Interpersonal psychotherapy: A review and multicultural critique

Interpersonal psychotherapy (IPT) is a therapeutic approach focusing on the role of interpersonal dynamics in creating psychological difficulties that may be particularly relevant to the field of counselling psychology. IPT’s development within randomized controlled trials in the 1970s resulted in a strong empirical foundation without a cohesive theory. Regardless, theorists have since created a theoretical framework for IPT, which has received empirical support. Counselling psychologists have contributed to this research base and may have unique expertise to enhance IPT. Specifically, counselling psychologists can help integrate multicultural and diversity perspectives into IPT with the goal of creating a more culturally competent approach. For example, several aspects of IPT can be expanded to reflect these perspectives, such as integrating cultural sensitivity, cultural knowledge, cultural empathy, and cultural guidance. The authors conclude that IPT is a well-researched and effective treatment approach that holds potential for continued development within counselling psychology.     

Counsellors' experiences of changing their practice: Learning the psychodynamic‐interpersonal model of therapy

Seven counsellors were interviewed about their experiences of learning and applying a new approach to therapy: the psychodynamic‐interpersonal model. These interviews were analysed using grounded theory — a qualitative approach. Under the core category of ‘changing counselling practice: applying the PI model of therapy’, the material was organised into 10 major categories: difficult feelings; new awareness; therapeutic identity; identifying reasons for choosing how to work; experiencing difficulties in adherence; attributing causes of difficulties; ways through the difficulties; understanding how change in practice occurs; changing interventions; and specific other inputs. Examples from the interviews are used to cast light on the difficulties experienced by counsellors in the process of changing their practice.     

Factors affecting self-referral to counselling services in the workplace: a qualitative study

The benefits of psychological support in the workplace (also known as workplace counselling) are well documented. Most large organisations in the UK have staff counselling schemes. However, it is unclear what, if any, factors affect employee decisions to use such schemes. This study has used a qualitative methodology to explore the reasons that make employees use workplace counselling. Eleven employees of a university in the north of England who had used the staff counselling service of their employer took part in the study. The employer had two schemes available: an internal staff counselling service and an external Employee Assistance Programme (EAP). A semi-structured interview was used with each participant and grounded theory techniques were used to analyse the interviews. The analysis resulted in the construction of a model of psychological help-seeking in the workplace. The main findings indicate that most participants were motivated to use their employer's counselling service by their prior positive experiences of similar or other type of mental health services. Other encouraging factors were: recommendation of service by others, a supportive environment and trust in the confidential ethos of the service. Conversely, negative preconceptions of psychological help-seeking and a perception of the employing environment as unsafe were shown to have been discouraging factors. The study concludes with suggestions for practice and for further research.     

A qualitative study of client experiences of working with novice counsellors

Aims: This paper reports on a qualitative analysis of written accounts by clients who participated in a counselling relationship with beginning-level trainees. The purpose of the study was to explore how clients experience the process of counselling with novice practitioners. Method: Consensual qualitative research was used for data analysis. Findings: Three general thematic categories were identified – client perceptions of self in counselling; client perceptions of the counsellor; and client perception of the counselling process. Conclusions: Overall, the findings suggest that these clients saw the interpersonal qualities and skills of the counsellor as major contributors to their experience. Implications: Clinical training of novices should start by developing the interpersonal and collaborative skills of trainees.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Relationships and Emotional Experience in a Process of Gay Identity Development: A Case-Study Based on Personal Construct Theory

A case-study of gay identity development is presented based on Kelly's personal construct theory. The subject is a married man in his early thirties. Repertory grid technique is used to investigate the subject's construing of his relationships with gay men, and Kelly's account of emotion in terms of constructs of transition is used in analysing the emotional dimensions of the subject's experience. Three dimensions of interpersonal construing emerged from the grid analysis: emotional impact, negative affect and friendship. Five aspects of the subject's emotional experience are discussed: aggression, threat, anxiety, hostility and guilt. Some implications of the study for counselling are outlined, its limitations noted, and possible avenues for further research identified. It is argued that the study serves to illustrate the value of Kelly's perspective in understanding the interpersonal and emotional dimensions of gay identity development.     

