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.     

Adapting Strauss and Corbin's grounded theory in clinical case study research in the field of counselling

Case study can be adopted when aiming to understand an individual's lived experience. Such experience produces rich and complex qualitative data for analysis, conducive to counselling and psychotherapy research. Furthermore, grounded theory (GT) can be adopted to produce a theory from qualitative data, fitting well with case study research that explores complex experiences regarding social, psychological and phenomenological processes. This paper aims to guide the counselling researcher to incorporate Strauss and Corbin's model into the main arena of qualitative counselling research. In addition, this paper draws on a multiple case study that adopted Strauss and Corbin's method and identified various phases in the GT process. The aim is to inform the reader how to put the iterative process and pragmatic theoretical sampling into practice to produce a robust theory from clinical case study data.     

Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches

Thematic analysis methods, including the reflexive approach we have developed, are widely used in counselling and psychotherapy research, as are other approaches that seek to develop ‘patterns’ (themes, categories) across cases. Without a thorough grounding in the conceptual foundations of a wide variety of across‐case analytic approaches, and qualitative research more broadly—something rarely offered in counselling training—it can be difficult to understand how these differ, where they overlap, and which might be appropriate for a particular research project. Our aim in this paper is to support researchers in counselling and psychotherapy to select an appropriate across‐case approach for their research, and to justify their choice, by discussing conceptual and procedural differences and similarities between reflexive thematic analysis (TA) and four other across‐case approaches. Three of these are also widely used in counselling and psychotherapy research—qualitative content analysis, interpretative phenomenological analysis and grounded theory. The fourth—discourse analysis—is less widely used but importantly exemplifies the critical qualitative research tradition. We contextualise our comparative approach by highlighting the diversity within TA. TA is best thought of as a spectrum of methods—from types that prioritise coding accuracy and reliability to reflexive approaches like ours that emphasise the inescapable subjectivity of data interpretation. Although reflexive TA provides the point of comparison for our discussion of other across‐case approaches, our aim is not to promote reflexive TA as ‘best’. Rather, we encourage the knowing selection and use of analytic methods and methodologies in counselling and psychotherapy research.     

Energy psychology and psychotherapy: A study of the use of energy psychology in psychotherapy practice

Aim: The aim of the study was to increase understanding of how energy psychology informs and affects counselling/psychotherapy practice. By undertaking phenomenological interviews with experienced clinicians, the aim was to enrich and expand on the scientific approaches to energy psychology research. Method: This research is based on in‐depth semi‐structured interviews using interpretative phenomenological analysis (IPA). Five experienced psychotherapists who are also practitioners of energy psychology were interviewed. Findings: Four main themes emerged from the analysis: energy psychology as a potent intervention that facilitates shifts in emotions, cognitions, behaviours and physiology; the safety of energy psychology techniques; the role of the therapeutic relationship when using energy psychology techniques; and the challenges of integrating energy psychology into the work context, highlighting the need for more complex, systemic models to understand how people experience distress and how change is facilitated. Conclusion: Overall, participants in this study found energy psychology to be a valuable supplement to counselling and psychotherapy. The implications for current practice are discussed.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

The client as a self‐aware agent in counselling and psychotherapy

Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self‐awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over‐arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non‐directive and directive counsellor performances alike. Vignettes selected from the participants' reports illustrate the theme. Implications for the practice of counselling and psychotherapy are discussed.     

Using the Delphi Technique: Experience from the world of counselling and psychotherapy

Background: Delphi studies have been popular in the health and social care domain for some time, particularly within nursing. They are used to elicit views and opinions from experts in the field on specific topics, without the need for face‐to‐face interviews. Focus: This paper brings Delphi methodology to the attention of potential researchers in the counselling and psychotherapy field, who may not have previously considered Delphi methodology, describing the researcher's experience of using a Delphi study through the media of electronic mail, and incorporating participant feedback. Aims: To discuss the advantages and disadvantages, as well as the complexities and limitations of the Delphi methodology. I will outline previous recommendations from Delphi researchers and offer further suggestions based on my experience of completing a Delphi study.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Counselling and psychotherapy as a form of learning: some implications for practice

This paper explores counselling and psychotherapy as a form of learning. Previous experiences may create distortions in meaning-making perspectives, distortions that create templates for evaluating future experience. These templates act as barriers to being open to experience; thus there is an inability to learn from experience. The process of therapy can provide a learning milieu for the exploration and working through of these barriers, with a potential outcome of a return to learning from experience. It is suggested here that intrinsic to the learning milieu created in therapy there are elements of significant, transformative and emotional learning. Therapy is thus a reparative discourse that facilitates a return to learning from experience. A deconstruction of this concept is provided here as a way of developing the exploration of counselling and psychotherapy as a form of learning.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.     

