The significance of psycho‐peristalsis and tears within the therapeutic relationship

This paper represents a heuristic study of the significance of involuntary, intuitive gut responses (psycho‐peristalsis) and tears within the therapeutic relationship. Autobiographical material and qualitative data were gathered from case‐notes and semi‐structured interviews with four client/co‐participants. Data on occurrences of psycho‐peristalsis and tears were collected from 92 clients seen within a six‐year period. Eleven elements of a ‘general constitutional structure of experience’ were identified. A central finding of the study concerns the gut's apparent ability to ‘pick up’, at an unconscious level, significant material that might otherwise have been overlooked. The research suggests some possible clues to the process of unconscious communication and healing, and adds an interesting psychological dimension to recent findings in the fields of neuroscience and cell biology which amount to the discovery of a ‘second brain’ in the walls of the small intestine. These phenomena are examined in the light of theoretical debates in counselling and psychotherapy.     

Exploring counsellor perceptions of the impact of counselling supervision on clients

This qualitative study explores counsellors’ experiences and perceptions of how counselling supervision impacts upon their clients. Data collection combined open‐ended questionnaires (n = 13) and semi‐structured interviews (n = 6). The findings indicate that supervision impacts client work both helpfully and unhelpfully. Areas that emerged as having the most direct impact on client work were the counselling relationship dynamics and self‐awareness, professional development, emotional support, clients not discussed in supervision and the quality of the supervisory relationship. Congruence and confidence were the most direct link between supervision and client work.     

Between the idea and the reality: A study of the counselling experiences of bereaved people who sense the presence of the deceased

There have been many theories of the process of loss and bereavement, from Freud, to the present day. Early theories of bereavement described a process which, following various stages and associated tasks, ended at the relinquishment of the bond to the deceased. In more recent years theories have taken different directions, identifying how bereaved people re‐learn life, recreate biographies, and continue relationships to the deceased. Some research studies of bereavement have investigated the counsellors’ perspective, but there are very few studies of the client's experience and most studies have focussed on outcomes of counselling. This qualitative study, using semi‐structured interviews, provides an insight into the bereaved client's perspective on the content and process of their counselling experiences. Taking as its focus the client's sense of the presence of the deceased, this study aimed to identify whether or how counsellors facilitate exploration of this experience and which theories they use in client work. The main finding is that 80% of the counsellors were not perceived by participants to have worked with them satisfactorily in relation to their sense of presence of the deceased or in relation to the story of the death itself.     

Chickens or eggs? A follow‐up case study exploring links between physical and psychological impact of Tourette's syndrome and sexual abuse

This follow‐up case study highlights the complex relationship when working at the interface between physical and psychological symptoms. The paper draws upon conversations between an ex‐client and myself, held seven years after the end of our six year therapeutic relationship. Conversational interviews, based upon social constructionist beliefs, led to an unexpected exploration of the client's subsequent diagnosis of Tourette's syndrome (given several years after the end of therapy) and evolved into a struggle to reach a shared understanding of how she now makes connection between her problem with eating in public, her neck and facial tics, and childhood sexual abuse. Our research relationship provided both of us with a rare opportunity to reflect upon how she had made meaning of her counselling and its outcomes. The paper draws attention to the impact of counselling and therapy discourses concerning sexual abuse on the work we did at the time and asks how that work might be different today. It also helps us understand the layers of complexity and ambiguity contained within the client's stories. This multi‐layered case study represents the overlap and ‘messiness’ that mirrors the ‘lived experience’ of the persons involved, and provides an example of how co‐constructed research conversations can evoke stories that create meaning as they are told.     

“Out on the edge of my comfort”: Trainee counsellor/psychotherapists' experiences of spirituality in therapy—A qualitative exploration

The integration of spirituality into counselling and psychotherapy poses complex challenges. Personal spirituality, professional competency and ethical considerations may impact on trainees' experiences of integrating spirituality into therapy. This study adopted an inductive, qualitative approach to explore trainee counsellor/psychotherapists' experiences and perceptions of integrating spirituality into therapy. Six trainee counsellors and psychotherapists were recruited using purposive sampling from a professional counsellor and psychotherapist training institution in the UK. In‐depth, semi‐structured interviews were conducted, audio‐recorded and transcribed verbatim. Thematic analysis of the interviews revealed two overarching themes: spirituality provides support but needs a warning; and spirituality is relevant but undervalued. These themes encompass a wide range of trainee concerns associated with integrating spirituality into therapy. Participants reported that they felt unprepared to work therapeutically with clients' spiritual beliefs. However, the value of spirituality in providing support to both the trainee and their clients was highlighted by several participants. Some participants described integrating clients' spirituality as having a positive impact on the therapeutic relationship, but often felt threatening to the trainee. This research has implications that are important for counselling and psychotherapy training and developing enhanced consideration of client spirituality and the interpersonal environment in which therapy is delivered.     

