A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference

There is evidence that therapists' countertransference responses can affect the therapeutic relationship. There is also evidence that trainee therapists can experience difficulty understanding and managing countertransference. This evidence suggests the need for greater focus on countertransference in the training of professionals, such as psychologists, for whom therapy is a core activity. However, little is currently known about the best way of providing such training or the impact of such training on recipients. This pilot study examined clinical psychology trainees' responses to a teaching and learning method for conceptualising and managing countertransference. The method was designed to be accessible to a range of psychology trainees including those in cognitive behavioural therapy programmes. This article outlines the method and its pilot evaluation. An anonymous online questionnaire was completed by 55 trainees pre‐intervention and 40 post‐intervention. Qualitative methods were used to examine changes in trainees' analyses of countertransference pre‐ and post‐intervention, and their reports of understanding and managing countertransference. Trainees also rated the intervention. The majority of participants who completed the post‐intervention questionnaire reported that training increased awareness of or the ability to conceptualise countertransference. They reported strategies for managing countertransference, although they were less confident in this area.     

The challenges of designing and piloting a system for measuring the impact of counselling provided by a national voluntary agency

This paper describes the issues, processes and difficulties encountered and solutions proposed when introducing an evaluation system into a large and complex voluntary organisation providing counselling and relationship support services. The organisation Relate has 2,000 counsellors in over 600 locations operated by a network of 81 Relate Centres, and over 140,000 people use its services annually. The present project arose from a need clearly identified at a Mental Health Foundation conference in 1993, for a common measure to evaluate ‘talking’ therapies; to identify ways of measuring costs and benefits; and to assess the skills and competencies of therapists. This project set out to (1) identify and pilot a validated scale that could demonstrate the value of Relate; (2) develop and pilot a further measure of Relate's work, broader than the validated scale, in order to foster organisational learning and develop good practice. The pilot encountered a range of methodological challenges, and it is believed that recognition of these might smooth the way for any other similar organisation planning to develop an ongoing system for evaluation of counselling and relationship support.     

Integrating core conflictual relationship themes in neurobiological assessment of interpersonal processes in psychotherapy

Interpersonal processes are a key target in counselling and psychotherapy. It is of paramount importance to sharpen their assessment using integrated methods. Hence, this methodological paper describes how fields of research in psychotherapy and neuroimaging can be integrated into one novel complementary neurobehavioural paradigm that can be applied to enhance our understanding of interpersonal processes in psychotherapy. To illustrate this integration, we present selected data from a pre–post pilot study where the authors assessed interpersonal processes in brief treatment for borderline personality disorder using the core conflictual relationship theme, functional magnetic resonance imaging (fMRI) and outcome questionnaires. To do so, they measured individual changes in neural activity using an fMRI task pre‐ and post‐treatment where clients gave feedback on the emotional valence of sentences extracted from their own Relationship Anecdotes Paradigm interviews mixed with neutral ones. In this paper, using data from two participants of said study, we discuss how to implement this methodology and what can be achieved in terms of results.     

A five‐year evaluation of the effectiveness of person‐centred counselling in routine clinical practice in primary care

Counselling is the recommended treatment for individuals with mild to moderate mental health problems of recent onset. In this evaluation of a primary care counselling service offering person‐centred counselling, the Core Outcome Measure (CORE‐OM) was administered at referral and at the beginning and end of therapy. A pre‐post therapy effect size for 697 individuals over a 5 year period was 1.2. This compares with a waitlist (between referral and pre therapy) effect size of 0.24 for 382 individuals over a three year period. The results indicate that person‐centred counselling is effective for clients with common mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate symptoms of recent onset, but extends to people with moderate to severe symptoms of longer duration.     

An outcome evaluation study of a psycho‐educational course in a primary care setting

Rationale: To date relatively little research has examined the effectiveness of psycho‐educational courses provided in a primary care setting to adults with mild‐to‐moderate mental health concerns. Aims: To determine whether group psycho‐education could be a viable alternative to individual counselling by (1) assessing the clinical effectiveness of an 8‐week psycho‐educational course, and (2) examining the group outcomes in comparison with individual treatment outcomes from a previous study in the same counselling service. Method: A total of 57 participants attending a psycho‐educational course provided data over a 36‐month period, using the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) pre‐ and post‐intervention. A comparison was then made with the data of 58 previous participants of individual counselling evaluation, using the same CORE‐OM system. Results: Participants reported significantly lower levels of psychological distress after attending the course and these results are comparable to outcomes measured in the same service for individual counselling, indicating that group interventions could be considered a legitimate alternative to individual counselling, thus increasing cost effectiveness and reducing waiting times. Limitations of the study and implications for practice and further investigation are considered.     

