‘Adolescent fantasies and the horror-film genre‘: The freud museum 1995 spring conference

Abstract

As I walked towards home across Waterloo Bridge, having left this conference in its apt setting of the National Film Theatre, I realized I had attended the day from two points of interest: firstly, from my professional position of working in a university counselling service where I encounter adolescents and their ‘phantasies’ regularly. Only the other day a young student I had been seeing started the session by telling me she had seen the film Interview with the Vampire the night before, had been sick at the end, and then casually ‘threw up’ to me that she did not think she would need to go on seeing me.     

Gliding across the liminal space between counsellor and counselling researcher: Using collective biography practices in the teaching of counselling research methodologies

Aims: Drawing on their engagement in a specific collective biography research project, the co-authors aim to demonstrate how the weaving together of creative story-telling and the theory underlining collective biography practices resulted in an understanding of rhizomatic research methodologies from within the process. This paper aims to demonstrate one way in which research methodologies training can become more firmly embedded within counsellor training courses. Method: A collective of counselling students and a session tutor colleague used collective biography practices to research their memories of traversing the liminal space between ‘counsellor’ and ‘counselling researcher’. Alongside the resulting collective stories, a collaborative review of the research process examined our chosen ways of working within the project. Outcomes: Engaging in collective biography practices resulted in an experiential shift from ‘learning to do counselling research’ to ‘becoming counselling researchers’. Weaving together research processes and researcher reflexivity generated personal and professional learning. Ways in which these research methodologies complement core components of counselling training, within and beyond the teaching of research, were identified. Conclusions: Collective biography practices offer a way of introducing non-arboreal creative research methodologies into counsellor training. Careful consideration of potential challenges surrounding the introduction of these practices is required.     

Cognitive counselling intervention: treatment effectiveness in an Italian university centre

Offering counselling to students is increasingly considered as a key academic service. However, the reduction of resources allocated to Italian universities emphasises the need to assess the quality of interventions. This paper presents data reporting the effectiveness of a university counselling service. A sample of 45 undergraduate students completed a cognitive-relational intervention at a counselling service in a University in the North of Italy. The project focused on the development of reappraisal skills and problem-solving strategies to manage difficult situations. The results showed a significant pre and post-intervention reduction in self-reported psychopathological symptoms (measured with Symptoms Check List 90-Revised) as well as in general levels of distress (measured with Clinical Outcome in Routine Evaluation-Outcome Measure). A significant increase in reappraisal levels, measured with the Emotion Regulation Questionnaire, was observed, which is a focal element of the counselling intervention. There were no detectable changes in the level of suppression.     

Life story research: A relevant methodology for counsellors and psychotherapists

Aims: This paper introduces, describes and proposes life story research as an important, relevant and appropriate contribution to counselling and psychotherapy research. It shows how narrative knowledge is created and constructed through the stories people tell about their lived experiences and explores the concept of ‘narrative knowing’ (Bruner, 1986). Methods: Drawing on life story research with people who linked their history of problematic drug use with experiences of historic trauma/abuse, the paper contributes to the ongoing discussion related to the similarities/differences between therapy and research and what we might learn from each that informs the other. Implications for practice: The paper offers narrative ideas and practices as ways of researching matters of social and psychological importance. It suggests that therapists (and counselling researchers) could learn from what participants tell us about the therapeutic value of using life story methods which one participant described as helping him to face ‘out into the world, without unduly or specifically delving into, or focusing on [my] emotional state’. This learning may be particularly relevant for therapists working with traumatised clients.     

The ‘tyranny of time’: getting to the heart of the impact of educational cuts on the provision of guidance counselling in Ireland

The Irish Education Act (Government of Ireland 1998) stipulates that each young person in secondary school in Ireland is entitled to access ‘appropriate’ guidance. It has been argued that this very right has been eroded since Budget 2012, where resource re-allocations in guidance counselling are obstructing the requirement for schools to implement this section of the Act. This qualitative study explored the effects of ‘educational cutbacks’ from the perspective of guidance counsellors. Findings from interviews with guidance counsellors, suggest that the effects of such cutbacks in guidance counselling are far-reaching and ultimately students are the one’s losing out. The paper proposes that there is a need to reinstate guidance counselling hours to allow guidance counsellors provide a comprehensive service to young people – which they are entitled to.     

Psychoanalytic psychotherapy and student counselling

This paper explores the experience of a psychotherapist working in a university counselling service, indicating the contribution I think a psychoanalytic orientation can make to this kind of work. The exposed ‘coal face’ nature of the work is illustrated, and some of the psychotherapeutic implications of working within a large organisation discussed. There is an exploration of institutional dynamics which bear directly upon the psychotherapist, in terms of what it is possible to provide, and of professional self-preservation and self-esteem. Analysis of the uses made of the counselling service is seen as a contribution towards enabling the service to represent properly itself and its concerns within the institution.     

Personal responsibility,empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential benefits of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as ‘difficult’ or ‘heartsink’ and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of ‘personal responsibility’ in patients/clients, this core objective should form an agreed ‘yardstick’ against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.     

