The relationship between existential-phenomenological and cognitive-behaviour therapies

The tendency of GPs to cap the number of counselling sessions offered to their patients in primary care has led to an ongoing debate about the effectiveness of time-limited counselling and brief therapy models. the advantages and disadvantages of brief as opposed to open-ended models of counselling in primary care need to be considered from the point of view of the client, the counsellor and the GP. Given that outcome research shows no difference between the two methods, a cost-benefit analysis would indicate that, for the majority of cases, time-limited counselling works very well. But there is still a minority of clients who do need open-ended therapy, and their needs are not being served by the present NHS system. Counsellors should therefore not be debating for either brief or open-ended style in primary care, but should be organizing themselves into expanding the service to give GPs the choice of both approaches.     

Counselling Supervision: The British context

Counselling/psychotherapy supervision is on the verge of a professional breakthrough in Britain today. Training courses are emerging, accreditation for supervisors is in progress and a Code of Ethics for Supervisors is finalised. Yet supervision is still little understood. There are few agreed definitions and certainly no agreed tasks, roles, or even goals of supervision. Conflict still abounds about whether it is more akin to therapy than to education, about whether or not it shold be evaluative, and about what areas of counselling it should cover. Supervisors are poorly trained in supervision and areas such as the legal implications and responsibilities of supervision not clear and often not even considered important. What research has been done is confined largely to United States and few attempts have been made to apply findings to Britain, e.g. how valid in Britain is the current research on Developmental Models of supervision which outline the stages through which counsellors in training travel.

Supervision is still tied to counselling theory despite its efforts to become a discipline on its own. Most supervisors in Britain seem to apply their theory of counselling to supervision setting. However, some of the conflicts are being faced and some questions raised about the future of supervision, about the kind of relationship involved, about its relationship to counselling. This article raises some current issues in the field and asks the kinds of questions that need answering before we are able to talk about a British understanding and application of counselling supervision.     

A generic and efficient emotion-driven approach toward personalized assessment and adaptation in serious games

Emotions have a major role in the player-game interaction. In serious games playing contexts, real-time assessment of the player’s emotional state is crucially important to enable an emotion-driven adaptation during gameplay. In addition, a personalized assessment and adaptation based on the player's characteristics remains a challenge for serious games designers. This paper presents a generic and efficient emotion-driven approach for personalized assessment and adaptation in serious games, in which two main methods and their algorithms are proposed. The first one is a method for assessing, in real time, the player's emotion taking into account the personality type and the playing style of the player. The second one is an emotion-driven personalized adaptation method based on Markov modeling of dependency between the serious game events and the change in the player's emotional state. Therefore, the proposed approach has been evaluated by playing an affective vs. non-affective version of a serious game that we have developed to illustrate the applicability of the above-mentioned methods. The overall results showed that owing to our approach, a serious game become able to enhance its adaptivity toward playing outcomes and improve its overall playability.     

Development of form similarity as a Gestalt grouping principle in infancy

Given evidence demonstrating that infants 3 months of age and younger can utilize the Gestalt principle of lightness similarity to group visually presented elements into organized percepts, four experiments using the familiarization/novelty-preference procedure were conducted to determine whether infants can also organize visual pattern information in accord with the Gestalt principle of form similarity. In Experiments 1 and 2, 6- to 7-month-olds, but not 3- to 4-month-olds, presented with generalization and discrimination tasks involving arrays of X and O elements responded as if they organized the elements into columns or rows based on form similarity. Experiments 3 and 4 demonstrated that the failure of the young infants to use form similarity was not due to insufficient processing time or the inability to discriminate between the individual X and O elements. The results suggest that different Gestalt principles may become functional over different time courses of development, and that not all principles are automatically deployed in the manner originally proposed by Gestalt theorists.     

Towards a taxonomy of philosophical counselling

As sympathetic outsiders trying to understand and explain the field of philosophical counselling to other (perhaps not so sympathetic) outsiders, we find ourselves repeatedly asking and being asked two questions: “What is philosophical counselling?” and “What is its relationship to psychological counselling?” In seeking to develop satisfactory answers to these questions, we present a taxonomy of philosophical counselling. This fourfold taxonomy was developed by classifying the work of a range of recognised philosophical counsellors in terms of their declared ends. This taxonomy makes sense of the diversity of the field, while also recognising the underlying coherence. Moreover, the categories of the taxonomy align with existing forms of psychological counselling practice, and in this way the taxonomy enables us to pinpoint the relationship between psychological and philosophical counselling. We end with some consideration of what philosophical counsellors can learn from their colleagues in psychology, especially in relation to the role of empathy and the importance of empirical testing.     

Accreditation: A reply to mathers

Accreditation in counselling is meant not for the benefit of the counsellor but for the protection of the public. It is concerned more with guaranteeing certain standards of ethics than with the acclamation of status. Whatever method is used, it must avoid the pitfalls of conservatism and academicism which in other professions have been jointly responsible for the attack on accreditation itself as a process. Those involved in counselling and psychotherapy should not wait passively until Parliament acts, but need to be critically involved in bringing into being a system of accreditation which is both flexible and creative.     