Supporting Japanese Mothers of Children with ADHD: Cultural Adaptation of the New Forest Parent Training Programme

International practice guidelines recommend medication and behavioral intervention as evidenced‐based treatments for attention deficit hyperactivity disorder (ADHD). Currently in Japan, the availability of non‐pharmacological interventions for ADHD is limited. We report the results of a pilot and a proof‐of‐concept study for a new behavioral intervention for Japanese mothers of children with ADHD. The pilot study delivered a standard six‐session behavioral intervention and two parent‐support sessions. Participants approved the group format and requested additional support to change parenting practices and behavioral strategies targeting ADHD symptoms. For the proof‐of‐concept study, the intervention was revised to include five sessions of pre‐intervention support followed by six sessions of the New Forest Parent Training Programme (NFPP), an evidence‐based intervention for ADHD. The revised intervention, NFPP‐Japan, was associated with reductions in the mothers’ reports of children's ADHD symptoms and aggression, more effective parenting practices, and reduced parenting stress. The pilot and proof‐of‐concept studies indicate that it is possible to successfully modify Western behavioral interventions for Japanese mothers and to justify a randomized controlled trial evaluation of the NFPP‐Japan, which is currently underway.     

Counselling in the workplace: How time‐limited counselling can effect change in well‐being

Background: Many employers provide counselling support on work and personal issues for their employees, but in times of economic pressure such services can be at risk if their effectiveness is not demonstrated. Aim: To evaluate whether time‐limited counselling in a workplace can effect sustained change in well‐being. Method: The study was carried out by a staff counselling team in a university setting. The Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS) was completed by clients at the beginning and end of counselling, and at three and six months following. A non‐treatment comparison group completed the survey at the same intervals. Results: The results of our investigation show clearly that the effect of time‐limited counselling (average seven sessions) on distressed clients is positive. The evidence of our treatment group suggests that they acquire an increased sense of well‐being as a result of the experience of counselling with a significant statistical difference between pre‐and post‐counselling treatment group scores on the WEMWBS and consistently higher scores found post counselling. The improvement was maintained at the same level for at least six months following the end of counselling. Conclusions: The provision of time‐limited counselling by employers is an effective support for personal difficulties affecting work.     

Testing the group polarization hypothesis by using logit models

This paper focuses on methodological aspects of group polarization research and has two well‐defined parts. The first part presents a methodological overview of group polarization research together with an examination of the inadequacy, under certain circumstances, of the traditional parametric approach usually used to test this phenomenon based on pre‐test/post‐test means comparison across groups. It is shown that this approach will produce masks effects when groups are heterogeneous with regard to the observed change from pre‐test to post‐test. The second part suggests an alternative methodological approach based on logit models for the analysis of contingency tables from a categorization of the variable ‘kind of shift’. This approach is illustrated and compared with the parametric approach with a simulated data set. Copyright © 2002 John Wiley & Sons, Ltd.     

Multilevel multidimensional item response model with a multilevel latent covariate

In a pre‐test–post‐test cluster randomized trial, one of the methods commonly used to detect an intervention effect involves controlling pre‐test scores and other related covariates while estimating an intervention effect at post‐test. In many applications in education, the total post‐test and pre‐test scores, ignoring measurement error, are used as response variable and covariate, respectively, to estimate the intervention effect. However, these test scores are frequently subject to measurement error, and statistical inferences based on the model ignoring measurement error can yield a biased estimate of the intervention effect. When multiple domains exist in test data, it is sometimes more informative to detect the intervention effect for each domain than for the entire test. This paper presents applications of the multilevel multidimensional item response model with measurement error adjustments in a response variable and a covariate to estimate the intervention effect for each domain.     

Counselling with a profoundly deaf client and the impact of a therapist's dream: A case study

This case study explores the experience of one client participating in a project evaluating the use of dreams in short‐term counselling within the National Health Service. The client received 24 sessions of counselling and completed a post‐counselling semi‐structured questionnaire. This was followed by a semi‐structured interview, which confirmed the internal coherence within the participant's narrative and allowed a more detailed exploration of her experiences, supported by process notes. Supervision challenged the therapist's preconceptions and held her in her uncertainty until the work was aided by a dream that the therapist had of the client.     

