Fibromyalgia: Predicting openness to counselling referrals

Fibromyalgia (FM) is a chronic pain condition that can negatively impact on all aspects of patients’ lives. The purpose of this study was: first, to explore the biopsychosocial factors that may contribute to adjustment to FM symptoms; second, to investigate how referrals to counselling related to patients’ ratings of their relationship with their physicians; and, last, to examine if self-reports of illness distress, emotional problems, and practical problems can predict who will be open to counselling referrals. For this cross-sectional study, data from 190 people were collected through an online survey. Statistical analysis revealed that emotional problems reported were the best predictor of variance in illness distress and contentment scores. Further, results indicated that referrals made in accord with patients’ perceptions that they would benefit from counselling may have a positive influence on how patients rate their relationships with their physicians. Finally, self-reported scores of illness distress, number of emotional problems, and number of practical problems accurately predicted who would be open to counselling referrals in 67% of cases. Research results provide support for addressing emotional issues to facilitate adjustment to FM symptoms, and for use of psychosocial measures to determine when patients with FM will be open to counselling referrals.     

Genetic Counseling: Clinical Geneticists' Views

Evaluation of genetic counseling requires a clear consensus about its objectives, which is not evident in published definitions and guidelines. This study aims to investigate clinical geneticists' beliefs and thoughts about their practice. Structured interviews with eight clinical geneticists addressed the aims, skills, and expectations of genetic counseling. Analysis of transcribed interviews revealed four key themes, with contradictory aspects: 1. Providing information that is objective, full, and accurate versus information that is contingent on circumstances and tailored to individual needs. 2. Eliciting emotion and dealing with it directly versus dampening down and containing emotion. 3. Communicating nondirectively versus directively. 4. Expecting to perform a range of sophisticated tasks while having minimal training in the necessary skills to achieve these. These results have implications for the nature of the professional role, the development of training required for it, and the evaluation of genetic counseling.     

Avatar‐based counselling for young people within school counselling. Qualitative analysis of client experience

Background

This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world ). The intervention was piloted in eight secondary schools in the UK in 2016.

Aims

Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness.

Materials and Methods

Interviews were semi‐structured and were analysed using thematic analysis.

Results

The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness.

Discussion

There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds.

Conclusion

Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling.     

Therapeutic outcomes in the Welsh Government's school‐based counselling strategy: An evaluation

Aims: The purpose of this study was to evaluate the outcomes of school‐based counselling, as delivered in the Welsh Government's School‐based Counselling Strategy, for reducing psychological distress in young people aged 11–18. Method: The study used a quantitative cohort design, comparing levels of distress on either the Young Person's CORE (YP‐CORE) or the Strengths and Difficulties Questionnaire (SDQ) from baseline to endpoint. Data were available on 3613 episodes of counselling, across 42 datasets. Meta‐analytical procedures were used to identify the mean effect size and predictors of outcomes. Results: Within each dataset, counselling was associated with significant reductions in psychological distress, with a mean effect size (d) of 0.93(95% CI = 0.89–0.97) using a fixed effects model and 1.09 (95% CI = 0.97–1.22) using a random effects model. Datasets using the YP‐CORE had larger effect sizes than those using the SDQ, and datasets with more complete response rates had lower outcomes than those with poorer response rates. Conclusion: The results confirm that school‐based counselling, as delivered in the UK, is associated with significant reductions in psychological distress, comparable to adult counselling and psychotherapy services.     

Understanding the role of hope in counselling: Exploring the intentional uses of hope

In this paper we look at various conceptual models of hope and research evidence for the integral role that hope plays in counselling. We recognize hope as a dynamic process during which counsellor and client interact in ways that can be mutually influencing and we review research that explores this reciprocal process. A model for the intentional use of hope in counselling that recognizes both implicit and explicit approaches is offered. Metaphors for hope-work that position and re-position both counsellor and client in ways that may foster hope are explored. Finally, we provide suggestions for initiating conversations in which hope can be an explicit therapeutic focus.     