Exploration of counsellors' perceptions of the redesigned service pathways: a qualitative study of a UK university student counselling service

To address the mental health needs of students, UK universities offer bespoke student counselling services. Economic pressures have led services to find innovative ways of redesigning their service pathway. Few studies have investigated staff perceptions of these changes. The aim of this study was to investigate perceptions of staff employed as counsellors at a student counselling service at a UK university that underwent service delivery changes. Face-to-face interviews were conducted with counsellors (n = 5). Framework analysis was used to identify themes and meta-themes. Five meta-themes were identified: the overarching service ethos and service working style; change in the university context; impact of change on working practice; recording and perceived impact on confidentiality; acceptability and effectiveness. Changes to the service resulted in a more efficient service that is perceived to be more acceptable to students. Staff perceptions differed regarding how changes have affected their counselling practice. Despite these differences, the increase in workload was consistently expressed. Tensions remain as staff strive to maintain high standards of service in this changing context. Future research should investigate the process of developing and implementing change as student counselling services strive to evolve sustainable ways of working.     

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.     

Effectiveness of students and parents in a psycho-educational intervention programme for children with learning problems

This study investigated the effects of involving two sources of ‘non-traditional manpower’ — namely, university students and parents — in a programme of psycho-educational intervention. It was predicted that, while intervention for children with learning problems would produce significant changes in their perceptions in relation to their families, in their scholastic skills and in their adjustment, the additional involvement of their parents would lead to even greater changes. To test this prediction, 36 children referred to a university Education Clinic were randomly divided into three equal-sized groups: youth counselling plus parent counselling (E₁), youth counselling (E₂), and a control group (C). While the hypothesised changes following intervention were not statistically demonstrated, clinical data did yield support for the effectiveness and potential value of the intervention programmes.     

Revisiting a meta-analysis of helpful aspects of therapy in a community counselling service

This small scale mixed methods study examines helpful events in a community counselling setting, categorising impacts of events according to Timulak’s [(2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: A qualitative meta-analysis. Psychotherapy Research, 17, 305–314] meta-synthesis of significant events research. Comparisons were made between the types of impacts reported as helpful by clients receiving cognitive behavioural therapy (CBT) or relational integrative counselling. Seventy-five clients identified 291 significant events on 216 Helpful Aspects of Therapy (HAT) forms. The findings broadly reflect all nine impacts identified by Timulak (2007). The study also suggests that a potential new category, ‘voicing’ may exist. Differences between the types of impacts reported as helpful by clients in CBT and integrative therapy showed a higher percentage of CBT clients reporting ‘behavioural change/problem solution’, ‘reassurance’ and ‘client involvement’ as helpful. Differences in other categories were not statistically significant.     

A qualitative investigation into the online counselling relationship: To meet or not to meet,that is the question

Background and aim: Online counselling, as a psychotherapeutic approach, provokes debate amongst practitioners and researchers concerning its efficacy and validity. This reflexive study extends existing research into the nature of the online counselling relationship when it is conducted asynchronously (by email) and explores the possibility this approach may facilitate both online and face‐to‐face therapeutic engagement. Method: Semi‐structured interviews were conducted electronically with ten former email counselling clients of a university counselling service and six counsellors delivering email counselling in other higher education settings, to explore, in depth, their experiences of the online therapeutic relationship and its impact on the counselling process and outcomes. These were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four areas of focus emerged relating to: (1) the importance of the structure and processes involved; (2) their impact on thinking and feeling; (3) their impact on self and relationships (within and outside counselling), and (4) changes that followed email counselling. Having ‘time to think’ within the asynchronous exchanges, the anonymity and disinhibition afforded by the online medium, the creation of transitional space and the rich use of metaphor, visualisation and imagery all contributed to a sense of empowerment and relational depth for individuals who might have otherwise avoided seeking help. This led to positive change in many cases and for some, facilitated subsequent face‐to‐face counselling. Implications: The findings support the provision of counselling and therapy online and particularly its integration within existing face‐to‐face services.     

Therapists' views of the relative benefits and pitfalls of group work and one-to-one counselling for bereavement

Aim: To explore therapists' perceptions of the relative benefits and pitfalls of group work and individual counselling for bereaved clients. Method: Semi-structured interviews with nine experienced bereavement therapists from a range of different contexts generated data which was analysed using grounded theory methodology. Findings: Groups were perceived as having a normalising influence, helping members make new social contacts and practice social skills. Individual counselling was seen as facilitating the initial telling of the story and the expression of extreme emotion. Discussion: The findings suggest that individual counselling may be useful as a primary intervention easing ‘emotional loneliness’ caused by the death of a spouse or attachment figure. Group work may be of more benefit later in the bereavement process, facilitating an engagement with the outside world and alleviating ‘social loneliness’. Implications for practice: This suggests that bereavement services might usefully combine group and individual provision. Initial assessment could help clients clarify their needs and facilitate their choice of service. This would be more cost effective and potentially ease clients' bereavement experience.     

