Self‐help strategies to reduce emotional distress: What do people do and why? A qualitative study

Background: Some people with psychological distress do not seek professional help but opt instead for self‐help strategies to reduce their symptoms. Little is known about these strategies. Aim: To investigate which self‐help approaches might be employed to reduce the effects of emotional distress, and the reasons for these choices. Method: Semi‐structured interviews with 11 clerical employees generated data analysed using grounded theory. Findings: Managing distress is a complex and multi‐dimensional process unique to each individual. The use of self‐help options is determined by the interconnection between the person's core beliefs, their social networks, and ideas about coping. Such beliefs may hinder help‐seeking. People tend to engage in activities that are familiar to them already, rather than attempt new ones. The purpose of self‐help strategies is to distract the person from their problems and to contribute to physical and mental well‐being. Implications for practice are discussed.     

Recognition of workplace bullying: a qualitative study of women targets in the public sector

Workplace bullying is increasingly acknowledged as a major workplace stressor in the UK and Europe. However, identification and recognition of workplace bullying remain problematic, among targets and within organisations. This paper reports a qualitative study which explored experiences of bullying among ten British women targets, all public sector professionals. Data were collected using in‐depth interviews and analysed using grounded theory methods. Findings showed how these targets struggled to identify and cope with bullying. Major themes or processes identified from targets' accounts included: minimising interpersonal difficulties; preserving self; maintaining commitments to professional and organisational values and cultures; sickness explanations; and naming the problem. This research has implications for the development of coping strategies by targets and organisations, and raises questions about the type of support needed to facilitate recognition of workplace bullying. Copyright © 2006 John Wiley & Sons, Ltd.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

Help-seeking behaviour and attitudes towards counselling: a qualitative study among Hong Kong Chinese university students

This study examined Hong Kong university students’ perception of general help-seeking and seeking of professional help. Thirty-two students, aged from 25 to 46 years were interviewed. A grounded theory approach was adopted. The results indicated four domains to categorise culture-influenced factors: attitudes towards speaking, relational concern, nature of the problem and assumptions about counselling. Hong Kong students are not reluctant to receive help but are reluctant to seek help from outsiders. Help is expected to be received from those within their social network. Passive coping strategies are normally adopted for finding relief and solving problems. These issues may greatly hinder people from consulting professional counsellors, or may limit the counselling process to something superficial and short term. The implications for counsellors are discussed.     

Exploration of the attitudes of employees towards the provision of counselling within a profit‐making organisation

The provision of workplace counselling has risen significantly over the last 20 years in response to the increase in stress‐related illness amongst employees in UK profit‐making organisations. Despite this expansion there is very little exploration of employee attitudes towards this provision. This paper describes a case study of employee attitudes towards counselling in a UK profit‐making organisation utilising an Employee Assistant Programme (EAP) for staff counselling. The method used for the research was a quantitative approach administered using a short questionnaire distributed to employees by e‐mail. The responses to the questionnaire illustrated that most employees were highly aware of the service and believed stress to be the highest presenting issue to the EAP counsellors. However, stress was actually the lowest presenting issue. The results from this study also suggested that managers had a more negative attitude towards counselling than non‐managers. Men and women were found to have the same highly positive attitude towards counselling. Respondents felt that wider, constant and regular positive promotion of counselling, by the employer as well as the EAP, was needed to increase utilisation of the EAP counselling service. Concerns over confidentiality for those using, or contemplating using, the service were also found — as in other studies — but this study found concerns particularly in relation to managers finding out that an employee had attended counselling. The implications of these findings are discussed.     

Cultural values and attitudes towards guidance and counselling services in one secondary school in Malaysia: the role of a school cultural system

This narrative ethnographic study aims to explore students' attitudes towards guidance and counselling services in one secondary school in Malaysia. Semi-structured individual interviews, group interviews and observations were conducted with school students of different racial backgrounds. They were identified as referred clients, self-referred clients, and those not deemed to be involved in counselling. The data were analysed using the constant comparative analysis grounded theory approach. The findings indicate that there were different attitudes among the three groups of participants concerning counselling services. The study highlights the role of a school system in elucidating attitudes towards guidance and counselling services. It poses implications for understanding counselling services within the school system.     