Practice‐based evidence in school‐based counselling

Aims: Counsellors are becoming commonplace within the support structures of secondary schools. To date, research findings from practice‐based outcome studies suggest this is a positive move. There are, however, numerous limitations to this work, and this project aims to develop this existing body of literature. Method: Nine 13–15 year olds attending counselling in six school‐based services participated in the project – one individual withdrew. A standardised self‐report questionnaire (YP‐CORE) was collected at four intervals: (1) the point of referral; (2) the onset of counselling; (3) the completion of counselling; and, (4) a two‐month follow‐up. The change indicated in each of these phases is examined and reported here. Additionally, YP‐CORE was completed during each session. Findings: The YP‐CORE indicates an improvement in the well‐being of this small sample, while waiting for and attending therapy. Further examination of session‐by‐session data also highlights how pre‐ and post‐outcome data should not necessarily be viewed as linear in nature. Discussion: This is a small‐scale investigation and further work is needed in this area. It does, however, raise a number of issues regarding the complexity inherent in conducting outcome research that warrant further investigation.     

Changing negative attitudes towards persons with physical disabilities: an experimental intervention

An experimental study was designed and tested to change negative attitudes towards the physically disabled. A pre‐post‐test intervention was conducted including three conditions: (a) cognitive intervention; (b) cognitive and behavioural intervention involving equal‐status contact with the target group; (c) no‐intervention control. The sample consisted of 70 ninth grade students. Following baseline assessments of attitudes, attitude change was measured immediately following the intervention and at a follow‐up three months post‐intervention. The cognitive intervention provided information about physical disability and challenged stereotypic conceptions about the physically disabled. The behavioural intervention consisted of engaging in three paralympic disciplines under the instruction of a group of disabled athletes. The cognitive intervention alone did not result in significant changes in attitudes towards the physically disabled. However, the combined cognitive‐behavioural intervention resulted in greater attitude change than the no‐intervention condition, both immediately post‐intervention and at a three months follow‐up. The findings are discussed with regard to models of attitude change through equal‐status contact. Copyright © 2006 John Wiley & Sons, Ltd.     

A Mental Imagery Intervention to Increase Future Self‐Continuity and Reduce Procrastination

This research examined how mental imagery practice can increase future self‐continuity to reduce procrastination. A total of 193 undergraduate students were randomly assigned to a present‐focused meditation or to a future self‐focused mental imagery condition. Participants in both conditions were asked to listen to their respective audio recording twice per week for four consecutive weeks and to complete a pre‐intervention, half‐point, and post‐intervention questionnaire. At the four‐week mark, hierarchical regression analyses revealed that both future self‐continuity and empathic perspective taking were significantly higher for the mental imagery condition than the meditation condition. While vividness of future self moderated change in future self‐continuity, affective empathy for future self mediated the relation between vividness of future self and future self‐continuity. Lastly, only empathic perspective taking was a significant moderator of change in procrastination across time. The influence of empathy and future self‐continuity on procrastination is discussed.     

Incorporating feasibility protocols in intervention research

In this paper, we review some dimensions of feasibility research. Feasibility research focuses on the intervention process and addresses questions about whether and how an intervention can be evaluated and implemented. Feasibility studies are implemented prior to conducting an outcome-focused pilot study or full-scale evaluation to test the effectiveness of an intervention. We propose a feasibility framework that includes 10 possible dimensions to evaluate in a feasibility trial, including (a) recruitment capability, (b) data collection procedures, (c) design procedures, (d) social validity, (e) practicality, (f) integration into existing systems, (g) adaptability, (h) implementation, (i) effectiveness, and (j) generalizability. Among these dimensions we offer some priorities that researchers can consider in establishing feasibility. Although feasibility investigations can advance evidence-based practice in psychology and education, we review current challenges for researchers to consider when incorporating a feasibility protocol into their intervention research agenda.     

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.     

An experimental study of attitudes toward homosexuals

A major shortcoming of research on homophobic attitude change has been methodological deficiencies. This report presents details of an experimental design, along with results.

A Solomon Four‐Group Experimental Design (SFGD) was employed for the study. Ninety‐two volunteer college students at a Mid‐Atlantic university were randomly assigned to four groups, two of which represented the classic experimental design (with pre‐test and post‐test for both experimental and control group) while the two remaining groups parallel the post‐test only design (with no pre‐test for both experimental and control group).

The principal independent and dependent variables of the study were positive social interaction with homosexuals and the degree of homophobia. Findings indicated that interaction strongly influences reduction of homophobic behavior.     

