Avatar‐based counselling for young people within school counselling. Qualitative analysis of client experience

Background

This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world ). The intervention was piloted in eight secondary schools in the UK in 2016.

Aims

Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness.

Materials and Methods

Interviews were semi‐structured and were analysed using thematic analysis.

Results

The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness.

Discussion

There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds.

Conclusion

Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling.     

Very brief psychodynamic counselling with young people

Abstract

This paper attempts to re-create the flavour and the atmosphere that is evoked when counsellor and client meet with prior agreement to engage in a piece of very brief counselling work. The context is an informal self-referral service operating on the boundary of a large psychiatric clinic which specializes in psychoanalytic and systemic work.

The situation provides a transitional space for both counsellor and client to observe and to learn from their own responses to each other and in so doing to concentrate their minds on the essential core anxieties that the client is currently experiencing. In this way the area of difficulty can be named and become available for thought.     

Practice‐based evidence in school‐based counselling

Aims: Counsellors are becoming commonplace within the support structures of secondary schools. To date, research findings from practice‐based outcome studies suggest this is a positive move. There are, however, numerous limitations to this work, and this project aims to develop this existing body of literature. Method: Nine 13–15 year olds attending counselling in six school‐based services participated in the project – one individual withdrew. A standardised self‐report questionnaire (YP‐CORE) was collected at four intervals: (1) the point of referral; (2) the onset of counselling; (3) the completion of counselling; and, (4) a two‐month follow‐up. The change indicated in each of these phases is examined and reported here. Additionally, YP‐CORE was completed during each session. Findings: The YP‐CORE indicates an improvement in the well‐being of this small sample, while waiting for and attending therapy. Further examination of session‐by‐session data also highlights how pre‐ and post‐outcome data should not necessarily be viewed as linear in nature. Discussion: This is a small‐scale investigation and further work is needed in this area. It does, however, raise a number of issues regarding the complexity inherent in conducting outcome research that warrant further investigation.     

Motivation as a predictor of outcomes in school‐based humanistic counselling

Background: Recent years have seen a growth in the provision of counselling within UK secondary schools, and research indicates that it is associated with significant reductions in psychological distress. However, little is known about the moderators and mediators of positive therapeutic benefit. In the field of adult mental health, motivation has been found to be one of the strongest predictors of therapeutic outcomes, and it was hypothesised that this may also be a predictor of outcomes for young people in school‐based counselling services. Aims: To assess the relationship between young people's motivation for counselling and its effectiveness within a secondary school setting. Sample: Eighty‐one young people (12–17 years old) who attended school‐based humanistic counselling services in Scotland. Method: Clients completed a measure of motivation for counselling at the commencement of their therapeutic work and a measure of psychological wellbeing at the commencement and termination of counselling. Results: Motivation for counselling was not found to be significantly related to outcomes. Discussion: The results indicate that the association between motivation and outcomes may be weaker in young people as compared with adults. However, a number of design factors may also account for the non‐significant findings: insufficient participants, marginal reliability of the motivation measure and social desirability effects.     

Self‐construal and students’ math self‐concept,anxiety and achievement: An examination of achievement goals as mediators

This study examines the role of self‐construal in student learning by testing a mediation model: through math achievement goals, self‐construal predicts math self‐concept and anxiety, which further predict math achievement. A sample of 1196 students from 104 secondary classes in Singapore took a survey and a math achievement test. The results from multi‐group structural equation modelling support measurement invariance and equal path coefficients in the mediation model between boys and girls. Interdependent self‐construal positively predicted mastery approach and avoidance goals, through which interdependent self‐construal had a positive total indirect effect on math anxiety. Independent self‐construal positively predicted mastery approach, performance approach and performance avoidance goals, and through the two approach goals, high independent self‐construal was associated with high math self‐concept. Overall, self‐construal was not associated with math achievement. The findings enhance our understanding of achievement motivation from a sociocultural perspective and help explain East Asian students’ relatively higher anxiety and lower self‐concept in comparison with their Western counterparts as reported in international studies.     

