about their receipt of counseling to their clients, and demographics. Ninety-three of the 510 respondents reported receiving genetic counseling. Of these, almost three-fourths were practicing genetic counselors while receiving services. Reasons for services include prenatal concerns, family history of cancer, and history/risk of other genetic conditions. Frequently endorsed effects on practice include increased empathy and understanding of client decisions, feeling more connected with clients, greater emphasis on psychosocial support, and sympathy. Forty-six respondents disclosed to clients about their receipt of genetic counseling. Prevalent reasons include client asked, help clients feel they are not alone, demonstrate counselor understanding, decrease client anxiety, build rapport, and normalize client feelings. Practice and research recommendations are given.     

Culturally competent assessment practice in the United States

Assessment practice with multicultural populations in the United States requires cultural competence. Culturally competent assessment includes culture-specific styles of service delivery, use of the client's first language, and an evaluation of the client as a cultural being prior to test administration using cultural orientation categories. This information is essential for understanding health/illness beliefs, to indicate the possible presence of culture-specific symptoms, and to select standard or culture-specific tests. Assessment ethics recognize the desirability of alteration or modification of standard tests by translation and development of new norms. Cross-cultural construct validity, response sets, and cultural variables are also research priorities. Culture-specific tests should be constructed and validated for some clients as determined by cultural orientation status. Feedback of test findings to clients and significant others should be consistent with cultural expectations. Professional and societal benefits of cultural competence in assessment are suggested.     

A Case Study Demonstrating Reduction of Aggressive Client Behaviors Using the Neuro-Occupation Model: Addressing Professional Burnout through Nonlinear Thinking

This single case study suggests that mental health practitioners adopt nonlinear modes of thinking within the neuro-occupation model to avoid professional burnout. Accordingly, the elimination of severely aggressive behavior of an institutionalized client was reviewed following an intervention using the model. Provided with new opportunities, the client self-extinguished aggressive interactions, reinstated social behaviors, and expanded occupations. Accepting clients as their own change agents limits our role to facilitators and reframes service delivery in mental health, which argues for comparison studies that measure reduced burnout in occupational therapists using the model.     

New frameworks for careers guidance: developing a conceptual model of the interview

Recent research has highlighted limitations in our understanding of the dynamics occurring within the careers guidance interview. A study was conducted of how the client and practitioner engage in the exchange within the interview and how meanings are negotiated and received by each of the participants. The objectives for the study were to examine a sample of guidance interviews in order to: (i) identify which interventions by practitioners are perceived as helpful and unhelpful by clients and practitioners; (ii) establish how helpful and unhelpful interventions relate to change in understanding; and (iii) compare and contrast the identification and commentaries by practitioners and clients. The results showed that practitioners reported significantly more helpful interventions than clients and that there was limited agreement in the identification of interventions. Three thematic categories were derived to group the helpful interventions. This analysis provided the basis for the development of a conceptual model of the interview. Further research to test the model and assess its potential to inform careers guidance training and practice is outlined.     

Informing supervision practice through research: A narrative inquiry

Intention: This study focused on questions of whether and how clients benefit from supervision. As practitioner research, the study was intended to shape the researchers’ own supervision practice. Method: The qualitative approach was based on interviews with a small number of experienced practitioners about their supervision experiences. The findings are presented in the form of reflexive stories, told by each researcher. Findings: In these stories the researchers tell how engagement with experienced practitioners’ accounts of their past supervision shaped the hopes and intentions the researchers hold for their future supervision. Implications forpractice: The stories suggest there are therapeutic benefits in an ethic of transparency that provides for practices that overtly carry stories in both directions between counselling and supervision.     

Group work in general practice

In this article, consideration is given to a problem often experienced in relation to courses offering psychodynamic understanding to front-line workers with troubled clients – the complexity for the student in taking the learning ‘home’ in a productive manner and the potential isolation of the student in, or alienation from, their workplace. A model of course delivery is described in which an active three-way partnership between student, course and workplace is fostered which enhances the students' learning, enables the workplace to benefit more fully from the course and enhances the effectiveness of the course in improving service to the ultimate client – the service user.     

