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.     

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.     

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.     

心理的动态平衡论与和谐心理构建——兼谈灾后心理辅导

人的心理是一个动态开放的系统,这个系统在运动、变化、发展中遵循从相对平衡到相对不平衡,再从相对不平衡走向新相对平衡的规律。人心理问题的实质是由于内部或外部某些因素的运动变化,致使心理系统的相对平衡状态遭到破坏,在个体内部及个体与环境之间出现的暂时相对不协调状况,属于从一种心理平衡状态向另一种心理平衡状态的过渡阶段。结合灾后心理辅导,根据动态平衡论提出了心理系统的边界调控、要素调控、途径调控和环境调控,通过个体自身的努力以及这些调控措施,让个体心理顺利地恢复到可以自我调节的动态平衡状态,或者从低级的动态平衡状态顺利地过渡到更能适应环境的高一级的动态平衡状态。     

Embodied narratives in becoming a counselling trainer: an autoethnographic study

This autoethnographic study addresses the newly appointed counselling trainer's question ‘How did I get here?’ The procedure is described, and findings are presented as partial narratives of the Wounded Dancer, poems and prose written from different voices. Themes are revealed of love, healing, risk taking, unconventionality, physicality and overcoming physical limitations. ‘Wounded healer’ stories are inscribed alongside ‘powerful body’/‘subversive body’ stories. The role of the father is considered in facilitating these stories, including the tomboy throwing off ‘definitions of what it means to be a girl’. The study is evaluated in terms of Richardson's (2000) criteria. One contribution to knowledge lies in the methodology's potential application to research-led learning and teaching with counsellor education.     

Introducing counselling in secondary schools: A case study with reference to frame issues

Abstract

I am a deputy headteacher in a comprehensive school. I believe that the widespread re-introduction of counselling into secondary schools offers possibilities for great benefit, both in terms of the personal well-being and emotional health of students, and also in terms of academic results and other educational indicators. It is my view that, currently, this may particularly be true for boys.

This paper is a double case study: first, of the failure of a student to cope with ordinary schooling because of his emotional difficulties; and, second, of the establishment of a counselling service which resulted from his permanent exclusion from the school.

I allude to some of the theoretical issues which meshed with the practical details of establishing the counselling service, and offer some tentative conclusions about the rationale for counselling in secondary schools and the kind of model which seems most likely to be beneficial.     

The effectiveness of UK student counselling services: an analysis using the CORE System

Despite concern surrounding the mental health of students, brought about by the government's policy of widening participation and increasing demands upon students, the effectiveness of student counselling has been a neglected research area. This study examines data from seven UK student counselling services using the CORE System in the routine evaluation of their services. Results indicate that counselling is effective, with 70% (service range 67% to 83%) of clients with outcome measures available showing reliable improvement on the CORE-OM from pre- to post-therapy. However, students who complete a course of counselling show significantly greater improvement, according to practitioner pre- and post-therapy severity ratings of depression and anxiety, than those clients who drop out or have an unplanned therapy ending (effect size 1.03, 0.85, respectively). The stage at which students drop out of therapy is important, with those students dropping out of therapy before the third session being the most vulnerable. The implications of these findings are discussed.     

Understanding the role of hope in counselling: Exploring the intentional uses of hope

In this paper we look at various conceptual models of hope and research evidence for the integral role that hope plays in counselling. We recognize hope as a dynamic process during which counsellor and client interact in ways that can be mutually influencing and we review research that explores this reciprocal process. A model for the intentional use of hope in counselling that recognizes both implicit and explicit approaches is offered. Metaphors for hope-work that position and re-position both counsellor and client in ways that may foster hope are explored. Finally, we provide suggestions for initiating conversations in which hope can be an explicit therapeutic focus.     

Certainty and uncertainty in genetic counselling: a qualitative case study

This study examines the communication that occurs during routine genetic counselling sessions. It involves the qualitative analysis of nine consultations with one member of a clinical genetics team. The consultations were characterised by a contrast between the sense of certainty apparent in how the clinicians talked about the power and promise of the new genetics and the uncertainty communicated regarding the actual information produced by genetic tests and their limitations in solving people's problems. There was also a contrast between how the clinician seemed to control the format and agenda of the consultation and the apparently uncontrollable personal and social implications of the topics discussed. We speculate that this may be explained in terms of the clinician giving some order and certainty in an area of inherent uncertainty, and where great promises are as yet unrealised.     

