A qualitative investigation into the online counselling relationship: To meet or not to meet,that is the question

Background and aim: Online counselling, as a psychotherapeutic approach, provokes debate amongst practitioners and researchers concerning its efficacy and validity. This reflexive study extends existing research into the nature of the online counselling relationship when it is conducted asynchronously (by email) and explores the possibility this approach may facilitate both online and face‐to‐face therapeutic engagement. Method: Semi‐structured interviews were conducted electronically with ten former email counselling clients of a university counselling service and six counsellors delivering email counselling in other higher education settings, to explore, in depth, their experiences of the online therapeutic relationship and its impact on the counselling process and outcomes. These were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four areas of focus emerged relating to: (1) the importance of the structure and processes involved; (2) their impact on thinking and feeling; (3) their impact on self and relationships (within and outside counselling), and (4) changes that followed email counselling. Having ‘time to think’ within the asynchronous exchanges, the anonymity and disinhibition afforded by the online medium, the creation of transitional space and the rich use of metaphor, visualisation and imagery all contributed to a sense of empowerment and relational depth for individuals who might have otherwise avoided seeking help. This led to positive change in many cases and for some, facilitated subsequent face‐to‐face counselling. Implications: The findings support the provision of counselling and therapy online and particularly its integration within existing face‐to‐face services.     

Career development and counselling needs of LGBTQ high school students

There is a dearth of research concerning the career development and counselling issues that are relevant for high school students who identify as lesbian, gay, bisexual, transgender and queer (LGBTQ). As such, little is known to understand LGBTQ students when it comes to their career-related struggles and needs. This article attempts to examine the career development needs of LGBTQ high school students, addressing and analysing career problems from the unique circumstances of this student population. To do so, it provides an overview of the various career-related issues afflicting LGBTQ high school students. It then proposes a series of career guidance and counselling intervention considerations that are tailored to address the specific career needs and challenges of the LGBTQ high school students.     

At the border: reflections on psychoanalytically oriented counselling in an Italian university setting

This paper analyses the ‘border’ position of counselling services in Italian universities. The concept of ‘border’ has great relevance in the work of psychoanalytically oriented university students’ counsellors. Counselling is part of a continuum of interventions, from befriending to psychotherapy. This closeness encompasses the need for identifying specificities and differences among interventions. Moreover, a university counselling service occupies a ‘marginal’ position, continuously confronted with the risks of rejection and/or assimilation. The concept of ‘border’ is also useful to define the developmental phase of university students, crossing the border between late adolescence and young adulthood, as represented by Conrad's novel The shadow line (1917/1999), recently analysed by Green (2008) as the metaphoric demarcation line between youth and adulthood. Finally, most of the students referring to our counselling service come from families that for the first time crossed the border of university education.     

Exploring the meaning in meaningful coincidences: An interpretative phenomenological analysis of synchronicity in therapy

Synchronicity experiences (SEs) are defined as psychologically meaningful connections between inner events (e.g. thought, dream or vision) and one or more external events occurring simultaneously or at a future point in time. There has been limited systematic research that has investigated the phenomenology of SEs in therapy. This study aimed to redress this by exploring the process and nature of such experiences from the perspective of the practitioner. Semi-structured face-to-face interviews were conducted with a purposive sample of nine practitioners who reported SEs in their therapeutic sessions (three counsellors, three psychologists and three psychotherapists), and focused on how participants make sense of their experiences of synchronicity in therapy. Interpretative phenomenological analysis was used to identify three superordinate themes: sense of connectedness, therapeutic process, and professional issues. Findings suggest that SEs can serve to strengthen the therapeutic relationship and are perceived as useful harbingers of information about the therapeutic process, as well as being a means of overcoming communication difficulties, as they are seen to provide insights into the client’s experiencing of themselves and others, regardless of whether or not the SE is acknowledged by the client or disclosed by the therapist.     

‘My language thing … is like a big shadow always behind me’: International counselling trainees' challenges in beginning clinical practice

Background: While counsellor education becomes increasingly culturally diverse, little is known about international trainees' experiences of training. Objective: The present study explores one aspect of training, namely clinical practice from the perspective of international, non‐native speaking trainees. In particular, this paper focuses on the challenges this group encounters when practicing in a second language. Methodology: Semi‐structured interviews with four non‐native English‐speaking trainees were conducted and analysed following the principles of interpretative phenomenological analysis (IPA). Results: Findings suggest that participants encounter practical difficulties related to their non‐native/foreign identity in practice, such as problems with articulate self‐expression and understanding the client's speech. These difficulties generate anxiety and impact on the trainees' confidence. Conclusions and implications for counsellor training: This study elucidates language as a fundamental aspect of culture, and identifies second language use as a significant source of difference in counselling practice. This paper highlights the need for attention to linguistic diversity and for appropriate support during counsellor education. This will improve international trainees' experiences of training, but also enhance all trainees' understanding of difference, resulting in better service provision for the community.     