The influence of personality and theoretical models on applicants to a counselling psychology course: A preliminary study

We examined whether personality variables in prospective condidates for a postgraduate program in counselling psychology were associated with an interest in models of counselling or therapy. The models were classified as directive models or non-deiective models of counselling. Using the Millon Index of Personality Styles we found that subjects who expressed an interest in the directive models of counselling (e.g. cognitive behavioural therapy) scored higher on scales measuring interpersonal boldness, systematizing and conforming in comparison to subjects who expressed an interest in non-dieective counselling (e.g. psychodynamic) who scored greater on intuitiveness (a perference for intangible, unstructured and symbolic). Implication for training and future research in this area are discussed.     

Client experiences of counselling and treatment interventions: A qualitative study of family views of family therapy

The case is made that personal experience and social life are inherently meaningful. The presence of meaning in human affairs requires all participants to develop interpretive skills if they are to understand what is happening. Researching social life is greatly helped by methods which acknowledge the hermeneutical quality of interpersonal experience. The use of qualitative research methods to investigate all aspects of counselling is therefore highly appropriate. To illustrate the use of qualitative research designs and methods of analysis, a study of family members' views of family therapy is briefly described.     

Intentions to participate in counselling among front-line,at-risk Irish government employees: an application of the theory of planned behaviour

ABSTRACT

The study set out to examine intentions to engage in counselling among at-risk Irish government employees and the differential utility of two alternative theory of planned behaviour (TPB) models of behaviour to explain intentions to participate in counselling. Individuals (N=259) employed in a front-line, at-risk occupation for the Irish government completed a TPB-based questionnaire. Quantitative analyses revealed that participants held positive to neutral intentions to participate in counselling, irrespective of gender. The original TPB model explained 49.9% of variance in intentions whereas an alternative TPB model, splitting the perceived behavioural control (PBC) construct between its internal and external control components, explained a further 8.9% of variance. Furthermore, self-efficacy was found to be the strongest predictor of intentions. This study therefore supports the use of the TPB in understanding counselling-seeking behaviour.     

Counselling children using a multiple intelligences framework

This paper presents a three-stage framework that has been shown to be useful in the counselling of children. Some of the qualitative results of a study into counselling practice informed by Gardner's theory of multiple intelligences are reported. The study, which sought to explore the essence of the counselling act, highlights techniques and environmental factors that are useful in the counselling of children, particularly small children who have not developed the language required for more formal counselling sessions. The use of Gardner's (1983) theory of multiple intelligences as a framework enabled the counsellors to make available a variety of activities that tapped a variety of talents.     

Creating a research agenda in career counselling: the place of action theory

After identifying historical and current problems in career counselling research, we propose a research agenda based on contextual action theory. This theory has been used as a framework for research in the career field and for general counselling practice. It is advantageous for several reasons including its conceptual basis, its detailed qualitative and quantitative research method, and the significant link it provides between research and practice. It is supported by the action-project method, an integrated set of procedures developed for conducting research. Contextual action theory and the action-project method can address major emerging issues in career counselling, for example the place of emotion and the use of narrative, and advance the research agenda in this field.     

Factorial and construct validity of the revised short form integrative psychotherapy alliance scales for family, couple, and individual therapy

The Integrative Psychotherapy Alliance model brought an interpersonal and systemic perspective to bear on theory, research, and practice on the psychotherapeutic alliance. Questions have been raised about the independence of the theoretical factors in the model and their operationalization in the Individual, Couple, and Family Therapy Alliance Scales. This paper presents results of a confirmatory factor analysis of the scales that delineated at least three distinct interpersonal factors as well as shorter versions of the three scales to facilitate their use in research and practice. The paper also presents the results of a study testing each factor's association with client retention and progress over the first eight sessions in individual and couple therapy. At least two of the interpersonal factors were uniquely associated with progress in individual and couple functioning. Implications of the results for theory, research, practice, and training in individual, couple, and family therapy are elaborated.     