Exploring the supervision experience of some mainstream counsellors who integrate prayer in counselling

The use of prayer in counselling can be transformational and promote psychological well‐being, but it can be problematic and requires good supervision. A survey conducted into the extent of the use of prayer in counselling revealed that many counsellors do not bring their use of prayer to supervision. The aim of this research was to discover why this may be. Participants were 19 BACP accredited and CMCS approved counsellors who use prayer in their practice. They were interviewed, and data were analysed using interpretative phenomenological analysis. The data indicate that there is not a culture of openness towards the use of prayer. Counsellors do not feel free to explore their practice of prayer because of fear: of not being understood; of being judged; of losing respect and credibility; of being thought of as transgressing; of exposure by the supervisor; of how the supervisor will treat the disclosure; and of condemnation and dismissal of something that is important and precious to the counsellor. The central implication for supervision is the need to create a culture of openness and a collaborative working alliance where all aspects of the counselling process can be explored with appropriate theoretical consideration and personal challenge, and where the supervisee feels accepted, able and open to exploring all aspects of the work with the supervisor. This prevents unethical practice, protects the client and enables consistency of work.     

On not being able to dream

In this paper, the author explores the phenomenon of not being able to dream (as opposed to not being able to remember one's dreams) from three different vantage points. First, from the point of view of psychoanalytic theory, he discusses Bion's idea that the work of dreaming creates the conscious and unconscious mind (and not the other way around). A person who cannot dream is unable to generate differentiable conscious and unconscious experience and, consequently, lives in a psychic state in which he is unable to differentiate waking from sleeping, dreaming from perceiving. The author then approaches the problem of the inability to dream from the perspective achieved by a literary work. He discusses a Borges fiction that creates, in a singularly artful way, the experience of not being able to dream. Finally, the author utilises the vantage point of a detailed account of a clinical experience to explore what it means not to be able to dream. He describes an initial state characterised by the patient's proliferation of unutilisable 'psychic noise' which, over a period of years, led to the analyst's experiencing 'reverie-deprivation' and brief periods of countertransference psychosis. Two analytic sessions are presented and discussed in which psychological work was done that contributed to an enhanced capacity on the part of both patient and analyst for genuine dreaming - both in sleep and in analytic reverie states.     

Telephone counselling for adolescent suicide prevention: changes in suicidality and mental state from beginning to end of a counselling session

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact. Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.     

Psychodynamic counsellor training integrating difference

Abstract

Psychodynamic counselling has been criticized for being inflexible, authoritarian, antiquated and unresponsive to the issues of modern-day society. Psychodynamic counsellor training is sometimes seen as a poor relation of ‘proper’ psychotherapy therapy training. This article is written by two psychodynamic counselling course trainers who have wresded with the above criticisms and who have striven to deliver a training course that is coherent in its adherence to a psychodynamic counselling model but which embraces equal opportunities issues and takes account of a diverse society. The article focuses on ways in which sexual identity, race and culture are integrated into the course curriculum and indeed into the course philosophy and community. Traditional psychoanalytic interpretations of homosexuality are challenged and multicultural counselling ideas are merged with psychodynamic counselling theory and skills.     

Last but not least

A central tenet of Gestalt psychology is that the visual scene can be separated into figure and ground. The two illusions we present demonstrate that Gestalt processes can group spatial contrast information that cuts across the figure/ground separation. This finding suggests that visual processes that organise the visual scene do not necessarily require structural segmentation as their primary input.     

Counselling — Why not? A qualitative study of people's accounts of not taking up counselling appointments

The aim of this research was to explore the reasons behind people's decision not to take up a counselling referral. A qualitative study was carried out, using semi‐structured interviews and written responses. The investigation was based in NHS primary care counselling services in a GP practice in the North of England. People who had been referred for counselling by their GP, but did not attend any counselling appointments, were interviewed or invited to submit written comments. Many people talked about the courage it took to ask for help. The referral itself was sometimes therapeutic as it legitimised their distress. The GP's response affected people's decisions. Waiting time and what happened during waiting was important. Some people had their own resources, which they used actively, seeking other sources of help; others were more passive, their lives changed around them. Other factors that contributed to non‐engagement were being referred in a crisis; lack of knowledge about counselling and mental distress; and concern about stigma and its impact on work. Perceived waiting time was the most significant factor for participants in this study, but most people had a combination of reasons for not engaging. Support from the GP, information about the service and being given a realistic expectation of waiting times, may help people feel better able to access counselling services.     

Can CORE assessment data identify those clients less likely to benefit from brief counselling in primary care?