An initial study of transgender people's experiences of seeking and receiving counselling or psychotherapy in the UK

Background: There are no published empirical research studies exploring transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. As a result, counsellors know little about why transgender people seek counselling, who they seek counselling from, and what their experiences are of receiving counselling. Aim: To address this gap in the literature, this study investigated transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. Funding for this study was provided by a BACP Seedcorn grant. Method: A mixed method small‐scale qualitative research design was employed, comprising an online survey and five semi‐structured interviews. Findings: Participants tended to seek counselling on two or more occasions and received between 2 and 12 sessions. Participants sought counselling for common psychological concerns as well as gender identity and coming out issues. A fear of being discriminated against and exploring gender for the first time were significant barriers in seeking help. Participants reported mixed experiences of counselling but valued a therapeutic relationship in which they felt affirmed, listened to and understood. Discussion: The findings from this study mirror aspects of previous research conducted in the USA concerning transgender clients' experiences of counselling. However, these findings point to the importance of recognising the potential vulnerability transgender clients experience when seeking counselling and the need for therapists to develop greater awareness, knowledge and competence regarding working with transgender clients.     

Counselling a Taiwanese woman with infertility problems

The purpose of this case report is to describe, analyse and discuss the process and outcome of counselling a 38-year-old Taiwanese woman with infertility problems by a female Taiwanese counsellor who employed the relationship-centred counselling (RCC) approach. The client's long-standing fertility has been deeply connected to her symptoms of depression, anxiety, psychological and physiological pain, and social stress. During a 10-month counselling intervention, the client gradually minimized her physiological symptoms, reduced her negative emotions, improved her interpersonal relationships, built up her social support network, and enhanced her sense of internal control, self-esteem and satisfaction with life.     

Integrating traditional and non‐traditional approaches to treat a client with a co‐occurring addictive and mental disorder: A case study

This paper presents a case study of a male client with co‐occurring addictive and psychological problems. The aim is to describe this client's treatment within an inpatient facility that provided integrated care for those diagnosed with both mental illness and substance abuse. The course of treatment from admission to discharge and follow‐up are discussed in an effort to provide a detailed account of the treatment modalities used to best help this client. Implications for counselling clients with similar issues and concerns are discussed.     

The effect of counselling programmes involving expressive activities with semi‐structured groups on self‐concealment levels of adolescents

The aim of this study was to investigate the effects of counselling programmes based on expressive activities with semi‐structured groups, on the self‐concealment levels of adolescents. The research was carried out using a pretest–posttest control group design. The dependent variable of the present research, is the psychological counselling programme conducted with a semi‐structured group based on expressive activities. The research was carried out with 18 6th and 7th grade secondary school students (10 female and 8 male). The Self‐Concealment Scale was used as data collection tool. In this research, the use of nonparametric tests was preferred, as the sample was smaller than 30. Therefore, it was determined whether there is a statistically significant difference between the arithmetic means of the experimental and control groups’ pretest, posttest and trail test scores by use of Wilcoxon signed‐rank test, to determine the effects of a psychological counselling programme with semi‐structured group based on expressive activities. Also, it was determined whether there was a statistically significant relationship between the pretest, posttest and trail intervention scores received by the intervention and control group students from the Self‐Concealment Scale, using Mann–Whitney U test. The research results revealed that the “psychological counselling programme based on expressive activities with semi‐structured groups” was significantly effective in alleviation of self‐concealment levels, and this effect was also maintained in follow‐up evaluations. The obtained results are discussed in the light of related literature findings and recommendations are proposed accordingly.     

Intimate boundaries: Therapists’ perception and experience of erotic transference within the therapeutic relationship

Aim: This study explored therapists’ understanding and experiences of erotic transference within therapeutic relationships. Method: A small‐scale qualitative research project was undertaken with six therapists working within different counselling contexts. Data was collected through semi‐structured face‐to‐face interviews, and an Interpretative Phenomenological Analysis used for analysis of individual perception and experience. Findings: All participants had experienced what they understood to be erotic transference and/or sexual and loving feelings within therapy. There was little differentiation between the two phenomena, and both were often referred to interchangeably. There were contradictory views as to whether using the phenomena would be beneficial to client work, but there was a strong motivation to learn more about it. Therapists who encountered sexual attraction within therapy experienced feelings including shame and embarrassment. Supervisory support was seen to be beneficial. Implications/conclusion: The importance for therapists to acknowledge a lack of clarity that exists around the understanding of erotic transference and its relationship to sexual attraction within therapy is noted. Also, a recognition that better access to training regarding erotic transference and sexual responsibility within client relationships might be helpful to therapists in their work.     

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.     