Counselling values and their relationships with self-efficacy among Chinese secondary school teachers in Hong Kong

Two-hundred-and-ninety-nine Chinese secondary school teachers in Hong Kong were assessed on their endorsement of counselling values using a 19-item self-report checklist, and on their perceived self-efficacy towards helping using the 10-item Schwarzer-Wegner scale. These teachers were found to share the same counselling values as counselling psychologists. They prized most highly the humanistic counsellor qualities, followed by counselling practice with a preventive, developmental and holistic perspective. Their relative endorsement of scientific values suggested that they were not resistant to the promotion of empirically supported and evidence-based treatment approaches. Teachers’ self-efficacy towards helping was also predictable from endorsing values related to interpersonal relationships and diversity in counselling practice. Implications of the findings for improved counselling training for teachers are discussed.     

Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

New Maps for Old: Guidance and the Reform of Vocational Qualifications

The reform of occupational qualifications in England and Wales being undertaken by the National Council for Vocational Qualifications will affect the qualifications of those who work in guidance and counselling, and the opportunities open to their clients. While early development work concentrated on lower-level qualifications, attention is now turning to higher levels, including occupations like guidance and counselling where interpersonal skills play a major part. The principles underpinning the reform of qualifications are outlined; the project work carried out up to the end of 1991 is described; and some of the implications and issues arising from this work are identified, both for the professional qualifications available, and for the map of the broad fields of guidance and counselling.     

Interpersonal issues in counselling a resistant child: A case-study

A therapeutic relationship was established with a resistant child whose experiential background together with the ongoing uncertainty of her life situation created interpersonal issues which threatened the continuance of counselling. The case-study focuses on the aims of counselling and how these were handled within the oscillating relationship that was developed between counsellor and child.     

Item analysis of the 'My Use of Interpersonal Skills Inventory'

A 32-item inventory was designed to provide data concerning the extent to which training in interpersonal and counselling skills was applied by educators in their professional and personal lives. An item analysis of the responses of 82 experienced educators was carried out on three testings completed before, soon after and one year following a training skills course. The item analysis revealed a high level of internal coherence for the inventory, indicating that improvement on any skill was related to improvement in the others. Correlations between the three applications of the inventory indicate an acceptable level of test-retest reliability. Apart from a clear face validity, data are reported confirming that interpersonal and counselling skills reported in the inventory are being applied in terms of reports of specific incidents.     

Using doctor-patient communication to affect patients' lifestyles. theoretical and practical implications

Abstract

Physicians very often do not perceive themselves as being efficient in affecting patients' life style. The aim of this article is to elucidate theoretical constructs and models in health education and their practical implications for individual health counselling in daily work as a guidance for physicians. The current most commonly used strategies are giving information and exhorting people, which have a limited ability to change peoples' behaviour. Derived from current behavioural constructs and models in health education - such as the health belief model, social learning theory, health beliefs, self-efficacy, self-determination theory - principles for successful strategies are described: to use patient-centredness instead of directing, to encourage patients to reflect and decide on their behavior, to find out the patient's readiness to change, to present knowledge as neutral facts instead of valuations, to focus on the actual behaviour instead of information-giving, to highlight patients' health beliefs and to discuss the advantages and disadvantages which the patients experience with their life style. The article concludes with a comprehensive model for individual health counselling in consecutive steps.     

Reversal theory: A new perspective on crisis counselling

Caplan, in a variety of publications, has presented a model of crisis development which seeks to exemplify the core conditions of a crisis. Brandon has elaborated this model and shown its relevance to counselling and therapy. The recent development of the theory of psychological reversals, however, poses questions about the validity of Caplan's model. In this paper, a critique of crisis theory is presented, focusing particularly upon the notion of homeostasis and upon the relationship between arousal and anxiety. It is suggested that the five crisis models derived from the theory of reversals offer a fuller understanding of crises and crisis counselling than can be derived from Caplan's work.