Arts for the blues – a new creative psychological therapy for depression

ABSTRACT

Routinely prescribed psychological therapies for depression are not always effective. Arts therapies, particularly Dance Movement Psychotherapy, may offer additional therapeutic mechanisms for depression. Therefore, client-reported helpful factors from various therapy types, along with client preferences, are key in devising new therapeutic interventions. We present a framework for a new pluralistic “meta-approach” of therapy for depression, based on an interdisciplinary thematic synthesis (Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8[1], 45) of active ingredients from both talking therapies and creative approaches. Lastly, we offer an illustrative group therapy workshop based on this approach, to be piloted with clients and practitioners within an NHS mental health service. Further research is required to evaluate this pilot and to devise a full treatment for trialling within the service.     

Art Speaks in Healing Survivors of War

Abstract

Mental health clinics can use creative art therapies as a means of reaching out to war refugees in their communities who may not respond to traditional talk therapy. In this case, the use of quilting and other artwork was utilized by the staff at Chicago Health Outreach to assist displaced Bosnians to cope with their war-related trauma and integration into their new environment in the United States. It can be difficult to reach refugee populations within a community whose culture and language are different from the majority, but finding other means of communicating can make a real difference for these individuals as they find safety and understanding by working on and sharing special creative projects.     

‘Pluralistic accountability’ for the psychological therapies? Holding the tension between diversity's virtues and the need for accountability

ABSTRACT

This paper argues that the field of counselling and psychotherapy needs to find values-congruent ways of managing, and creatively engaging with, the challenging tension between accountability and diversity in therapy work. The authors strongly support the preservation of pluralism and diversity in therapy practice, in the face of the increasingly urgent, anxiety-driven demands for audit, regulation and accountability typifying Late Modernity. It is argued that if accountability itself is to be ‘evidence-based’, then incorporating a relational dimension is essential; for if relationship factors are central to successful therapy, then accountability frameworks must themselves be founded on/in ‘relationship’. The arguments against formal institutional regulation of the psychological therapies in relation to the ineffectiveness of systems are rehearsed, and alternative, more values-congruent approaches considered. In making a case for ‘pluralistic accountability’, a detailed case-study of Bristol's developing local directory of therapists is offered, illustrating how local initiative can deliver good-enough accountability, avoiding the many negative side-effects of more didactic, centralised systems. The paper concludes that innovation and diversity in the field are more likely to be preserved if approaches can be found that hold and embrace the tensions between accountability and diversity, rather than seeking ‘solutions’ that prematurely and inappropriately resolve them.     

Inclusion of Alternative and Complementary Therapies in CACREP Training Programs

Abstract

Given a heightened focus within the mental health profession on creative, complementary, and alternative practices, the authors surveyed CACREP programs with respect to their inclusion of such approaches in counselor training. For the purpose of this study, these approaches were designated as complementary and alternative methods (CAM) and defined as those therapeutic practices that fall outside of the established traditional realm of medical, psychiatric, and psychological practice (hypnotherapy, breath work, meditation, Qigong, Reiki, Thought Field Therapy, etc.). Sixty-two programs responded. Over half (54%) stated that they currently include these approaches in course offerings. This article includes a discussion of creativity, expressive arts, and energy psychology as they relate to complementary and alternative therapies in mental health and medicine.     

The role of randomised controlled trials in developing an evidence‐base for counselling and psychotherapy

Background: Representatives of counselling and person‐centred organisations indicate many of their members feel their profession and orientation is under threat, with counselling services being decommissioned in NHS settings. Aims: To understand the views of key figures in the psychological therapies field (policy makers, researchers and representatives of the counselling community) towards randomised controlled trials (RCTs), and their present and future role in developing the evidence‐base for counselling and psychotherapy. Method: Interviews (phone, Skype or face‐to‐face) were conducted with 24 authorities in the field. Relevant practitioner and academic networks were also contacted and key documents in the field were reviewed. Results: Key figures believe that RCTs will continue to play a decisive role in determining which psychological interventions are recommended and commissioned within the NHS for the foreseeable future. Other methods are seen as having some validity, but are generally considered supplementary to RCTs and not a replacement for them. Discussion: Although many members of the counselling community are critical of RCTs, they are likely to remain the mainstay of commissioning policy for some years to come. This means, in the coming years, members of the counselling community may face difficult choices in how to promote their work, while maintaining their core principles and values.     