Counselling in the workplace: How time‐limited counselling can effect change in well‐being

Background: Many employers provide counselling support on work and personal issues for their employees, but in times of economic pressure such services can be at risk if their effectiveness is not demonstrated. Aim: To evaluate whether time‐limited counselling in a workplace can effect sustained change in well‐being. Method: The study was carried out by a staff counselling team in a university setting. The Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS) was completed by clients at the beginning and end of counselling, and at three and six months following. A non‐treatment comparison group completed the survey at the same intervals. Results: The results of our investigation show clearly that the effect of time‐limited counselling (average seven sessions) on distressed clients is positive. The evidence of our treatment group suggests that they acquire an increased sense of well‐being as a result of the experience of counselling with a significant statistical difference between pre‐and post‐counselling treatment group scores on the WEMWBS and consistently higher scores found post counselling. The improvement was maintained at the same level for at least six months following the end of counselling. Conclusions: The provision of time‐limited counselling by employers is an effective support for personal difficulties affecting work.     

Women,alcohol, self‐concept and self‐esteem: A qualitative study of the experience of person‐centred counselling

This study explores the self‐concept and self‐esteem of women with alcohol problems from a client perspective, and relates the findings to person‐centred theory and practice. Eight women with severe and long‐standing alcohol problems, who had received person‐centred counselling, were interviewed in relation to their sense of self over time. The data were analysed using grounded theory methodology, resulting in the emergence of five key categories. Examples from the interviews are used to illustrate the complex relationships between life experience, self‐concept, self‐esteem and drinking. The possible significance of the findings for counsellors working with this client group is discussed.     

Different approaches to understanding patients in general practice in Denmark: a qualitative study

General practitioners (GPs) treat more than 90% of common mental disorders. Their approaches to psychological interventions have been little studied and their process of understanding patients remains unexplored. This qualitative interview and observation study aimed to explore Danish GPs’ approaches to emotional problems and mental disorders in ‘talking therapy’ and in routine consultations. Different typical approaches were identified and could be described using the concept of mentalisation. Some participants used a basic reflective approach but no well-described method. Others were satisfied with the biomedical professional identity and did not engage in patients' emotional problems. The individual participant's approach in talking therapy was mirrored in routine consultations. Training a mentalising or reflective stance might promote more uniform therapeutic approaches to patients' emotional problems.     

Ten principles of counselling: Grounded theory in a mixed methods research project

This grounded theory (GT) study is part of an extensive mixed methods research project to develop general principles for counselling. Nine hundred counselling protocols were examined. The material is characterised by a quantitative amount of data with a qualitative character. The research is based on the systemic-constructivist research paradigm. The variety of perspectives is an important aspect of the work. Therefore, it is important that the entire research process with GT takes place in exchange with other research settings in order to minimise the limitations caused by the perspective of the researchers. During the research process, there was an intensive examination of GT in order to adapt it to the research project. By using the GT to analyse the extensive qualitative material, the actions of the counsellors were observed and 10 counselling principles were developed. This article presents the research process and the findings.     

Factors affecting the involvement of teachers in guidance and counselling as a whole-school approach

This study explores factors affecting the involvement of regular secondary school teachers in the whole-school approach to guidance and counselling by interviewing 12 secondary school teachers in Hong Kong. Emerging themes include teachers' ownership of their role in student guidance and counselling, the alignment of their disposition with education policies, school missions and culture, and their philosophy in education. Findings of what these teachers are actually doing in guidance and counselling are presented. Implications for policy-makers, administrators and leaders for comprehensive guidance and counselling programmes are drawn from constraints that limit interviewees' full potential in assisting students.     