Tracking trends: A longitudinal look at internship placements in counselling psychology in the United States

Efforts to track trends in internship placements across time serve the field of counselling psychology in a number of ways. But this research is qualified by its reliance upon a single source of data: the Council of Counseling Psychology Training Program (CCPTP) annual survey. This paper provides a review of the concerns related to this over-reliance, and addresses these concerns by supplementing this data source with the comprehensive data collected by the Association of Psychology and Post-doctoral Internship Centers (APPIC). Findings provide a longitudinal look at the supply and demand issue concerning internship placements, track the nature of pre-doctoral internship placements across a 30-year period of time, and generally support the validity of the CCPTP data by documenting their close correspondence to recent APPIC data.     

Beyond the qualitative paradigm: A framework for introducing diversity within qualitative psychology

The case for qualitative research in psychology is considered. We argue against the idea that qualitative research is merely a matter of technique or method, and question the utility of viewing it as a unitary paradigm. Rather, the links between epistemology, methodology, and method are explored within three theorized strands of qualitative inquiry, making reference to illustrative projects. Each strand is organized around a different approach to the issues of justifying and warranting psychological knowledge: (1) reliability and validity; (2) generativity and grounding; and (3) discourse and reflexivity. These are exemplified in Miles and Huberman's ‘data display’ model, Glaser and Strauss' method of ‘grounded theory’, and in various forms of ‘discourse’ analysis. Reflections upon points of contact between the three strands address two main issues: (1) rendering research publicly accountable; and (2) challenging relativism.     

Mapping grief: A study in practice using a quantitative and qualitative approach to exploring and addressing the range of responses to loss

The Adult Attitude to Grief (AAG) scale was devised for an earlier study (Machin, 2001) to test the validity of a concept of loss, which proposed that grief reactions fall broadly into three categories — ‘overwhelmed’, ‘balanced’ and ‘controlled’. There was statistical support for the proposed differences but the AAG scale, more importantly, provided insight into the diverse reactions taking place in individual bereaved respondents. This paper describes a second study undertaken to examine the clinical usefulness of the AAG scale with clients receiving help within the Psychological Services Operating Unit of the North Staffordshire Combined Healthcare (NHS) Trust. The scale has been used both in its original form with bereaved clients and in a modified form with clients having distress symptoms associated with other losses, such as relationship breakdown or the onset of chronic illness. The use of the AAG scale in this clinical setting suggests that, both as an assessment tool and as a cue for therapeutic dialogue, it provides a promising way of mapping the general and particular characteristics of response to loss in individual clients. Consideration is also given to varying therapeutic approaches needed to help clients regain the equilibrium disturbed by their grief.     

A follow-up study on students attending a university counselling service in Northern Italy

The aims of this study were to evaluate the effectiveness of a university counselling service in Northern Italy, to assess the sociodemographic and clinical characteristics of students who used counselling service, and to assess the psychological conditions of the students who ended the counselling after a 4 month follow-up period. The study involved 100 students, who filled out the General Health Questionnaire (GHQ-12), the Brief COPE Inventory, and the Symptom Checklist-90-Revised (SCL-90-R). The results showed that who received counselling were positively affected by this experience. The areas of benefit were psychological well-being, coping behaviours, ability to positively reframe problems and less sense of guilt. Additional studies are needed to identify which factors influence the outcomes of university counselling services in Italy. These studies would be important to evaluate the services rendered, upgrade the skills of counsellors and visualise priority areas of need.     

Therapist perspectives on using silence in therapy: A qualitative study

Twelve experienced therapists were interviewed about their perceptions of why they used silence in therapy. Qualitative analyses revealed that these therapists typically perceived themselves as using silence to convey empathy, facilitate reflection, challenge the client to take responsibility, facilitate expression of feelings, or take time for themselves to think of what to say. Therapists generally indicated that a sound therapeutic alliance was a prerequisite for using silence, and they typically educated their clients about how they used silence in therapy. Therapists typically believed they did not use silence with clients who were psychotic, highly anxious, or angry. They typically thought they now used silence more flexibly, comfortably, and confidently than when they began doing therapy. Therapists typically believed they learned how to use silence from their own experience as a client and from supervision.     