The experiences of therapy from the perspectives of carers of people with dementia: An exploratory study

Design: Interviews were conducted with six carers of people with dementia about their experience of receiving counselling/psychotherapy. Interviews were conducted in the carer's own home, and data were analysed thematically using a narrative approach. Findings: Three themes were identified from the data: ‘Still doing the best I can’ (identified as losses and processes of personal growth); ‘Feeling connected and being understood’ (identified as attributes believed to be important within the therapeutic relationship); and ‘Wanting to share information’ (identified as sharing information with someone ‘neutral’). Carers placed emphasis on the age of the therapist and the amount of therapist self‐disclosure. Attending counselling and/or psychotherapy also helped the carer to find a ‘safe space’ to disclose and share concerns. Discussion: Carer loss and personal growth are explored, together with the importance of building therapeutic relationships and, for the therapist, seeking supervision when managing personal self‐disclosure. The theme of therapist self disclosure is explored together with the importance of therapists seeking supervision when managing personal self‐disclosure.     

'Audit-mindedness' in counselling: Some underlying dynamics

Some key ideological beliefs that typically inform and underlie 'audit-mindedness' in counselling are critically examined. Specifically, and drawing upon the radical and neglected ideas of psycho-social analyst Wasdell, it is argued that the preoccupation with 'quantity' and measur-ability that typifies 'objective' counselling outcome studies reflects, at least in part, the disintegrative splitting process that pervades technocratic culture; and that this is in turn rooted in the pathological aspects of early developmental experience. Positivist conceptions of the scientific method are seen to be not only fundamentally ideological and pathology-driven, but a singularly inappropriate means of evaluating the efficacy of counselling and psychotherapy. The article then considers the possibility of transforming the ideological belief system that underlies the positivist conception of science which drives the demand for 'objective' outcome studies in counselling and psychotherapy. It concludes by considering some implications for counselling practice of these challenging arguments.     

Addressing disparities: The impact of a lesbian,gay, bisexual,and transgender graduate counselling course

Background: Lesbian, gay, bisexual and transgender (LGBT) individuals experience serious mental health disparities and treatment inequities. Counsellor education has been identified as both a contributing factor to these problems as well as an ameliorating mechanism to address these inequalities. Aim: The purpose of the current study was to evaluate the impact of an LGBT‐affirmative counselling course. Method: A total of 23 students enrolled in a graduate LGBT counselling course were administered the Sexual Orientation Counselor Competency Scale (SOCCS, Bidell, 2005) and the Lesbian, Gay, and Bisexual Affirmative Counseling Self‐Efficacy Inventory (LGB‐CSI, Dillon & Worthington, 2003) pre‐ and post‐course. In addition, a comparison group of 23 matched counselling students was obtained from an existing data source in order to make further assessments of the course's effectiveness. Those in the comparison group were not enrolled in the LGBT course, but were administered the SOCCS at analogous time intervals. Results: After completing the LGBT course, enrolled students demonstrated significant improvements regarding their sexual orientation counsellor competency and self‐efficacy. In addition, these students showed significant gains in SOCCS scores versus those in the comparison group. Implications: Results from this study show the positive effect a full‐credit LGBT psychotherapy course can have on graduate counselling students' sexual orientation counsellor competency and self‐efficacy. The findings also indicate that such a course can significantly impact counselling skills, a facet of LGBT cultural competency found to be the most attenuated. Findings are discussed in conjunction with LGBT‐affirmative counsellor training and clinical practice.     

