Counselling children and young people: A review of the evidence for its effectiveness

This paper summarises and presents the results of a BACP commissioned systematic scoping review on the research evidence on counselling children and young people. The methodology was based on a structured, hierarchical, systematic approach to searching and reviewing the research literature. Inclusion criteria defined the scope of the review in relation to a range of issues in counselling children and young people: behavioural problems and conduct disorders; emotional problems including anxiety, depression and post‐traumatic stress; medical illness; school‐related issues; self‐harming practices and sexual abuse. Four groups of counselling approaches were examined: cognitive‐behavioural; psychoanalytic; humanistic; and creative therapies. The findings indicate that the four therapeutic approaches are effective to a greater or lesser degree in relation to the range of issues. Although the findings show that there is little or no evidence for the effectiveness of some therapies for particular issues, this may not reflect the lived experience of children and young people engaged in counselling in a range of community and institutional settings. Instead, the absence of evidence is likely to reflect a lack of published studies that fit the inclusion criteria for this review.     

Parenting programmes for parents of children and young people with behavioural difficulties

Children and young people exhibiting behavioural difficulties present a major challenge not only to parents but also to education and health professionals and to society as a whole. In this paper, I shall address some key issues regarding these parenting programmes, based particularly on a programme of research over 13 years in the Centre for Educational Development, Appraisal and Research at the University of Warwick. This has comprised large‐scale studies across all areas of England, both programmes targeted at parents whose children are presenting or at risk of developing behavioural difficulties: the Parenting Early Intervention Pathfinder and Parenting Early Intervention Programme; and universal programmes aimed at all parents, as a positive contribution to behavioural development across the population: the CANparent trial. All were funded by the Department for Education plus the continuation of the CANparent trial was funded by the Department of Health. In addition, I consider studies that have built on this research to examine the use of parenting programmes with parents of children and young people with special educational needs; and also the effectiveness of programmes during sustained implementation, beyond formal trials and similar research initiatives, that is, as day‐to‐day practice. I show that well‐constructed parenting programmes that are acceptable to parents are effective, that these positive effects on parents can remain over time, and also that the positive effects found in well‐organised trials can be maintained when programmes are delivered by community services as part of their normal practice.     

Life Design Career Counselling with an Abandoned Adolescent: A Case Study

This article describes the value of life design counselling with an abandoned adolescent female. The participant was selected purposively from among a group of abandoned adolescent females who had expressed a need for career counselling. The life intervention comprised two 90-minute sessions per week over a period of a month. Life design data included collage, family constellation, life line, career style interview, asset map and life chapters. Following the intervention, the participant demonstrated career adaptability and an eagerness to take an active part in her evolving life story. Life design counselling has potential to meet the career counselling needs of children with neglect and abandonment experience.     

Caregivers, young people with complex needs, and multiple service providers: a study of triangulated relationships

Five patterns of service provider-caregiver-adolescent interaction are discussed using qualitative interviews and file review data from 44 youth with complex needs who were clients of more than one psychosocial service (child welfare, mental health, addictions, juvenile justice, and special education). Findings show that young people and their families become triangulated with service providers, either engaging with, or resisting, interventions. For young people with complex needs involved with multiple service providers, both positive and negative patterns of interaction contribute to the complexity of caregiver-child interactions. According to young people themselves, the most functional of these patterns, empowerment, was experienced as protective when it helped them to meet their personal needs and enhance communication. In contrast, four problematic patterns produced triangulations described as conflictual or unsupportive. The implications of these patterns for family therapy are discussed with an emphasis on the therapist as both clinician and advocate for better services from multiple providers.     

People who help people: A needs assessment of those who provide interpersonal support to individuals with chronic illnesses

Social support during an ongoing illness has been shown to be beneficial for both the provider and the receiver, but people often struggle with offering effective, appropriate support. There is a lack of communication-focused training not specifically tied to caregiving or training that is designed for all social network members of a person experiencing a chronic illness, which we call interpersonal support providers (ISPs). We conducted a concurrent mixed-methods needs assessment, surveying both ISPs and support receivers, to understand communicative challenges and inform an evidence-based intervention. Analysis of results from an online survey (N_providers = 91, N_receivers = 97), consisting of five open-ended and 15 quantitative items, suggests that ISPs have difficulty managing their worries and emotions while providing comfort to others, which may impact support quality. In addition, ISPs and receivers both identify “listening” as a key skill for ISPs to hone, though ISPs feel they are more skilled at listening than receivers say they are. Lastly, ISPs feel they are good at sharing information and advice, but receivers often perceive it as patronizing or unhelpful. These results will inform the creation of an intervention for everyone offering emotional, esteem, and informational support to individuals with chronic illnesses.     

