Counselling young people: Counsellors' perspectives on ‘what works’ – An exploratory study

Aim: Counsellors who work with young people in a range of contexts know that they are not engaging with ‘mini‐adults’. The issues young people bring to counselling are often complex, challenging and wide‐ranging, as adolescents are experiencing times of turbulence and change in their physical, emotional, social and psychological development. This paper focuses on a research project undertaken with five counsellors who work with young people, and asks the question: ‘What works?’ Method: The research project is an in‐depth qualitative study into the counsellor's experience of counselling young people, using a narrative approach. Findings: Four key shared themes emerged: the significance of ‘safety’ in the relationship; building the therapeutic alliance; flexibility and integration relating to theoretical orientation; and the use of creativity. Outcomes: This paper offers counsellors the opportunity to reflect on ‘what works’ and consider the professional knowledge, which underpins their own counselling practice with young people.     

The effectiveness of counselling with older people: Results of a systematic review

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand‐searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak.     

Communicating evidence‐based mental health care to service users

There is a significant gap between evidence‐based mental health care and patients, their family members and carers. To inform preventative mental health care among existing and potential service users, this review identifies effective methods for communicating evidence. A systematic review located 14 publications that met search criteria. Several methods can effect behavioural and/or intermediary change among existing and/or potential service users: namely, mass media; health warning labels; policy change; community interventions; school‐based programs; parent programs; and psychoeducation. Robust evidence, however, is lacking. Although effective approaches are likely to be founded on several factors, the review concludes with a discussion of a research agenda, and appropriate methodologies that could strengthen the knowledge base that guides the communication of evidence‐based mental health care to service users. This agenda has important implications for practitioners, policymakers, and researchers, which are also discussed.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies

Scope of review: The paper reports a meta‐review of 15 previous systematic reviews and meta‐analyses of the literature concerning the outcome of counselling and psychotherapy with people at risk of suicide; a meta‐analysis of 67 outcome studies in this area; and a narrative review of 17 studies of the therapeutic process. Publication time span: The literature reviewed was published between 1981 and 2008. Publication origin: The majority of the literature reviewed was by authors from the USA or the UK, but there were also authors from other European countries, Australia, Canada, India, and Sri Lanka. Findings: There is evidence of the effectiveness of dialectical behaviour therapy, cognitive‐behavioural therapy, and problem solving therapy, but also for other forms of therapy. Therapist and client variables, as well as the therapeutic relationship, appear to be related to treatment outcome. Conclusions: People at risk of suicide should have access to psychological interventions, including, but not necessarily limited to, those within the cognitive‐behavioural spectrum. Therapies for which there have been promising findings, but which are under‐researched, should be a research priority.     

Career guidance and therapeutic counselling: sharing ‘what works’ in practice with young people

Many young people in the UK and across the world, where austerity measures are biting deep, find themselves at a time of crisis and uncertainty in their lives. The assumptions previously held of clear and straightforward career paths are being challenged and ‘career’ has come to mean more than simply ‘work’ or ‘employment’. This has implications for career practice, where career advisers are engaging with a range of complex issues in their guidance interactions with clients. This article draws on research undertaken with therapeutic counsellors into ‘what works’ when counselling young people. It offers career practitioners the opportunity to reflect on four key emerging themes and to consider how the discipline of therapeutic counselling might inform guidance practice.     

How effective is workplace counselling? A review of the research literature

The provision of counselling for work‐related problems has expanded in recent years, as organisations have recognised the value of this approach to staff support. However, there has been relatively little research into the outcomes of workplace counselling, and no systematic reviews have been conducted into the effectiveness of counselling in this setting. This paper presents the results of a preliminary review of evidence in this area. 34 studies of the effectiveness of workplace counselling were identified, of which 16 were sufficiently well designed to be considered as comprising reliable findings. The results of these studies suggest that, in general, workplace counselling is effective for clients for a wide variety of type and severity of presenting problems, employed across a range of different organisational contexts. The paper includes discussion of methodological issues associated with this research, recommendations for further research, and implications for practice.     

Impact of Well-being Interventions for Siblings of Children and Young People with a Chronic Physical or Mental Health Condition: A Systematic Review and Meta-Analysis

Siblings of children and young people with a chronic illness are at increased risk of poor psychological functioning. A number of studies have attempted to implement and evaluate interventions targeting the psychological well-being of this at-risk group. This systematic review summarises the evidence regarding psychological functioning of siblings following an intervention targeting their well-being. The meta-analysis considered behaviour and knowledge, two of the most frequently studied outcomes. The following databases were used: PsycINFO, EMBASE, CINAHL, PubMed, Scopus and Web of Science. Seventeen studies were eligible to be included in the systematic review and eight in the meta-analysis. Results from the systematic review reflected the inconsistency of intervention evaluations in this area with a high level of heterogeneity and a total of 23 outcomes considered across the 17 included studies. The meta-analysis estimated effect sizes using a standardised mean difference (SMD) approach. Pre-post analysis suggested significant improvement in behavioural outcomes and knowledge of their sibling’s health conditions with a SMD of ? 0.44 [95% CI (? 0.6, ? 0.29); p = 0.000] and 0.69 [(95% CI = 0.42, 0.96); p = 0.000], respectively. The SMD was not significant for behavioural outcomes when considering treatment–control studies. In conclusion, the findings suggest interventions for well-being have a positive effect on the psychological functioning of siblings of children and young people with a chronic illness, but their specificity needs to be established. There is a need for further, more methodologically robust research in this area.     

