Therapists’ understandings and experiences of working with clients with problems of addiction: A pilot study using Q methodology

This pilot study aims to increase our understanding of therapists’ subjective attitudes, beliefs, and experiences of working with clients with problems of addiction. The study yielded useful clarifications, arising from the finding that opinions about the nature of addiction support different approaches to therapy. In addition, it seems that diverse or conflicting attitudes and beliefs are likely to impact on the ability of therapists to work together effectively. Another objective was to test the feasibility of using Q methodology in this study and more broadly in qualitative research in psychotherapy. Participants were 13 therapists from a variety of backgrounds and working in a range of agencies. Using Q methodology, four distinctive factors were identified, indicating divergent understandings of addiction. Each factor is shown to be a multifaceted construct which does not correspond to any single theory or therapeutic orientation. It is suggested that the results have significant implications for therapists’ training and supervision. In addition, this study demonstrates the capacity of Q methodology to identify commonalities and diversity in viewpoints which do not conform to a priori conceptualisations. As a pilot study, this paper invites further discussion and research.     

Introduction to the Special Section ‘Innovative counselling and psychotherapy research methods’: Defining the future of counselling and psychotherapy research

In the call for papers for this Special Issue, we sought submissions that would introduce innovative methods with the potential to shape counselling and psychotherapy research into the future. We believe that we accomplished this goal and that this issue introduces a range of valuable examples of current innovations in counselling and psychotherapy research methods. Through the review process, we encouraged authors to offer practical guidelines on how to innovatively assess and analyse change and other relevant aspects of therapy. We also guided authors to not only provide the field with an update on cutting‐edge methodology, but also describe these methods in a practice‐friendly way. As such, the Special Issue aims at becoming a building block for future practice‐friendly research in counselling and psychotherapy.     

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.     

The experience of counselling for female clients with anorexia nervosa: A person‐centred perspective

Anorexia nervosa is a serious and potentially life‐threatening condition, which has been studied from a range of theoretical perspectives. However, the relevance of person‐centred theory and practice in relation to anorexia nervosa has not previously been explored in the literature. The purpose of this study was to understand the experiences of clients who had received counselling for anorexia nervosa, and to set these experiences against the backdrop of person‐centred theory. The study is based on intensive heuristic analysis of interviews with five clients who had completed counselling for anorexia nervosa within the previous three months. Collaboration between the researcher and the participants led to an identification of two of the six ‘core’ conditions identified by Rogers as being of real importance to clients with anorexia: unconditional positive regard and congruence. The context in which counselling is offered was also of crucial significance to these clients. Implications for practice are discussed.     

The application of self-psychology to short-term counselling

Abstract

This article explores how key aspects of Heinz Kohut's self-psychology can inform short-term counselling work. Initially a summary is offered of Kohut's developmental theory, his understanding of the nature and causes of psychopathology and his view of the analytic cure. The application of his ideas to short-term counselling is then discussed. Specifically, it is suggested that short-term therapeutic work based on self-psychology involves a stronger emphasis on the curative aspects of the selfobject transference between client and therapist, a more limited notion of the role of interpretation, and a different understanding of working through to that of long-term self-psychological analysis.     

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.     

Sturdy roots for the graceful eucalyptus: The parallel process of integrating counselling around a client's needs and aligning research paradigms with methodology

This article explores the relationship between the therapist as an eclectic clinician and the therapist as researcher. The process of finding a well-grounded place for my heuristic inquiry in academic discourse is compared with the struggle to find unity and integrity in the counselling of a client using many modalities. The intellectual and emotional struggle in either case is similar. It is posited that the engagement of students of counselling in research, therefore, has a clinical as well as an academic purpose, but that this benefit needs to be made explicit.     