Dyslexia and the school counsellor: A Maltese case study

Aim: This paper seeks to understand whether Maltese school counsellors are equipped to deal with dyslexic clients, considers whether specific strategies need to be used, and what positive effects, if any, counselling has on these clients. Previous studies: A literature review on self-concept and techniques on how to improve the self-concept of children with Learning Disabilities (LD)/Specific Learning Difficulties (SpLD) will place the current study in context. Method: Questionnaires (available from the authors on request) were distributed to all school counsellors on the island and analysed using content analysis. Findings: Findings from respondents indicate a need for more training, evidence-based knowledge of specific techniques when dealing effectively and successfully with dyslexic clients, specific specialised training to understand dyslexic clients and that counselling has a positive effect on dyslexic clients.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.     

Severity of sleep problems in children with severe learning difficulties: Description and correlates

In this study we have examined the percentage occurrence of settling and waking problems and of sleeping in the parents' bed in a sample of children with sleep problems. We found that about two-thirds had settling problems, nearly nine-tenths had waking problems, and one-third slept regularly in their parents' bed. Parents of children with sleep problems were more likely to experience a range of family problems than were parents of children without problems, and they were more likely to report a range of symptoms of stress. Most children with settling problems took at least two hours to settle to sleep at night. This behaviour was mainly tolerated or accepted by the parents. Parents gave a variety of suggestions as to triggers for settling problems, from being upset during the day to fears, illness and alterations in routine. Most parents thought the underlying explanation was the child's intellectual impairment. Over half the children with waking problems woke up every night, while 85% woke up at least three nights a week. One-third woke up three or more times a night. About two-thirds took up to half an hour to resettle, with one-third taking up to an hour. Parents (mainly mothers) tended to get up to attend to the waking child. About half of the children were thought to need attention because of physical disabilities. Illness, alteration in routine, becoming ‘overtired’ and ‘upset’ were thought to trigger waking problems. Intellectual impairment was again seen as the more general underlying reason for waking problems. Very few children were receiving treatment for their problems—7% were receiving medication and one was receiving a behavioural programme. Few parents had a systematic bedtime routine for their child and few had a consistent agreed response to settling or waking problems. When we examined the relationship between certain family variables and severity of sleep problems a number of relationships were found. Sleep problem severity was related to maternal responsiveness, maternal stress, impact of the child on the family, maternal behaviour towards the child, maternal attitudes towards the child and marital satisfaction. Severity of sleep problems was also related to certain child characteristics. Children with more severe problems tended to present more problems in their daytime behaviour. Sleep problem severity was also found to be related to child communication skills. These findings, together with those from other pilot studies, suggest that using behavioural methods of managing sleep problems might prove a promising way forward.     

Message in a bottle: a comparative study of spiritual needs of children and young people in and out of hospital

Using the metaphor of a message in a bottle as a framework and sending an S.O.S. to adults, the question of what are the three biggest needs of children and young people was asked. Data consisting of 107 important needs of children and young people was collected from 36 children and young people both in and out of hospital: in hospital by chaplains and other health care professionals, and out of hospital by children and youth work undergraduate students. This was a convenience sample across the United Kingdom with the majority of respondents in the Midlands. The data were coded and then thematically analysed and separately compared to Maslow’s hierarchy of needs. Emotional needs was the largest theme for hospitalised children and young people and relationship needs for the non-hospitalised children and young people. For both groups Maslow’s level 3 need of belonging was the greatest averaging at just over half the needs shared. A discussion of the results of the analyses identifies some ways in which the needs of hospitalised children and young people may differ, identifying some implications for practice.     