Help-seeking behaviour and attitudes towards counselling: a qualitative study among Hong Kong Chinese university students

This study examined Hong Kong university students’ perception of general help-seeking and seeking of professional help. Thirty-two students, aged from 25 to 46 years were interviewed. A grounded theory approach was adopted. The results indicated four domains to categorise culture-influenced factors: attitudes towards speaking, relational concern, nature of the problem and assumptions about counselling. Hong Kong students are not reluctant to receive help but are reluctant to seek help from outsiders. Help is expected to be received from those within their social network. Passive coping strategies are normally adopted for finding relief and solving problems. These issues may greatly hinder people from consulting professional counsellors, or may limit the counselling process to something superficial and short term. The implications for counsellors are discussed.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

Perceptions of stress and stress interventions in finance organizations: Overcoming resistance towards counselling

This paper presents the findings from a qualitative study conducted to gain further insight into the attitudes of finance organizations towards workplace stress and stress interventions. Semi-structured interviews were used and seven individuals, each representing their organization, participated in the study. Interpretative Phenomenological Analysis (IPA) (Smith, J., Jaraman, M., & Osborn, M. 1999 Smith J Jaraman M Osborn M 1999 Doing interpretative phenomenological analysis In M. Murray & K. Chamberlain (Eds) Qualitative Health Psychology London Sage [Crossref] [Google Scholar] was used to analyse the data. In M. Murray & K. Chamberlain (Eds), Qualitative Health Psychology. London: Sage.) was used to analyse the data. One main theme that emerged was “resistance towards counselling for stress”. This theme and several related sub-themes are discussed, and suggestions to reduce resistance to counselling for stress are presented in a model.     

'The power of being seen': an interpretative phenomenological analysis of how experienced counselling psychologists describe the meaning and significance of personal therapy in clinical practice

There is a widely acknowledged lack of clarity in psychotherapeutic training about the role of personal therapy in developing practitioner competence. This paper presents part of a wider ongoing qualitative study exploring the role that personal therapy plays in the clinical practice and training of experienced counselling psychologists. Results derived from an interpretative phenomenological analysis suggest that personal therapy is valued mainly as a means of enhancing reflectiveness within clinical work. Detailed examination of a subset of the data offers scope for exploring how this process may occur within therapy, and points to the potential significance of early attachment experiences in the development and amplification of participants' reflective capacities. A possible theoretical framework is proposed and implications for future research discussed.     

‘The bereaved therapist speaks’. An interpretative phenomenological analysis of humanistic therapists' experiences of a significant personal bereavement and its impact upon their therapeutic practice: An exploratory study

Aim: The aim of the research was to explore the under‐researched area of therapists' personal bereavement and its impact upon their therapeutic practice. Method: Data were collected via semi‐structured interviews with four humanistic therapists and were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four master and eight subordinate themes emerged from the rich data collected that exemplified both convergence with and divergence from the small body of extant literature on therapist bereavement and current thinking in thanatology. The findings suggest that bereavement is a unique experience that can affect the individual's personal and social identity and worldview. It can also be a transformative experience resulting in personal growth and a renewed sense of self and agency. In terms of professional practice, the findings suggest that the lived experience of the grieving process, mediated by supportive supervision, enabled participants to experience deeper levels of empathy and connectedness within their therapeutic relationships. Conclusion and implications: Bereavement is an experience that can profoundly impact upon therapists' personal identity and assumptive world. Such an experience can have an equally profound impact upon their therapeutic practice. There are therefore implications for students, trainers, therapists and supervisors particularly in terms of self‐care and the use of the ‘self’ in therapy. Further research needs to be undertaken in order to explore in greater depth the intersection between personal bereavement and therapists' evolving personal and professional identity development.     

Picturing ourselves in the world: Drawings,interpretative phenomenological analysis and the relational mapping interview

ABSTRACT

Some aspects of experience can be challenging for research participants to verbalise. Interpretative phenomenological analysis (IPA) researchers need to get experience-near to meet their phenomenological commitments, capturing the “texture” and quality of existence, and placing participants in relation to events, objects, others, and the world. Incorporating drawing into IPA designs provides a vehicle through which participants can better explore and communicate their lifeworlds. IPA researchers also require rich accounts to fulfil their interpretative commitments. Drawing taps into multiple sensory registers simultaneously, providing polysemous data, which in turn lends itself to hermeneutic analysis. This article outlines a multimodal method, the relational mapping interview, which was developed to understand the relational context of various forms of distress and disruption. We illustrate how the approach results in richly nuanced visual and verbal accounts of relational experience. Drawing on an “expanded hermeneutic phenomenology,” we suggest how visual data can be analysed within an IPA framework to offer significant experiential insights.     