Oppression within the counselling room

This paper suggests that the oppression experienced by disabled people in society is sometimes replayed in the counselling room by counsellors who are unaware of their own disablist attitudes and prejudices. Whilst the provision of Disability Equality Training (DET) within counselling courses would ameliorate the problem, I believe that disabled people would be most empowered by a counselling approach which recognises the potential for oppression within the counsellor‐client relationship. One solution may be the creation of a new counselling approach (disability counselling) which includes the social model of disability as one of the foundations. An alternative solution may be found within the emerging counselling approaches that treat counselling as a social and political process and place emphasis on developing comprehensive anti‐discriminatory practice.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

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.     

The future of Canadian counselling psychology: Doctoral students

Little is known about the overall characteristics and beliefs of Canadian counselling psychology doctoral students. An online survey was administered to 43 doctoral students across all Canadian counselling psychology programmes, representing an approximate 26% response rate. Results indicated that the average age of doctoral students in the sample was about 32 years and that the majority were women (about 77% in the sample). Additionally, findings can be taken to suggest that participants were satisfied with their choice of counselling psychology as a career. The doctoral students sampled primarily practised from an integrationist theoretical standpoint and spent very little of their practice time providing formal psychological assessment services or career counselling. Participants generally intervened through individual counselling or psychotherapy and were focused on disorder treatment rather than preventative or developmental services. Curriculum changes that should be considered from the results of this study pertain to the topics of assessment, career counselling, advocacy/media skills, professional identity development and prevention/developmental interventions. The results of this study can also be taken to predict characteristics of the next generation of Canadian counselling psychologists and the future practice of counselling psychology in Canada.     

Tracking trends: A longitudinal look at internship placements in counselling psychology in the United States

Efforts to track trends in internship placements across time serve the field of counselling psychology in a number of ways. But this research is qualified by its reliance upon a single source of data: the Council of Counseling Psychology Training Program (CCPTP) annual survey. This paper provides a review of the concerns related to this over-reliance, and addresses these concerns by supplementing this data source with the comprehensive data collected by the Association of Psychology and Post-doctoral Internship Centers (APPIC). Findings provide a longitudinal look at the supply and demand issue concerning internship placements, track the nature of pre-doctoral internship placements across a 30-year period of time, and generally support the validity of the CCPTP data by documenting their close correspondence to recent APPIC data.     

Motivation as a predictor of outcomes in school‐based humanistic counselling

Background: Recent years have seen a growth in the provision of counselling within UK secondary schools, and research indicates that it is associated with significant reductions in psychological distress. However, little is known about the moderators and mediators of positive therapeutic benefit. In the field of adult mental health, motivation has been found to be one of the strongest predictors of therapeutic outcomes, and it was hypothesised that this may also be a predictor of outcomes for young people in school‐based counselling services. Aims: To assess the relationship between young people's motivation for counselling and its effectiveness within a secondary school setting. Sample: Eighty‐one young people (12–17 years old) who attended school‐based humanistic counselling services in Scotland. Method: Clients completed a measure of motivation for counselling at the commencement of their therapeutic work and a measure of psychological wellbeing at the commencement and termination of counselling. Results: Motivation for counselling was not found to be significantly related to outcomes. Discussion: The results indicate that the association between motivation and outcomes may be weaker in young people as compared with adults. However, a number of design factors may also account for the non‐significant findings: insufficient participants, marginal reliability of the motivation measure and social desirability effects.     

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

Action: a bridge between vocational and mental health counselling*

A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.     