Inter-professional learning: initial observations of the art psychotherapy tools used in the post-qualifying postgraduate training in counselling children and young people

ABSTRACT

Children and young people (C&YP) counselling training and art psychotherapy training lead to two distinctive psychological therapy approaches; one is informed by British Association for Counselling and Psychotherapy’s Competences for work with children and young people (4–18 years) [BACP. (2019a). Competences for work with children and young people (4–18 years). Retrieved from https://www.bacp.co.uk/media/5863/bacp-cyp-competence-framework.pdf], the other by Health and Care Professions Council’s Standards of Proficiency for Arts Therapists [HCPC. (2013). Standards of proficiency - Arts therapists. Retrieved from http://www.hpc-uk.org/publications/index.asp?id=39#publicationSearchResults]. In this article we outline the training methods utilised on the Postgraduate Diploma in Counselling C&YP at a British University and share initial observations of how creative and arts-based therapeutic tools form an important part of the curriculum delivery. The aim of this paper is also to outline the role of intentionality application in the use of creative interventions in therapeutic practice.     

Measuring executive function skills in young children in Kenya: Associations with school readiness

Most of what is known about the association between children’s executive function (EF) and school readiness skills is derived from research conducted in Western countries. We tested whether these associations were evident in a middle‐income country context. Participants were 1,480 children, aged 4–7 years old, who participated in an endline assessment of the Tayari program, an early childhood education (ECE) model that is being delivered by the Kenyan education system. High rates of task completion, low rates of floor effects, and high rates of assessor quality ratings supported the feasibility of large‐scale direct assessments of EF with young children. Assessor ratings of children’s attention‐related behaviors during testing were positively associated with their performance on EF tasks (rs = 0.12–0.27). An EF composite score was not related to demographic factors or to children’s exposure to the Tayari program. However, the EF composite score was uniquely associated with performance‐based measures of early literacy (β = 0.18, 95% confidence interval [CI] = 0.05, 0.31), early numeracy (β = 0.16, 95% CI = 0.07, 26), and social‐emotional competencies (β = 0.12, 95% CI = 0.03, 0.20), even after adjustment for multiple covariates. These results are discussed with respect to the ways in which EF skills inform ongoing efforts to invest in ECE in low‐ and middle‐income countries.     

The nature space. A reflexive thematic analysis of therapists' experiences of 1:1 nature-based counselling and psychotherapy with children and young people: Exploring perspectives on the influence of nature within the therapeutic process

Nature-based therapy is an emerging and rapidly developing field within counselling and psychotherapy, yet there is little published empirical research, or integrated models relating to its practice with Children and Young People (CYP). The present study aimed to explore therapists’ experiences of one-to-one nature-based counselling and psychotherapy with CYP, eliciting perspectives on the interaction between nature and the therapeutic process. A reflexive thematic analysis provides preliminary insights into possible mechanisms of action with the potential to inform a longer-term exploration of whether nature-based therapy is effective, for whom and why. The study highlights the need to better explore and understand how nature-based therapy supports relational and intrapsychic change in interaction with developmental processes, to inform construction of coherent and consolidated theory and models for practice.     

School‐based humanistic counselling for psychological distress in young people: A practice research network to address the attrition problem

Aims: School‐based humanistic counselling (SBHC) is a common psychological intervention for young people, particularly in the UK. However, studies have tended to suffer from high attrition rates, such that effects may have been over‐estimated. This paper describes a low budget ‘star topology’ practice research network (PRN) outcome evaluation of SBHC in a sample where attrition rates were minimised. Design: A practice‐based longitudinal study in a small PRN compared levels of psychological distress at first and last session from session‐by‐session data. Multilevel regression modelling was used to identify predictors of outcomes. Methods: Eight counsellors working across 11 schools agreed to use session‐by‐session self‐rating on the Young Person's CORE (YP‐CORE) yielding data from 256 young people aged 11 to 17. Predictors of outcomes were analysed using multilevel regression analysis. Results: Mean levels of distress on the YP‐CORE reduced from 18.29 (SD = 7.32) at baseline to 9.10 (SD = 6.19) at endpoint, giving a baseline to endpoint effect size of 1.26 (95% CI = 1.06–1.46). Lower levels of psychological distress at endpoint were associated with male clients, younger age groups, greater rates of attendance at counselling, and bereavement as a presenting problem. Conclusions: This ‘star topology’ PRN focused on a single study and demonstrated that such a system can provide relatively low cost, high quality data. The data showed that SBHC is associated with large reductions in psychological distress, and that this cannot be attributed to the high attrition rates of previous datasets.     