Use of narratives and collage in the exploration of the self and the meaning of a career

ABSTRACT

A methodological challenge during my doctoral research led me to use collage to reflect upon my own life and career. The insights it allowed me into the relationship between who we are and what we do led me to conclude that such methods can also illuminate these connections for clients of career counselling. In this paper I argue that such constructivist approaches allow the examination of that psycho-social space within which career is shaped and understood, allowing access to both the conscious and unconscious meaning made of a career and life story. I further argue that in times of increasing complexity such methods will be an important tool for career counsellors to meet the holistic needs of clients.     

Introducing counselling in secondary schools: A case study with reference to frame issues

Abstract

I am a deputy headteacher in a comprehensive school. I believe that the widespread re-introduction of counselling into secondary schools offers possibilities for great benefit, both in terms of the personal well-being and emotional health of students, and also in terms of academic results and other educational indicators. It is my view that, currently, this may particularly be true for boys.

This paper is a double case study: first, of the failure of a student to cope with ordinary schooling because of his emotional difficulties; and, second, of the establishment of a counselling service which resulted from his permanent exclusion from the school.

I allude to some of the theoretical issues which meshed with the practical details of establishing the counselling service, and offer some tentative conclusions about the rationale for counselling in secondary schools and the kind of model which seems most likely to be beneficial.     

Where Meaning is

Abstract

In an attempt to find some new ways of tackling old problems about meaning, I explore some possible models in which meaning may be conceptually situated. I take a close look at a traditional realist conception of meaning and give some reasons as to why we may have more room to move within this than is immediately apparent. Alternative frameworks are explored along the way.

The approach of thus situating meaning is an ontological one, but it is also an epistemological, as well as a hermeneutical one; in that the models put forward illuminate central issues and offer potential solutions to outstanding puzzles ranging across (at least) all of these broad realms of enquiry. Such solutions give a set of initial conceptualizations of the potential role meaning can play across broader frameworks of enquiry. As such they offer fresh inroads into otherwise deadlocked debates over the nature and place of meaning across philosophical enquiry in general.     

On Wittgenstein’s Comparison of Philosophical Methods to Therapies

Abstract

Wittgenstein’s comparison of philosophical methods to therapies has been interpreted in highly different ways. I identify the illness, the patient, the therapist and the ideal of health in Wittgenstein’s philosophical methods and answer four closely related questions concerning them that have often been wrongly answered by commentators. The results of this paper are, first, some answers to crucial questions: philosophers are not literally ill, patients of philosophical therapies are not always philosophers, not all philosophers qualify as therapists, the therapies are not necessarily to be thought of as psychological therapies and the ideal of health does not consist in the end of philosophy. Second, the paper shows that the comparison has had a misleading effect, because properties of therapies have been illegitimately projected onto the philosophical methods advanced by Wittgenstein.     

Making use of the vignette technique to examine methods of bereavement counselling: An exploratory study

Aim: The principal objective of this small‐scale study was to examine methods of bereavement counselling because of their lack of clarity. Method: The study made use of the vignette technique along with six semi‐structured interviews analysed by means of thematic analysis. Findings: Results showed that bereavement counsellors are using a multitude of different and diverse methods of counselling, characteristic of postmodernism. Advantages of these postmodern methods are that bereavement counselling methods are rich, creative, supportive, pluralistic and attentive to otherness. However, disadvantages of these postmodern methods have led to a lack of consensus amongst experts, unclear methods and an anti‐methodological way of working by counsellors. Implications for practice: Postmodernism is inherent in bereavement counselling. As a result no two counsellors work in exactly the same way because of the difference in their background and experience similarly it can be said that no one counselling method has exclusivity due to the diverse nature of postmodernism.     