A thematic analysis of young people's experience of counselling in five secondary schools in the UK

Aim: To investigate young people's views on the effects of school‐based counselling, and what they found helpful and unhelpful. Method: Eleven semi‐structured interviews were conducted and thematically analysed. Findings: Participants expressed predominantly positive views of school‐based counselling with changes in three main domains: emotional, interpersonal and behavioural. Participants viewed these changes as having had an important effect on their lives. The most commonly cited helpful aspects of counselling were related to talking or getting things out, and counsellor qualities. Conclusions: School‐based counselling is viewed positively by those who have experienced it, and appears to be an appropriate and valuable intervention for young people.     

Private work in public places: Confidentiality and role tensions in a university counselling service

This paper aims to explore issues of confidentiality relating to working with undergraduate and postgraduate students in a university counselling service. The context of a counselling service within our institute of higher education has to be understood in its relationship to academic, administrative and managerial staff, to medical and psychiatric services personnel and to the wide range of other student support and welfare services in the organization whether run by university staff or the students' union. Some reflection will be given to the need for clarity in the range of roles counsellors have to play within the different functions of the university. The client-counselling relationship cannot be seen as a dyad but as a triad or an even more complex constellation of relationships when regarded in an institutional context. The central premise is based on understanding the conscious and unconscious dynamics in the institution and how these impinge on the relationship between client and counsellor in challenging or assuming the confidentiality held by the service. Such boundary issues are identified in consultation and referral, breaking confidentiality, referral of disruptive students, calls for help and holding confidentiality. The case material drawn on to illustrate these five areas is also described in terms of anxieties raised and how these are projected, introjected and contained.

Within the service client and counsellor contract to work together. It is made clear that counselling is a professional relationship with agreed boundaries and a commitment to confidentiality. This is crucial to the working relationship and is a means of providing the client with both safety and privacy. Any limitation on the degree of confidentiality offered may reduce the usefulness of counselling. Bound by his or her professional code of ethics the counsellor will reach an agreement with the client at the outset about the extent of confidentiality they are offering, take care not to disclose information given in confidence and, when possible, be able to negotiate any change in agreement with the client.

Exceptional circumstances which may occur and give rise to the counsellor's decision to break the confidentiality formerly agreed between him or herself and the client are those which give grounds for believing the client will cause serious harm to others or themselves or have harm caused to them. Reference will be made to the role of consultant supervision in such situations and how any breaking of confidentiality can best be minimized. Attention will be given to the relevant ethical codes to which counsellors adhere and the issues of confidentiality within the legal process as well as whether the requirements of providing counselling services for students in higher education impel us, logically and practically, towards certain policies in regard to boundaries.     

What difference does counselling make? – The perceptions of drug‐using clients on low incomes

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi‐structured interviews with six participants. Findings: Findings included changes in the clients’ internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives.     

‘I never talked about,ever’: A comprehensive process analysis of a significant client disclosure event in therapy

Aims: The present study was intended to examine how a particular client disclosure came about and what made it important to the client. Method: A client‐identified significant therapy event involving disclosure of childhood abuse was analysed using Comprehensive Process Analysis (CPA), a qualitative interpretive method for examining the process, effects and context of significant events in therapy. Results: The analysis identified therapist invitation and client universalisation as the key elements of the disclosure event. The context analysis showed how the event linked to the client's symbolisation of her fear earlier in the session and in the previous session. The client gained insight into how the earlier abuse had affected her life, linking it to the victimisation that was her primary reason for seeking therapy, and to her relationship with her mother. The therapist facilitated the event by following up the client's hints, trusting the strength of the alliance, and staying close to the client's frame of reference. Conclusion: The findings suggest that the initial significance of an invited disclosure event may diminish for a client over the course of therapy.     

Counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact such work has on the therapist

Introduction: This paper describes a qualitative study focusing on counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact this has on the therapist. Method: Semi‐structured interviews were employed and the constant comparative method utilised to analyse the data. Findings: Findings indicate that counsellors experience intense emotions in response to self‐harm including: shock; sadness; anxiety; anger; and frustration. Counsellors also struggled to manage the tension between multiple dualities, corresponding to professional opinions of a seemingly polar opposite nature. Although participants indicated a requirement to work in a client‐led way, they all had either an explicit or implicit agenda for change. These two conflicting states create a tension for a counsellor that is difficult to resolve. In addition there were various views of client progression, yet all participants agreed that progression was not simply about stopping self‐harm. Conclusion: There is a significant impact on the counsellor when working with clients who intentionally self‐harm and the complexity of the phenomenon appears to exacerbate their anxiety. Implications: Further research within the counselling field focusing on the ambiguous nature of the subject may increase understanding, which in turn may contribute to greater therapist efficacy when working with this client group.     

The relationship between integrative and Islamic counselling

Integrative counselling is a valuable tool. However, it only considers the client within a social and natural framework. Islamic counselling on the other hand, utilizes the major tenets of integrative counselling, but adds to them an added dimension. This is the relationship between the client and his/her creator. In this paper I aim to draw out areas of commonality between integrative and Islamic counselling and highlight the main difference between these two therapeutic approaches.     

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.