Growing up with severe learning difficulties: A longitudinal study of young people and their families

The paper reports on a longitudinal study of young people with severe learning difficulties. Two types of comparison are made: changes between Time 1 and Time 2, and comparisons with the younger age group in the study. The young adults acquired considerably more self-help and communication skills between Time 1 and Time 2. They were less likely to require help with self care than the younger age group and their carers were less stressed. Parents' needs for additional service provision fell into three categories: information needs, help with communication and other skills, and practical help. The greatest need was for information. The main concerns of the mothers at Time 1 and Time 2 are documented. The young adults' preparation for leaving school, current day placements at Social Education Centres and employment prospects are discussed. It is concluded that there are few opportunities to move on to less sheltered environments.     

Patterns of emotional availability between mothers and young children: Associations with risk factors for borderline personality disorder

Emotional availability (EA) characterizes a warm, close relationship between caregiver and child. We compared patterns (clusters) of EA on risk factors, including those for borderline personality disorder (BPD). We sampled 70 children aged 4 to 7 years from low socio‐economic backgrounds: 51% of whose mothers had BPD. We coded filmed interactions for EA: mothers' sensitivity, structuring, non‐intrusiveness, non‐hostility, and children's responsiveness to, and involvement of, mothers. We additionally coded children's over‐responsiveness and over‐involvement. Using person‐centred analyses, we identified four clusters: high functioning, low functioning, asynchronous (mothers above average on two of four dimensions and children below), and below average. Mothers in the low‐functioning cluster had lower income, less social support, more of the borderline feature of negative relationships, and more depression than did mothers in the high‐functioning cluster. The children in the low‐functioning group had more risk factors for BPD (physical abuse, neglect, and separation from, or loss of caregivers, and negative narrative representations of the mother–child relationship in their stories) than did children in the high‐functioning group. The asynchronous group included older girls who were over‐responsive and over‐involving with their mothers in an apparent role reversal. Interventions targeting emotional availability may provide a buffer for children facing cumulative risks and help prevent psychopathology.

Highlights

• This paper investigated how mother‐child emotional availability (warmth and closeness) relates to risk factors for borderline personality disorder, including mother‐child role reversal.
• In filmed mother‐child interactions, low emotional availability was associated with risk for borderline personality disorder and role reversal was more likely for older girls.
• Findings support the cumulative risk hypothesis and may inform interventions to improve mother‐child emotional availability to prevent the development of psychopathology.

     

自我录像示范干预学龄初期儿童课堂学业自立的个案研究

为了探讨自我录像示范对学龄初期儿童课堂学业自立养成的影响,研究采用单个被试的A-B实验设计,用自我录像示范对一名学龄初期儿童的课堂学业自立进行干预。结果表明:自我录像示范的干预能提高个案的课堂学业自立水平,在干预期和追踪期出现高课堂学业自立行为的频次均高于基线期。结论:自我录像示范能够促进学龄初期儿童课堂学业自立的养成。儿童对于示范录像中目标行为的习得和运用可以泛化到日常生活中类似的其他情境中,且情景越相似,效果越佳。     

Making a difference for young people with learning disabilities: A model for inclusive counselling practice

The prevalence of mental health problems in young people with learning disabilities and the disability rights movement provide the background to this paper. The aims are to investigate the inclusivity of counselling; gain insight into inclusive practices; and put forward a model for inclusive counselling practice. Mixed methodology provides quantitative and qualitative data through a survey of counsellors (n = 396) and a series of semi‐structured interviews (n = 15). The results produce six indicators of inclusive counselling, which are used to build a model for inclusive counselling practice: proactive approach to inclusion; focus on building relationships; operationalising equal opportunities policies; inclusive initial assessments; adopting flexible and creative approaches to counselling; and training and awareness raising. The implications for research and practice are to acknowledge the exclusive nature of the profession and address the issue of inclusion through training, professional development and further research in the field. The model for inclusive counselling practice is put forward as a tool for auditing existing counselling provision and as guidance for counsellors and policy makers in increasing inclustion of young people with learning disabilities in mainstream counselling.