Group psychodynamic counselling with final-year undergraduates in clinical psychology: A clinical methodology to reinforce academic identity and psychological well-being

Educational institutions should ensure that students develop a professional identity, as well as safeguarding their well-being and activating awareness and change processes. The aim of this study was to assess the efficacy of group psychodynamic counselling as a means of reinforcing academic identity – considered the forerunner of professional identity – and psychological well-being in a group of final-year undergraduates studying clinical psychology. Thirty-three final-year-students of clinical psychology who participated in six group psychodynamic counselling sessions were compared with sixteen final-year students of clinical psychology who had never participated in an intervention of this kind. The results suggested that group psychodynamic counselling made students feel more capable of managing their lives and more open to new experiences as well as encouraging them to perceive their relationships as more positive and satisfying, to believe that their life is meaningful, and to achieve greater self-acceptance. The in-depth exploration also prompted students to consider their commitment to their choice of career. Group psychodynamic counselling also reinforced students’ educational choice, as the likelihood of students becoming less committed to this choice was reduced after the intervention. Thus, the study confirmed the efficacy of group psychodynamic counselling as a means of reinforcing both academic identity and promoting well-being and demonstrated that it is a tool clinical psychologists and university teachers could use to activate self-reflection and change within educational settings.     

Negotiating professional and personal biographies in a liquid world: creating space for reflexive innovation in career counselling

This paper explores the constraints to innovative, creative and reflexive careers counselling in an uncertain neo-liberal world. We draw on previously reported research into practitioners’ use of a narrative model for career counselling interviews in England and a Europe-wide auto/biographical narrative study of non-traditional learners in universities. The latter draws on a number of narrative interviews with an asylum seeker, to debate whether such a way of working with people, ‘in a clinical style’, offers contextualised insight into people's struggles to construct a career and a methodology for doing so. The paper also examines the difficulties of creating a ‘good enough’ professional, psychosocial space for experimentation with creative approaches in a marketised guidance world, where more is expected from less.     

Self-compassion,coping strategies and gender differences in psychology,counselling and psychotherapy practitioners during COVID-19: Lessons learnt

Effective coping strategies can protect against the adverse effects of stress. This study investigated self-compassion's ability to predict approach and avoidance coping in psychology, counselling and psychotherapy practitioners (PCPPs) during COVID-19, and whether this differed between genders. To date, no research has investigated this relationship, despite positive associations being drawn in other populations. Three hundred and nineteen PCPPs completed an online survey including the Brief COPE and Self-Compassion Short Form. Self-compassion significantly predicted greater use of approach coping and reduced use of avoidance coping. The predictive ability of self-compassion was slightly better in female practitioners. Self-judgement arose as a prominent subscale of self-compassion across genders, increasing both approach and avoidance coping. Implications for future research and practice are discussed, concerning barriers to self-compassion and the requirement of therapeutic programmes and psychoeducation as a prerequisite for effective coping strategies in the PCPP population.     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ ² (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001–0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.     

Investigation of psycho-physiological interactions between patient and therapist during a psychodynamic therapy and their relation to speech using in terms of entropy analysis using a neural network approach

In the present contribution we investigate in an exemplary single-case study the behavior of psycho-physiological variables in psychotherapy sessions. The values are measured continously during a single session at the same time for both patient and therapist. The analysis of the data is done using an artificial neural network approach for non-linear principal component analysis and faithful data representation/visualization and compression required for subsequent process analysis. The used network (growing self-organizing map, GSOM) thereby uses a kernel smoothing for improved data density estimation. In this way, we are able to generate an entropy model of psycho-physiological variability detecting emotionally instable phases during the therapy process. We relate our finding to results obtained by speech analysis of the therapy sessions according to the cycle model invented by Mergenthaler. Thus, we get preliminary suggestions how psycho-physiological reactions are related to the therapeutic process.     

Stress and quality of life in international and domestic university students: cultural differences in the use of religious coping

Studying overseas entails a number of transitions and challenges, and the present study investigated the strategies international university students use to cope with stressors. Previous research suggests that international students may be more likely than domestic students to draw on religion/spirituality as a source of dealing with stress, but the direct links between stress, religious coping and quality of life are yet to be documented explicitly. A sample of 679 university students in New Zealand completed the quality of life scale WHOQOL-BREF with an additional WHOQOL module used to assess spiritual, religious, and personal beliefs (SRPB). The students also completed the Perceived Stress Scale and the Brief COPE inventory. Irrespective of stress levels encountered or whether participants were international or domestic students, Asian students were more likely to use religious coping strategies than European students. Unlike European students, Asian students’ use of religious coping was effective in improving psychological and social quality of life. The findings also provide support for the main effects hypothesis of religion/spirituality. The present study demonstrates that cultural factors play an important role in the manner in which individuals maintain mental health and quality of life.     

“A definite feel‐it moment”: Embodiment,externalisation and emotion during chair‐work in compassion‐focused therapy

Chair‐work is an experiential method used within compassion‐focused therapy (CFT) to apply compassion to various aspects of the self. This is the first study of CFT chair‐work and is focused on clients' lived experiences of a chair‐work intervention for self‐criticism. Twelve participants with depression were interviewed following the chair‐work intervention and the resulting data were examined using interpretative phenomenological analysis. Three superordinate themes were identified: “embodiment and enactment,” “externalising the self in physical form” and “emotional intensity.” The findings suggest the importance of accessing and expressing various emotions connected with self‐criticism, whilst highlighting the potential for client distress and avoidance during the intervention. The role of embodying, enacting and physically situating aspects of the self in different chairs is also suggested to be an important mechanism of change in CFT chair‐work. The findings are discussed in terms of clinical implications, emphasising how core CFT concepts and practices are facilitated by the chair‐work process.