Studies show that counsellors in primary care see many clients with difficulties of a severity similar to those found in secondary care services. Evidence from both RCTs and studies of routinely collected data indicates that many of these ‘clinical’ clients benefit from brief counselling intervention. However, little is known about why some benefit while others fail to do so despite completing their counselling contract. This paper considers client characteristics recorded at assessment and aims, using logistic regression analysis, to identify those characteristics predictive of a poor outcome. Results indicate that a number of characteristics are associated with poor outcome; the most important predictors are economic inactivity and aspects of the patient's condition, particularly continuous/recurrent depression, with some differences between genders. However, the models produced were not acceptable in their predictive power. This may be partly due to data quality issues or important characteristics not being available in the data. The paper concludes that being unemployed or on state benefits may be a proxy measure of severity that has an important impact on outcome for all patients, and particularly for males. Some reasons are suggested and areas of future research are identified.     

Obtaining informed consent for HIV antibody testing: the decision making process

All patients referring themselves for HIV antibody testing must receive pre-test counselling and must give their informed consent before testing can proceed. All patients being referred by their doctors for HIV antibody testing must also receive pre-test counselling and must give their informed consent before testing can proceed, except in very unusual circumstances. This paper is written primarily for medical and nursing staff who are considering referring a patient for testing and it is particularly relevant to those staff working in the field of mental health. This paper draws on professional guidelines and suggests that staff use a two-part decision making process. In the first part die referrer decides whether there are substantial clinical grounds for needing the test result immediately. If there are, the referral is made for pre-test counselling and testing, for example at the local Genito-Urinary Medicine (GU) clinic. In the second part experienced AIDS counsellors try to enable the patient to decide whether or not to proceed. If the patient is not able to understand or make a decision the AIDS counsellors, in consultation with other staff, will decide whether to proceed. Whatever the decision, it should be respected by professional staff.     

'If you don't want to tell anyone else you can tell her': young people's views on school counselling

The aim of the research was to assess the views of young people about school counselling. In total, 415 pupils from five secondary schools took part in the survey. A smaller number of these pupils took part in focus groups (n=9) to explore their views in more depth. In general, the young people seemed to value having a school counsellor. Most were aware of the school counselling service, although a substantial number (21%) indicated a lack of awareness. For many who were aware, their knowledge of the service was limited. Just over one third of the pupils stated that they would go to see the school counsellor, and girls were more likely to state this than boys. The confidentiality of the service was perceived to be one of the benefits. However, this was also reported to be a hindering factor—the concern that it may not, in fact, be confidential. Two other main reasons for not accessing the service were the counsellor being a stranger and (for boys in particular) a concern about other people finding out (associated with the social stigma of going for counselling). Suggestions to improve the school counselling service included a room in a discrete location, better promotion of the service, more counsellors or a full-time counsellor, and ways to get to know the counsellor better. Those responsible for developing and managing school counselling services should consider these suggestions.     

A computational feature binding model of human texture perception

We present a computational model for human texture perception which assigns functional principles to the Gestalt laws of similarity and proximity. Motivated by early vision mechanisms, in the first stage, local texture features are extracted by utilizing multi-scale filtering and nonlinear spatial pooling. In the second stage, features are grouped according to the spatial feature binding model of the competitive layer model (CLM; Wersing et al. 2001). The CLM uses cooperative and competitive interactions in a recurrent network, where binding is expressed by the layer-wise coactivation of feature-representing neurons. The Gestalt law of similarity is expressed by a non-Euclidean distance measure in the abstract feature space with proximity being taken into account by a spatial component. To choose the stimulus dimensions which allow the most salient similarity-based texture segmentation, the feature similarity metrics is reduced to the directions of maximum variance. We show that our combined texture feature extraction and binding model performs segmentation in strong conformity with human perception. The examples range from classical microtextures and Brodatz textures to other classical Gestalt stimuli, which offer a new perspective on the role of texture for more abstract similarity grouping.     

Counselling and well-being: on the road to realities

This article aims to discuss the rationale and some guiding principles for the realm of counselling in the fostering of well-being. After some brief observations of a theoretical nature, the principles analysed are: the revitalisation of counselling; the reflection on the concept of dialogue, including the notion of context; the perspective of counselling as social activity; understanding counselling and how it adjusts on the road to realities. From this perspective, practitioners view counselling as a social activity aimed at self-construction and life designing. In following that view, the idea of counselling as being socially produced is also examined. At the end, some considerations on the future of counselling are discussed.     

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.     

Prognosis in medicine: An analysis of its meaning and rôles

The medical concept of prognosis is analysed into its basic constituents: patient data, medical intervention, outcome, utilities and probabilities; and sources of utility and probability values are discussed. Prognosis cannot be divorced from contemplated medical action, nor from action to be taken by the patient in response to prognostication. Regrettably, the usual decision-theoretic approach ignores this latter aspect. Elicitation of utilities, decision contemplation and prognostic counselling interweave, diagnostics playing a subsidiary role in decision-oriented clinical practice. At times the doctor has grounds for withholding information. As this is known to the patient, prognostic counselling becomes a conflict-prone and rationality-thwarting activity. The meaning of standard phrases such as “prognosis of a disease”, “the prognosis of this patient”, “the prognosis is unknown”, is examined.