Gliding across the liminal space between counsellor and counselling researcher: Using collective biography practices in the teaching of counselling research methodologies

Aims: Drawing on their engagement in a specific collective biography research project, the co-authors aim to demonstrate how the weaving together of creative story-telling and the theory underlining collective biography practices resulted in an understanding of rhizomatic research methodologies from within the process. This paper aims to demonstrate one way in which research methodologies training can become more firmly embedded within counsellor training courses. Method: A collective of counselling students and a session tutor colleague used collective biography practices to research their memories of traversing the liminal space between ‘counsellor’ and ‘counselling researcher’. Alongside the resulting collective stories, a collaborative review of the research process examined our chosen ways of working within the project. Outcomes: Engaging in collective biography practices resulted in an experiential shift from ‘learning to do counselling research’ to ‘becoming counselling researchers’. Weaving together research processes and researcher reflexivity generated personal and professional learning. Ways in which these research methodologies complement core components of counselling training, within and beyond the teaching of research, were identified. Conclusions: Collective biography practices offer a way of introducing non-arboreal creative research methodologies into counsellor training. Careful consideration of potential challenges surrounding the introduction of these practices is required.     

Making sense of the study of spirituality: late modernity on trial

ABSTRACT

In this article I offer a meta-theoretical mapping of spirituality studies and its many controversies. I begin by distinguishing between two projects that together constitute the field: the study for and the study of spirituality. I argue a good deal of the confusion surrounding ‘spirituality’ is the result of scholars failing to make this distinction. Next, I outline the few areas of agreement within the study of spirituality in order to illuminate what I consider the issue that defines the field: the merits and shortcomings of late modernity. By late modernity I mean the current era, whose origins can be traced roughly to the 1960s. I then offer a meta-theoretical analysis of the social-cum-political theoretical frameworks commonly used to study spirituality, delineating them according to their assessments of the contemporary epoch. I contend this is a useful and much-needed means of dispelling some of the fuzziness that characterizes the field.     

Learning about empathy with unconscious states of mind 1

2008 Ellen Noonan Annual Counselling Lecture, Birkbeck College, University of London

It was a very special privilege to give this lecture in honour of my dear colleague and friend Ellen Noonan. The lecture is based on one of the new chapters of my book about therapy with older people. Ellen was a most helpful mentor to me when I was preparing the first edition of this book and I have dedicated the new edition to her memory. The lecture is essentially about learning to use one's feelings in therapeutic work and to illustrate this theme I shall be drawing on experiences of supervising clinical psychology trainees on placement with me in my NHS work. The theme of this lecture applies as much to counselling as to psychotherapy and I use therapy to refer to counselling and psychotherapy.     

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.     

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.     

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.     

Link between early maladaptive schemas and defense mechanisms

IntroductionDefense mechanism and early maladaptive schemas are two concepts distorting the perception of reality.ObjectiveThe aim of this study was to explore the link between two reality-distorting concepts from two theoretical models: early maladaptive schemas from the cognitive and behavioral model and defense mechanisms based on the psychoanalytic model.MethodTwo hundred thirty-two non-clinical participants completed the Defense Style Questionnaire and the Young Schema Questionnaire (short version). Then a Bravais Pearson correlation analysis connecting these two concepts, and a multiple regressions analysis using early maladaptive schemas as predictors for defense style mechanisms levels were conducted.ResultsThe results indicate that 2 early maladaptive schema domains (i.e. other-directedness as well as over-vigilance and inhibition) predict the frequency of use of the neurotic defense mechanism, and 3 schema domains (i.e. disconnection and rejection, impaired autonomy and performances as well as impaired limits) predict the frequency of use of the immature defense mechanism.ConclusionTo conclude, two psychological concepts based on two different theoretical models (psychoanalytic and cognitive and behavioral therapy) seem to share an important link justifying the use of integrative therapies such as schema therapy.     

Psychotraumatic Stress and Anxiety

Abstract

A systematic review of all available treatment studies for music performance anxiety was undertaken. Interventions were categorised into psychological treatments and pharmacological treatments. Psychological treatments included behavioral, cognitive, cognitive-behavioral, combined treatments and other therapies. Issues such as the number of studies in each treatment modality, their sample sizes and the methodological quality of most of the studies reviewed precluded firm conclusions about the effectiveness of any of the treatments assessed for music performance anxiety. The field is in urgent need of larger scale, methodologically rigorous studies to assist the large minority of musicians who suffer from performance impairing music performance anxiety.