A follow‐up study of the long‐term effects of counselling in a primary care counselling psychology service

Despite much recent work examining the short‐term effect of counselling in primary healthcare settings, to date relatively little research has examined the effectiveness of such treatment programmes over the longer term. In this study, 58 participants underwent brief, time‐limited integrative counselling sessions, with symptoms being measured using the CORE‐OM immediately before, immediately after, and 30 months after counselling. It was found that in addition to participants reporting significantly lower levels of psychological distress immediately post‐counselling, a further significant improvement at 30‐month follow‐up was also apparent, indicating that the benefit from counselling was maintained. In addition to this reduction in symptoms post‐counselling, a significant reduction in GP visits was also detected in the 12 months following counselling when compared with the 12 months prior to counselling, indicating a lower reliance on the primary healthcare team after counselling.     

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.     

The effectiveness of workplace counselling: A systematic review

Background: In response to the stresses of the contemporary workplace, the challenges of maintaining satisfactory work-life balance, and the costs to business of employee mental health problems, many organisations have contracted to make counselling services available to their staff. It is essential to evaluate the effectiveness of workplace counselling, in order to maintain standards, and to identify examples of good practice. Objectives: This paper presents a comprehensive, systematic review of the effectiveness of workplace counselling. Findings are analysed in terms of client satisfaction, psychological functioning, the meaning of work, work behaviour, and negative outcomes. Findings: Taken as a whole, the results of research suggest that counselling is generally effective in alleviating psychological problems, has a significant impact on sickness absence, and has a moderate effect on attitudes to work. Discussion: Methodological issues are discussed, and it is recommended that more high-quality research is required in order to reinforce the evidence base for workplace counselling in relation to a number of key questions.     

Kashmiri women's perceptions of their emotional and psychological needs,and access to counselling

This paper explores the meaning of mental illness for Kashmiri women, the issues that cause them distress, their coping mechanisms, and their perceptions and understanding of counselling. Interviews were used to compare the experiences and attitudes of two groups of Kashmiri women: those born in Britain and those who had been brought up in Kashmir and had settled in Britain as adults. It was found that Kashmiri women in this study had a clear understanding of mental illness, with little difference in beliefs between those born and raised in the UK and those brought up in Kashmir. In both groups the majority of those who were not aware of formal counselling still wanted to talk to a professional about their emotional distress. The majority of UK born women, and a smaller proportion of Kashmiri born women, were aware of counselling. Most women associated it with talking to someone about one's feelings, about problems in one's heart, in one's mind, and as a means of support when experiencing distress. The implications of these findings for practice are discussed.     

Online counselling: The experience of counsellors providing synchronous single‐session counselling to young people

Kids Help Line (KHL) is a national Australian youth counselling service that provides free online and telephone counselling. This qualitative study examines the experience of 26 online KHL counsellors. Using a focus group methodology, counsellor responses were organised into categories: privacy and an emotionally safe environment; communication through text; and time. Counsellors reported the main benefit of the online environment to be emotional safety, due to reduced client emotional proximity to the counsellor, and the main disadvantage to be that reduced emotional proximity and the absence of non‐verbal cues could result in communication problems and difficulty in accurately assessing young people's concerns. Time proved a significant issue for counsellors, as the slow speed of text exchange could limit their ability to complete interventions. Methods that enhance both the process and effectiveness of online counselling are needed. Potential solutions to the challenges faced by online counsellors are discussed.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.     

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.     

Examining process constructs of narrative career counselling: an exploratory case study

The present article examines how the five process constructs of reflection, connectedness, meaning making, learning and agency are operationalised in a constructivist approach to career counselling, specifically a storytelling approach. This article reports on an exploratory case study of a Black South African female university student. The case study provides examples of how a career counsellor enacts these constructs and facilitates their development in a client, as well as examples of how they are evident in client dialogue and action. Insight into the process of a storytelling approach to narrative career counselling is demonstrated, from which tentative suggestions are made about how to facilitate the process constructs of reflection, connectedness, meaning making, learning and agency.     

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.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

Counselling students' views and concerns about weeping with clients: A pilot study

This study examines counselling students' concerns and views about a phenomenon that has received little attention in the counselling literature: the counsellor weeping during a session with a client. Over 20 per cent of the counselling students who were surveyed reported being concerned about weeping in session with clients. However, the majority of students believed, to varying degrees, that weeping with clients could facilitate the therapeutic process. This paper sheds light on this unexplored dimension of countertransference, and has implications for those involved in providing counsellor training.     

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.