Effect of an intervention to prevent unwanted pregnancy in adolescents. A randomized,prospective study from Nordland County,Norway, 1999–2001

The aim of this study is to evaluate the effect of an intervention designed to prevent unwanted pregnancy in adolescents. A stratified sample of 74 compulsory schools was drawn at random from all compulsory schools in the county of Nordland in northern Norway. Of these 54 schools were willing to participate. The participating schools were assigned to four different groups according to a Solomon four‐group design. A total of 1183 pupils gave their informed consent for participation. For the intervention, a textbook in sex education was developed and handed out to pupils and teachers participating in the intervention groups. Data collections were carried out 1999–2001. The results from this study stem from data collected at post‐test 1. The individual was used as unit of analysis. Among adolescents who made their coital debut between the pre‐test and post‐test 1, more of those in the intervention group than in the pre‐test group reported use of contraception during first sexual intercourse. No other statistically significant effect of the intervention was found. The reason may be biased drop‐out. Copyright © 2003 John Wiley & Sons, Ltd.     

The Efficacy of a Group Triple P (Positive Parenting Program) for Chinese Parents with a Child Diagnosed with ADHD in Hong Kong: A Pilot Randomised Controlled Study

The present pilot study evaluated the efficacy of the Level 4 Group Positive Parenting Program (Triple P) with Hong Kong Chinese parents who had a child with attention deficit/hyperactivity disorder (ADHD), using a randomised controlled trial design. It was a mixed research method involving quantitative measurement and semi‐structured focus group. Participants were randomly assigned to Triple P (n = 8) or control group (n = 9) and completed measures on child disruptive behaviours, sense of parenting efficacy and satisfaction, family stress and service needs. Outcomes were assessed at pre‐, post‐, and 3‐month follow‐up. A focus group was also conducted with the participants in the intervention group upon the programme completion. Compared with the control group, the intervention group reported a significant reduction in intensity of child behaviour problems and a significant increase in parenting efficacy at post‐intervention. The gain in reducing intensity of child disruptive behaviours maintained to 3 months after the completion of programme. Qualitative data suggested the three key elements to help both parents and children get positive changes: understanding and empathy, emotional control, and persistence in applying positive parenting strategies. The results partially provided preliminary evidence supporting the efficacy of Triple P in reducing child behaviour problems for ADHD in Chinese society.     

Explorations of the effectiveness of a voluntary sector psychodynamic counselling service

This paper reports two studies of individual psychodynamic counselling provided by a voluntary sector service. The first study examines evidence of the effectiveness of counselling, as evaluated by the General Health Questionnaire and Personal Opinion Survey. Measures of the process of counselling indicated the improvements that clients attributed to counselling, the changes that occurred during it, and the factors that were most beneficial, as well as the approaches used by counsellors. The second study, using the CORE Outcome Measure and ratings of problem severity, found counselling to be equally effective with disadvantaged and non‐disadvantaged clients, as defined by British Department of Health criteria, but these clients differed somewhat in their perceptions of helpful aspects of counselling. Both studies also indicated predictors of positive outcome of counselling. The studies are used to illustrate some of the methodological issues around research in this area.     

Strengthening socio‐emotional competencies in a school setting: Data from the Pyramid project

Background. Development of socio‐emotional competencies is key to children's successful social interaction at home and at school. Aims. This study examines the efficacy of a UK primary school‐based intervention, the Pyramid project, in strengthening children's socio‐emotional competencies. Sample. Participants were 385 children from seven schools in two UK cities. All children were aged 7–8 years and in school Year 3. Children were screened for socio‐emotional difficulties through the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997 ) and a multi‐agency meeting of relevant professionals before being allocated to attend a Pyramid Club intervention (n= 103) or a comparison group (n= 282). Method. A 2 × 2 mixed‐model design was used: group (intervention group vs. comparison group) × 2 time points (pre‐ vs. 12 weeks post‐intervention) with repeated measures on the time factor to investigate the impact of the Pyramid Year 3 intervention. Teachers completed the SDQ‐T4‐16 for all children pre‐ and post‐intervention to measure participants’ socio‐emotional health status. Results. As measured by the two SDQ difficulty sub‐scales of Emotional and Peer problems and the SDQ strength sub‐scale of Prosocial behaviour, post‐intervention improvements in the Pyramid attendee group were of greater magnitude than those of the comparison group. Conclusions. The Pyramid project intervention improves the socio‐emotional health of vulnerable children through promoting positive outcomes as well as reducing socio‐emotional deficits. These findings further support the inclusion of a salutogenic approach in promoting children's socio‐emotional well‐being.