Practice‐based supervision research: A network of researchers using a common toolkit

Aim: Given that various systematic reviews of supervision literature have revealed how little is known about supervision, that studies are not usually routed in practice, and that a multitude of diverse measures are used, the primary aim of this project was to support and encourage practitioner research related to supervision using a prescribed common set of instruments. Method: Funded by the British Association for Counselling and Psychotherapy (BACP), a Supervision Research Practice Network (SuPReNet) was established. A toolkit (a series of measures) that could be used routinely by practitioners was selected following the assembly of available measures of supervision and an assessment of them. Findings: The appraisal, conducted by the three authors, yielded five core measures, free for anyone to use, and accessible through the SuPReNet website. The measures are being piloted through a practice research network at a university counselling and psychotherapy research clinic where supervision data are being collected through a special module of CORE Net. Discussion: The potential yield from this initiative for practitioners, researchers, and the developing evidence‐base is discussed and a model proposed for the next generation of research on supervision.     

The American Counseling Association Practice Research Network (ACA‐PRN): A New Research Tool

In an era of increasing accountability, there is a need to provide data on counseling outcomes. That is, there is a need to substantiate the claim that counseling works. This article describes the American Counseling Association Practice Research Network (ACA‐PRN), which is designed to provide data on evidence‐based counseling.     

Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

Young clients' narratives of the purpose and outcome of counselling

This study explores how adolescent clients construct the purpose and outcome of counselling. A narrative analysis was performed on interviews with 22 clients (aged 16–18) who had used a school-based counselling service. The aim was to identify the purpose and outcomes that participants attributed to their counselling experience. The analysis identified four narrative forms that young clients used to describe counselling. These included ‘transformative’, ‘supportive’, ‘pragmatic’ and ‘disappointed’ narratives. Each narrative form constructed a different purpose and outcome for counselling. Engaging with clients' narratives about the purpose and intended outcome of counselling may allow counsellors to better match their expectations and approach to fit with their young client or to work with them to co-construct more flexible narratives that support helpful outcomes.     

Holistic representation in juvenile defense: An evaluation of a multidisciplinary children's defense team

This study describes the results of an evaluation of a holistic defense model for juvenile clients. Longitudinal, retrospective analysis of de‐identified data from clients (N = 308) measured individual variable outcomes, relationships, and project performance. Bivariate and multivariate analyses examined the strength of association and interrelationships among client and defense team variables. Findings indicate that holistic defense was significantly associated with improved outcomes among juvenile clients, including increased mental health assessment resulting in treatment, increased employment and educational attainment, and decreased odds of recidivism. Favorable court or dispositional outcomes, including lower adjudication or early termination from custody, were also reported. Further practice‐level, controlled research is necessary to evaluate these models and offer comparison to other models for holistic defense.     

Conversational perspective of therapeutic outcomes: The importance of preference in the development of discourse

Major theme: Evaluation of therapeutic outcome. Logical development of the theme: We suggest a way for practitioners and researchers to assess if they are on track in conversing towards client preferred goals. We offer a critique of more conventional approaches to studying therapeutic progress, suggesting how a discursive (i.e. focused on interaction and language use) lens can address these limitations. Through this lens we examine therapeutic progress evident in ‘preference work’, where clients demonstrably indicate, imply, agree and disagree with where the therapeutic conversation is heading. Such ‘preference work’ offers a form of evidence of within‐session outcomes in a process of reaching larger client preferred outcomes. Authors’ point of view: We present the results of conversation analysis – a qualitative approach to the study of therapy – to illustrate our discursive perspective on therapy progress and change. Implications: we suggest a way for practitioners to assess if they are on track in conversing towards client preferred goals. We propose that our interactional perspective may significantly contribute to bridging practice and research in therapy.     

Termination: Analytic Reflections on Client Contact After Counselor Relocation

Client post-termination contact with counselors who have relocated has been neglected as a training and practice issue. The client may attempt to re-open the therapeutic relationship, even though the counselor has moved to a different geographical location and is not available to continue service delivery. In this article, analytic reflections are used to explore counselor, client, and process variables relative to counselors' response to “following” clients.     

The Client's Perspective of Genetic Counseling—A Grounded Theory Study

Previous studies of genetic counseling have mainly focused on outcomes defined by researchers or service providers, and have frequently related to changes in reproductive behavior and/or client knowledge. A longitudinal study of 43 families referred to a clinical genetic service was undertaken to ascertain client needs and expectations of the service, and to identify relevant outcomes from the clients' perspective. Semistructured interviews were conducted with each client, prior to and after genetic counseling. The transcribed interviews were analyzed using grounded theory. The need for certainty emerged as a powerful factor that motivated clients to pursue the genetic referral. The client's lay knowledge of the condition, satisfaction of the need for certainty, and the formation of a personalized relationship between the client and the genetics staff significantly influenced the central outcome, identified as a change in the client's psychological adaptation to the genetic condition in the family.