Men's experience of considering counselling: ‘Entering the unknown’

Agency statistics in the UK and North America reveal that fewer men than women attend counselling, at a ratio of about 1:2. This study investigated men's experience of considering counselling, with the aim of gaining further understanding of factors that might contribute to the existing gender discrepancy in utilisation of counselling. Following responses by 47 men to written questionnaires, 10 men who had considered and ultimately attended counselling were interviewed, and a grounded theory method of analysis was used to generate and analyse the participants' experiences. Three interconnected categories emerged: societal perceptions of counselling and gender roles; change of experience over time; and knowledge — ‘knowing’ and ‘not knowing’ the protocols of counselling. The implications of these findings are discussed. It is recommended that prospective male clients should be provided with information about the counselling process, and that there needs to be increased awareness by counsellors and referring agents of male gender issues.     

Women's experiences of workplace bullying: changes in social relationships

This article reports a qualitative study, which investigated social processes in workplace bullying, based on in‐depth interviews with ten British women professionals who were targets of workplace bullying. Data were analysed using grounded theory methods. The resulting analysis showed links between disclosures of bullying, reactions of others, and some impacts on targets' psychological health. Key themes which emerged from the data included ‘being heard’ which describes how others reacted to disclosures of bullying behaviours, and the ‘ripple effect’ which describes how bullying impacted upon targets' significant others; these predominantly describe relationships with others outside the workplace. The theme of ‘withdrawal’ describes how targets and others managed relationships within the workplace, and ‘denial’ and ‘personalizing problems’ describe how others within the workplace responded to knowledge of bullying behaviours. The theme ‘maintaining self’ describes how participants responded to changed relationships and struggled to maintain a coherent sense of self during and subsequent to bullying. This research emphasizes the role of social processes and social environments, rather than individual or personality characteristics, in explaining the development of workplace bullying and its impacts on targets. Copyright © 2004 John Wiley & Sons, Ltd.     

Intentions to participate in counselling among front-line,at-risk Irish government employees: an application of the theory of planned behaviour

ABSTRACT

The study set out to examine intentions to engage in counselling among at-risk Irish government employees and the differential utility of two alternative theory of planned behaviour (TPB) models of behaviour to explain intentions to participate in counselling. Individuals (N=259) employed in a front-line, at-risk occupation for the Irish government completed a TPB-based questionnaire. Quantitative analyses revealed that participants held positive to neutral intentions to participate in counselling, irrespective of gender. The original TPB model explained 49.9% of variance in intentions whereas an alternative TPB model, splitting the perceived behavioural control (PBC) construct between its internal and external control components, explained a further 8.9% of variance. Furthermore, self-efficacy was found to be the strongest predictor of intentions. This study therefore supports the use of the TPB in understanding counselling-seeking behaviour.     

An inquiry into the emotional impact of sight loss and the counselling experiences and needs of blind and partially sighted people

Background: The link between sight loss and depression is well documented. The UK Vision Strategy seeks to bring the emotional impact of sight loss into public awareness and improve access to emotional support for visually impaired people. However, dedicated counselling services for visually impaired people remain scarce, and research into the effectiveness of psychological interventions is predominantly anecdotal rather than evidence based. Aim: To explore the emotional impact of sight loss in four core areas (mood, self concept, social connectedness and loss), and to explore the counselling experiences and needs of blind and partially sighted adults. Method: Data were collected using the mental health and social functioning sub-scales of the National Eye Institute Visual Functioning Questionnaire-25 and semi-structured interviews transcribed and analysed using grounded theory. Results: Participants with a serious eye condition shared a common transition from sight to blindness, starting with diagnosis, coping with deterioration of sight, experiencing loss in different areas of life, experiencing changed perceptions of self in relation to society, experiencing others in a changed way and experiencing rehabilitation. A theoretical model describing the transition from sight to blindness is proposed. Participants reported negative perceptions of counselling and a lack of counselling opportunities in relation to their sight loss. Implications: The implications for policy and practice are discussed, particularly the need for counselling after diagnosis of visual impairment and the specific challenges facing those who deliver counselling to blind and partially sighted clients.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.