An exploration of an integrated counselling and coaching approach with distressed young people

This mixed methods study explored the effectiveness and experience of an integrated counselling and coaching approach with young people. An effectiveness study allocated 80 young people aged between 13 and 25 years from four Youth Information Advice and Counselling Services centres in England to two groups: an integrated counselling and coaching group, based on the Personal Consultancy (PC) model, and a humanistic counselling group. Self-report measures of distress were administered at baseline and endpoint. Findings of the quantitative analysis showed that although baseline distress levels between groups were equivalent, post-intervention levels were significantly lower in the integrated group. Interpretative Phenomenological Analysis of qualitative experiences from five young people from the integrated group explored possible reasons for these results. Five master themes emerged: making sense of past, present and/or future, developing a sense of agency, management of affect, enhancing interpersonal relationships and development of self. Findings indicated that young people responded well to the integrated treatment; attending to intra-psychic issues alongside their developmental challenges seemed to have a beneficial effect on their sense of agency in particular. In conclusion, PC may be an effective means of reducing distress in young people.     

Therapeutic outcomes in the Welsh Government's school‐based counselling strategy: An evaluation

Aims: The purpose of this study was to evaluate the outcomes of school‐based counselling, as delivered in the Welsh Government's School‐based Counselling Strategy, for reducing psychological distress in young people aged 11–18. Method: The study used a quantitative cohort design, comparing levels of distress on either the Young Person's CORE (YP‐CORE) or the Strengths and Difficulties Questionnaire (SDQ) from baseline to endpoint. Data were available on 3613 episodes of counselling, across 42 datasets. Meta‐analytical procedures were used to identify the mean effect size and predictors of outcomes. Results: Within each dataset, counselling was associated with significant reductions in psychological distress, with a mean effect size (d) of 0.93(95% CI = 0.89–0.97) using a fixed effects model and 1.09 (95% CI = 0.97–1.22) using a random effects model. Datasets using the YP‐CORE had larger effect sizes than those using the SDQ, and datasets with more complete response rates had lower outcomes than those with poorer response rates. Conclusion: The results confirm that school‐based counselling, as delivered in the UK, is associated with significant reductions in psychological distress, comparable to adult counselling and psychotherapy services.     

Reflecting on Maltese school‐based counselling practices: An autoethnographic collaborative writing project

Maltese counsellors working in schools are, at times, just making ends meet due to lack of human resources and work schedules. ‘Why do our students/children have to repeat the same story to so many professionals?’ teachers/parents angrily query. This autoethnographic study voices our professional experiences as authors and participants. This empowers us to be advocates for our young clients. Collaborative autoethnography (CAE) methodology best fits our research question as we ‘seek to discover and systemically analyze (graphy) personal experience (auto)…understand cultural experience (ethno)’ (Ellis, Adams, & Brochner, 2011, p. 273). Our writing and reflections conclude that best practices include counsellors who work, at least, in pairs within transdisciplinary teams at one school for cycles of five years, with clarity of roles across professionals.     

Inter-professional learning: initial observations of the art psychotherapy tools used in the post-qualifying postgraduate training in counselling children and young people

ABSTRACT

Children and young people (C&YP) counselling training and art psychotherapy training lead to two distinctive psychological therapy approaches; one is informed by British Association for Counselling and Psychotherapy’s Competences for work with children and young people (4–18 years) [BACP. (2019a). Competences for work with children and young people (4–18 years). Retrieved from https://www.bacp.co.uk/media/5863/bacp-cyp-competence-framework.pdf], the other by Health and Care Professions Council’s Standards of Proficiency for Arts Therapists [HCPC. (2013). Standards of proficiency - Arts therapists. Retrieved from http://www.hpc-uk.org/publications/index.asp?id=39#publicationSearchResults]. In this article we outline the training methods utilised on the Postgraduate Diploma in Counselling C&YP at a British University and share initial observations of how creative and arts-based therapeutic tools form an important part of the curriculum delivery. The aim of this paper is also to outline the role of intentionality application in the use of creative interventions in therapeutic practice.     