A feasibility study of the systematic evaluation of client outcomes in a voluntary sector counselling agency

There is an increasing demand on voluntary sector counselling agencies to evaluate the effectiveness of their work with clients. A pilot study was carried out in a voluntary sector counselling agency to assess the feasibility of adopting a well‐established evaluation system (CORE) designed to measure client outcomes. The paper describes the issues and complexities involved in introducing such a system, and explores the impact of the evaluation on counsellors, staff and users of the service. It is suggested that evaluation can play an important role within voluntary organisations in enabling counsellors and staff to reflect on their work.     

The impact of psychological distress and university counselling on academic outcomes: Analysis of a routine practice-based dataset

Whole university approaches to student mental health and well-being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE-OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE-OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study.     

Applying psychodynamic insights in brief counselling

Abstract

After a review of the place of brief work in the psycho-dynamic tradition, this paper explores how three psychodynamic insights may be of use in brief counselling. Using case examples drawn from work with employment problems, the paper discusses the activation of healing/developmental processes through brief counselling. The ‘significant emotional experience’ which is seen as important is analysed in terms of work with the transference and the punitive superego.     

Some ethical concerns about counselling research

The whole approach of counselling researchers to ethics may be assumed to have been improving in recent years, especially with the BACP research guidelines (Bond, 2004 Bond, T. 2004. Ethical guidelines for researching counselling and psychotherapy. Counselling and Psychotherapy Research, 4(2): 4–9. [Taylor & Francis Online] [Google Scholar]), with its focus on trustworthiness and on the researcher engaging with ethical issues. In this paper we share our concerns about the background to ethical decision making for researchers today followed by our specific concerns for counselling researchers namely: why do counselling research at all?; research that hurts participants; the impact of research on the therapeutic process; restrictive notions around what is data; the politics of funding and informed consent revisited.     

Nature and role of traditional forms of counselling in Zambia: a case of Lusaka province

The aim of this study was to determine the nature and role of traditional forms of counselling and the scope of common problems presented to traditional counsellors in Lusaka province. It used a qualitative research methodology and deployed a holistic single-case study design with multiple embedded units of analysis. The sample consisted of 80 adult participants and one focus group interview with 8 discussants; and it was selected based on the purposive sampling method and snowball technique. Data collection was elicited through structured individual interviews and semi-structured group interview. The study revealed that traditional forms of counselling are rooted in traditional systems of knowledge and sociocultural values, customs, and practices; and they are essentially community-based and multicultural in nature.     

Evolution,depression and counselling

In this paper a framework of evolutionary psychology is used to develop a model of depression. In this model depression is seen as not normally a biochemical illness or disorder, but instead as usually due to the person becoming trapped within a psychologically activated but unwanted and inappropriate suite of natural emotions, with the activation coming from a perception of a major decline in personal usefulness that can include failure, guilt, shame or perceived rejection. A neuropsychological observation that supports this model is described. The implications of the model for counselling with depressed clients are outlined in terms of a multi-dimensional approach, oriented around perceived usefulness. It is predicted that clients receiving such counselling will recover more rapidly and be less likely to suffer a relapse than those receiving just drugs or a form of counselling that covers fewer dimensions.     

Both group peer counselling and individual counselling reduce anxiety and depression,and increase self-esteem and overall life satisfaction in palliative cancer care

This study compared group peer counselling and individual counselling in relation to quality of life, well-being and perceived control in individuals receiving palliative cancer care. The study utilized a quasi-experimental pretest-posttest design to assess the effectiveness of counselling type, in a sample of individuals diagnosed with breast, bowel or lung cancer. Nine females underwent group peer counselling and nine underwent individual counselling. Individuals were administered self-report questionnaires which included standardized subscales that measure quality of life in terms of psychological well-being and perceived locus of control before and after counselling. Both group peer counselling and individual counselling significantly increased self-esteem, self-reported levels of overall life satisfaction, and reduced anxiety and depression. Self-esteem, overall life satisfaction, and anxiety and depression were comparable in the two counselling types, both at outset and after counselling, however, individuals with internal locii of control scored higher for self-esteem on post-test, and lower for depression and anxiety, irrespective of type of counselling.