Phenomenological research on supervision: Supervisors reflect on ‘being a supervisor’

A study using a phenomenological research method was performed to reveal the meanings of the concept ‘supervision’, from the supervisor's perspective. Eleven supervisors of counselling and psychotherapy from a humanistic/existential framework answered the open question: “What does being a supervisor mean?”. Content analysis and frequency measuring were performed, revealing six groups of statements; six facets describing the experience of supervision: ‘structuring’, ‘teaching’, ‘nurturing’, the ‘supervisor as person’, ‘supervisor as colleague’, and the ‘triangle, client-therapist-supervisor’. Structuring was the largest category, and the first three categories together represented more than 75% of the statements. The results showed that ‘teaching’ and ‘nurturing’ were very similar in their importance, as represented by the number of statements in each. Further research should address the possible relation between supervisors' perception and experience of their role and the theoretical framework of counselling and psychotherapy in which they are based, The phenomenological research method in this study has shown the possibility of doing research on processes without ‘betraying’ the subjective perspective.     

Brief psychodynamic counselling with young adults

Short-term counselling is frequently employed within university counselling services in which there can often be an inherent institutional objective of returning students to the academic treadmill as soon as possible (Coren, 1996). On the other hand, this is perhaps tempered by the availability of counselling throughout the student's academic career, affording them the opportunity to return for further intensive short-term work (or longer-term if indicated or required). However, research into the effectiveness of short-term counselling suggests that interventions of less than eight sessions are as effective as those lasting significantly longer (Barkham, 1989). This may be particularly true in the case of students experiencing transitory problems relating to their life at university. This paper uses a case illustration to examine the value of short-term psychodynamic counselling in a university situation.     

Long-Term Follow-Up of an Occupation-Based Group Addressing Occupational Performance and Satisfaction in University Freshmen

The long-term impact of a 5-week, occupation-based intervention to address the life transition of university students into young adulthood is presented here. Study participants showed statistically significant gains from baseline to long-term follow-up in both occupational performance and performance satisfaction. In post hoc analyses, occupational performance maintained a level of significance. During a time of rapid change, occupation-based interventions have the potential to provide transitioning university freshmen students the skills that they need for a successful transition into a university. Changes in the structure, timing, and focus of the intervention and studies using more diverse and larger samples are warranted.     

Supportive and interpretative interventions in fostering mentalisation during counselling

ABSTRACT

This work analysed which profiles of counsellors’ supportive and interpretative actions emerged in two group counselling interventions designed to promote mentalisation in underachieving university students. The Psychodynamic Intervention Rating Scale was used to analyse this and the level of depth of defence interpretations. Two outcome measures were administered to analyse student mentalisation and their academic achievements. Process findings showed that supportive actions were used for the most part in both counselling interventions; however, only one group improved in terms of mentalisation and academic performance. In the good-outcome group, there were more defence interpretations, especially during the early sessions, and with a deeper level of elaboration. The innovative relevance of these findings and their implications for practice among counsellors are discussed.     

Understanding the online therapeutic alliance through the eyes of adolescent service users

Aims: The therapeutic alliance is a concept that has received a great deal of attention within face‐to‐face counselling. Furthermore, links have been made between the creation of strong alliances and successful therapeutic outcomes. This study examines the therapeutic alliance when counselling services are offered online to young people. Method: Fifteen young people took part in online interviews (utilising synchronous and asynchronous methods), and Grounded Theory techniques were utilised to analyse the data. Findings: A core category of ‘Client‐Service Match’ and three subcategories pertinent to the individuals’ experiences of creating good quality relationships with the counsellors were identified: (1) initial engagement, (2) developing rapport, and (3) establishing control. Discussion: The themes elicited are all relevant to the matching process and viewed as a chronological process similar to face‐to‐face counselling. However, unlike face‐to‐face work, specific nuances related to the online work arise that counsellors should be mindful of, including the rationale behind each individual's choice to approach services online, their own computer‐mediated communication skills, technical hurdles, and the perceived ‘power’ of the counsellor.     

Computerised CBT self‐help for depression in Higher Education: Reflections on a pilot

Aims: This study comprised the second phase of a small‐scale exploration of the viability of a computerised CBT intervention for depression within the context of a Higher Education counselling service. Method: The program ‘Beating the Blues’? (BtB) was offered to students experiencing depression, with measurement of uptake, attrition, satisfaction and effectiveness of the program. Results: Outcomes were calculated alone and in combination with those found in Phase One (previously presented in this journal), to enable a whole study report. In Phase Two, 15 students commenced BtB. The low completion rate in the intended academic year of the study led to extension over a further term. Seven participants completed the programme in Phase Two, a rate of 46.7%; 27 students used the programme over the entire study, with 63% completion. In both phases depression scores fell significantly following completion of the programme; anxiety scores fell significantly for Phase Two completers. User feedback was mixed. Clinical implications and conclusions: Many students have a comparatively short wait for a psychological service which may reduce interest in a computerised self‐help intervention and may help explain the low uptake. It is suggested that whilst CCBT is acceptable and effective for some depressed students, the number of sufficiently interested students, together with reported satisfaction from the intervention, was too small to warrant current inclusion of BtB within our service, particularly given its cost implications. Suggestions for further CCBT‐related investigations within this setting are made.