Perceptions of stress and stress interventions in finance organizations: Overcoming resistance towards counselling

This paper presents the findings from a qualitative study conducted to gain further insight into the attitudes of finance organizations towards workplace stress and stress interventions. Semi-structured interviews were used and seven individuals, each representing their organization, participated in the study. Interpretative Phenomenological Analysis (IPA) (Smith, J., Jaraman, M., & Osborn, M. 1999 Smith J Jaraman M Osborn M 1999 Doing interpretative phenomenological analysis In M. Murray & K. Chamberlain (Eds) Qualitative Health Psychology London Sage [Crossref] [Google Scholar] was used to analyse the data. In M. Murray & K. Chamberlain (Eds), Qualitative Health Psychology. London: Sage.) was used to analyse the data. One main theme that emerged was “resistance towards counselling for stress”. This theme and several related sub-themes are discussed, and suggestions to reduce resistance to counselling for stress are presented in a model.     

At the border: reflections on psychoanalytically oriented counselling in an Italian university setting

This paper analyses the ‘border’ position of counselling services in Italian universities. The concept of ‘border’ has great relevance in the work of psychoanalytically oriented university students’ counsellors. Counselling is part of a continuum of interventions, from befriending to psychotherapy. This closeness encompasses the need for identifying specificities and differences among interventions. Moreover, a university counselling service occupies a ‘marginal’ position, continuously confronted with the risks of rejection and/or assimilation. The concept of ‘border’ is also useful to define the developmental phase of university students, crossing the border between late adolescence and young adulthood, as represented by Conrad's novel The shadow line (1917/1999), recently analysed by Green (2008) as the metaphoric demarcation line between youth and adulthood. Finally, most of the students referring to our counselling service come from families that for the first time crossed the border of university education.     

Mindfulness-based interventions in the workplace: An inclusive systematic review and meta-analysis of their impact upon wellbeing

ABSTRACT

Given the demanding nature of many professions, efforts are ongoing to develop initiatives to improve occupational wellbeing, including mindfulness-based interventions (MBIs). To assess the efficacy of MBIs, meta-analytic procedures were conducted on 35 randomized controlled trials derived from an earlier inclusive systematic literature search (covering all occupations, MBIs, and wellbeing-related outcomes). Mindfulness had moderate effects on deficit-based outcomes such as stress (SMD = ?0.57), anxiety (SMD = ?0.57), distress (SMD = ?0.56), depression (SMD = ?0.48), and burnout (SMD = ?0.36), and moderate to small effects on asset-based outcomes like health (SMD = 0.63), job performance (SMD = 0.43), compassion and empathy (SMD = 0.42), mindfulness (SMD = 0.39), and positive wellbeing (SMD = 0.36), while no effects were observed for emotional regulation. However, the quality of the studies was inconsistent, suggesting more high-quality randomised controlled trials are needed.     

An Evolutionary Theory of Diversity: The Contributions of Grounded Theory and Grounded Action to Reconceptualizing and Reframing Diversity as a Complex Phenomenon

The author discusses the contributions of grounded theory and grounded action to the development of a new, and evolutionary, theoretical framework for understanding diversity as a complex phenomenon. She discusses the work of Thomas and Gregory as pioneers in expanding the conceptualization of diversity, arguing that this new understanding increases the potential for creative action in systems.     

Infertility: Couples' experiences and the use of counselling in treatment centres

Abstract

Infertility can have profound effects on couples, who may spend years in an increasingly stressful quest for conception; by law, counselling must be offered to those undergoing licensed treatments. This study found that such couples relied on their own partnership as their main resource for managing stress. Predominantly the partnership was organized in a psychological division of labour -the woman experiencing emotional pain, the man supporting and seeking positive solutions. Normally a functional joint defence, this could become a dysfunctional split under excessive stress. Where counselling was offered directly, with a couple approach, couples who took it up were enabled to re-establish their own defences more adaptively. However, where access to counselling was by clinical referral - often of a distressed woman partner alone - the couple approach was more difficult to apply though apparently no less relevant. The counsellor-clinician partnership could mirror the ‘division of labour’, with a similar tendency towards dysfunctional splitting under stress.