The effectiveness of university counselling for improving academic outcomes and well-being

The work discusses the effectiveness of the counselling treatment to enhance student academic success. The participants were randomly assigned to either an experimental group (66 students who had completed counselling treatment) or a wait-list comparison group (44 students). The Adult Self Report (ASR) by Achenbach and Rescorla [2003. Manual for the ASEBA adult forms & profiles. Burlington, VT: Research Center for Children, Youth, & Families, University of Vermont] and the Outcome Questionnaire 45 (OQ-45) by Lambert and Hill [1994. Assessing psychotherapy outcomes and processes. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 72–113). New York: John Wiley] were applied before and after the counselling sessions. Data show statistically significant decrease in the ASR clinical scales for both internalising and externalising problems after counselling as well as in the OQ-45 scores for distress symptoms and relationship difficulties. Compared with the control group, the students who received counselling exhibited a significant recovery regarding their progress with their studies.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

A peocess model of ethnocultural counselling for African survivors of organized violence

By analysing some 500 counselling and psychotherapy cases of survivors of organized violence as a therapist and supervisor over ten years the author developed a heuristic framework for a process model of ethnocultural counselling considering: (1) African counsellor's indigenous concepts, (2) a WHO-UNHCR approach, (3) a heuristic approach to psychotherapy, (4) a constructive narrative perspective, (5) an ethnopsychotherapeutic approach, and (6) a counselling approach for lay counsellors. The counselling process model comprises the following components: (1) Establishing a counselling relationship and motivation for change; (2) defining the problem, explanatory models, goals, and finding interventional means; (3) social comparison, cognitive undoing, metaphors, shared experiences and relaxation techniques; (4) working through the trauma, testimony approach; (5) ritualistic, cognitive and supportive approaches; (6) principle of education and advice; (7) evaluating and revizing treatment and stabilizing behaviour. These seven counselling components are described and counselling case examples are provided from Sudanese refugees in a large camp in Uganda and Malawian torture survivors in Malawi.     

Everything you always wanted to know about therapy (but were afraid to ask): Social,political, economic and clinical fragments of a critical psychotherapy

Three seemingly consensual propositions concerning psychotherapy and counselling are examined critically. All turn out to be unreliable, tendentious and even damaging: (i) Psychotherapy and counselling can be free and independent professions provided therapists, acting together, fight for them to be that way. (ii) Psychotherapy and counselling are private and personal activities, operating in the realms of feelings and emotions – the psyche, the unconscious, affects rooted in the body. Above all other factors, the single most important thing is the therapy relationship between two people. (iii) Psychotherapy and counselling, and psychotherapy are vocations, not jobs. Therapists are not only motivated by money. In developing his critiques of these propositions, the author utilizes social, political and economic perspectives. The author reviews new clinical thinking on the active role of the client in therapeutic process and suggests that a turn to the legendary figure of the Trickster might be of benefit to the field. The author locates his arguments in his experience of the politics and practices of psychotherapy and counselling, and engages in self-criticism.     

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.     

The challenge of counselling and psychotherapy research

Aims: The purpose of this commentary is to argue that the value of counselling and psychotherapy research lies, not only in what it teaches us as therapists, but also in its ability to challenge us and our assumptions. Method: The paper identifies eight beliefs that may be prevalent in sections of the counselling and psychotherapy community, and presents evidence that challenges them. Findings: While many of our beliefs may hold true for some clients some of the time, the research evidence suggests that they are unlikely to be true for all clients all of the time. Discussion: By questioning and challenging therapists' a priori assumptions, research findings can help counsellors and psychotherapists to be less set in their beliefs; and more open to the unique experiences, characteristics and wants of each individual client.     

Metatherapeutic communication: an exploratory analysis of therapist-reported moments of dialogue regarding the nature of the therapeutic work

The purpose of the study was to investigate the nature of metatherapeutic communication (MTC), defined as dialogue between therapists and clients on the nature of the therapeutic work and the means by which it can be of greatest help to clients. Twelve counselling psychologists, working pluralistically with 35 clients experiencing depression, described on post-session forms moments of negotiation and collaboration around the therapeutic work. Two main dimensions of MTC were identified: the subject matter of the MTC and the temporal focus of the MTC. In addition, MTC varied by the time at which it took place. These findings provide a framework for understanding the nature of MTC in counselling and psychotherapy, and the opportunities for implementing it in practice.