Online counselling: The experience of counsellors providing synchronous single‐session counselling to young people

Kids Help Line (KHL) is a national Australian youth counselling service that provides free online and telephone counselling. This qualitative study examines the experience of 26 online KHL counsellors. Using a focus group methodology, counsellor responses were organised into categories: privacy and an emotionally safe environment; communication through text; and time. Counsellors reported the main benefit of the online environment to be emotional safety, due to reduced client emotional proximity to the counsellor, and the main disadvantage to be that reduced emotional proximity and the absence of non‐verbal cues could result in communication problems and difficulty in accurately assessing young people's concerns. Time proved a significant issue for counsellors, as the slow speed of text exchange could limit their ability to complete interventions. Methods that enhance both the process and effectiveness of online counselling are needed. Potential solutions to the challenges faced by online counsellors are 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.     

Counselling young people: Counsellors' perspectives on ‘what works’ – An exploratory study

Aim: Counsellors who work with young people in a range of contexts know that they are not engaging with ‘mini‐adults’. The issues young people bring to counselling are often complex, challenging and wide‐ranging, as adolescents are experiencing times of turbulence and change in their physical, emotional, social and psychological development. This paper focuses on a research project undertaken with five counsellors who work with young people, and asks the question: ‘What works?’ Method: The research project is an in‐depth qualitative study into the counsellor's experience of counselling young people, using a narrative approach. Findings: Four key shared themes emerged: the significance of ‘safety’ in the relationship; building the therapeutic alliance; flexibility and integration relating to theoretical orientation; and the use of creativity. Outcomes: This paper offers counsellors the opportunity to reflect on ‘what works’ and consider the professional knowledge, which underpins their own counselling practice with young people.     

Users of secondary school‐based counselling services and specialist CAMHS in Wales: A comparison study

Background: The increasing prevalence of mental health issues in young people has contributed to a rise in the provision of school‐based counselling services in the UK. Between 2008/09 and 2010/11, data were collected from users of secondary school‐based counselling services in Wales. Aims: To identify the characteristics of users of school‐based counselling services in Wales – including demographics, referral pathways, presenting issues, and predominant issues – and how they compare to users of specialist CAMHS in Wales and Welsh secondary school pupils in general. Method: Data were collected on 10,687 episodes of counselling. School counsellors completed a client record sheet after each counselling episode and submitted these to their Local Authority. Collated results were then compared to matched data from Welsh specialist CAMHS and Welsh secondary schools data. Results/findings: A typical user of a secondary school‐based counselling service in Wales was female, of white ethnicity, and from the ‘middle’ school years. There was a marked under‐representation of users from BME backgrounds. Users were most often referred by school staff, and the most common presenting issues were family‐related, anger, and behaviour‐related. Conclusions: There was a higher proportion of females accessing school‐based counselling services than males. This was in direct contrast to data from specialist CAMHS and possible explanations for this are discussed. The under‐representation of BME populations suggested that there were some equality issues associated with accessing these services. Implications for practice: Future research should explore equality issues associated with young people from BME backgrounds accessing intervention services.     

Counselling marginalised young people: A qualitative analysis of young homeless people's views of counselling

Aims: This study explored young homeless people's views of counselling, with a view to considering how the counselling profession can better meet their needs. Method: A small scale qualitative research project was undertaken in two residential projects for young homeless people. Data was gathered through focus groups and then analysed using grounded theory. Findings: The study revealed a lack of trust in counsellors and counselling, as well as a dislike of the counselling process. Implications for practice: Some suggestions for how best to work with this particularly marginalised client group are discussed. These include ways of making counselling more engaging, raising the profile of the counsellor in the young person's environment and having an awareness of the needs specific to at‐risk young people.