Users of secondary school‐based counselling services and specialist CAMHS in Wales: A comparison study

Background: The increasing prevalence of mental health issues in young people has contributed to a rise in the provision of school‐based counselling services in the UK. Between 2008/09 and 2010/11, data were collected from users of secondary school‐based counselling services in Wales. Aims: To identify the characteristics of users of school‐based counselling services in Wales – including demographics, referral pathways, presenting issues, and predominant issues – and how they compare to users of specialist CAMHS in Wales and Welsh secondary school pupils in general. Method: Data were collected on 10,687 episodes of counselling. School counsellors completed a client record sheet after each counselling episode and submitted these to their Local Authority. Collated results were then compared to matched data from Welsh specialist CAMHS and Welsh secondary schools data. Results/findings: A typical user of a secondary school‐based counselling service in Wales was female, of white ethnicity, and from the ‘middle’ school years. There was a marked under‐representation of users from BME backgrounds. Users were most often referred by school staff, and the most common presenting issues were family‐related, anger, and behaviour‐related. Conclusions: There was a higher proportion of females accessing school‐based counselling services than males. This was in direct contrast to data from specialist CAMHS and possible explanations for this are discussed. The under‐representation of BME populations suggested that there were some equality issues associated with accessing these services. Implications for practice: Future research should explore equality issues associated with young people from BME backgrounds accessing intervention services.     

Young people generating a repertoire of counselling psychology: Talking theory

This paper is concerned with how young people, who are trained as peer supporters in British secondary schools, construct a counselling repertoire. Issues of identity, boundaries and the dilemma of advice giving are all raised when pupils aged 14-17 talk about their roles in peer support. It becomes evident that young people's constructions of themselves and their schemes reflect the assimilation of both traditional psychological theories and contemporary counselling culture. In essence, their scheme may be marketed as a counselling/advising service, which could lead the young people to take on the role of 'counsellors'. On the other hand, their scheme may be promoted as a listening and/or support service and this will lead to young people questioning their role in the scheme. This paper will introduce these issues. This research is taken from an ongoing PhD project which uses language based research as its methodology.     

Une comparaison des apports des modèles de la construction de la carrière et de la construction de soi au life designing counseling

Recent developments in Western societies and transformations in work organizations have made the vocational issues that people face more frequent, complex, and puzzling. With the individualization of the life course, people now more than ever before need to reflect and deliberate as they design their lives. To assist individuals cope with difficult issues in life-designing, counselors have devised a new approach to counselling dialogues that differs from traditional information and guidance interventions. This article briefly presents the theoretical model for life designing counseling and then compares two distinct life-designing intervention approaches. Both of them share the epistemology of social constructivism and concentrate on the client and counselor's co-construction of meaning. Each approach provides a rigorous and systematic foundation for counselling interviews yet they differ in the ways they tackle meaning-making. The major difference is that the first approach presents a highly-structured form of life-designing interview that highlights the counselor's role in reconstructing a client's meanings, identity, and intentions. In contrast, the second approach presents a form of life-designing interview that highlights the client's role in self-construction of meaning, identities, and future prospects.     

Counselling glue sniffers and solvent abusers

This paper reviews the historical background and the current situation with reference to glue sniffing and volatile substance abuse practices by school children and young people. Various approaches to counselling are described and discussed with a view to encouraging the development of more caring services to treat those chronic cases who are urgently in need of help. It is emphasised that any response to volatile substance abuse should be directed more towards the person than the condition, which may be symptomatic of a whole range of personal problems requiring guidance and counselling.     

Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base

While the evidence base for psychodynamic therapy with adults is now quite substantial, there is still a lack of research evaluating the effectiveness of psychodynamic therapies with children and young people. Those studies that have been carried out are also not widely known in the field. To help address the second point, in 2011, we carried out a review of the evidence base for psychodynamic psychotherapy for children and adolescents, which identified 35 studies which together provided some preliminary evidence for this treatment for a range of childhood disorders. The present study is an updated review, focusing on research published between March 2011 and November 2016. During this period, 23 additional studies were published, of which 5 were reports on randomised controlled trials, 3 were quasi-experimental controlled studies and 15 were observational studies. Although most studies covered children with mixed diagnoses, there were a number of studies examining specific diagnostic groups, including children with depression, anxiety and disruptive disorders. whilst the quality of studies was mixed, some were well-designed and reported, and overall indicated promising findings. Nevertheless, further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy across a range of different disorders, and to ensure that services can provide a range of evidence-based treatments for children and young people.     

Parenting programmes for parents of children and young people with behavioural difficulties

Children and young people exhibiting behavioural difficulties present a major challenge not only to parents but also to education and health professionals and to society as a whole. In this paper, I shall address some key issues regarding these parenting programmes, based particularly on a programme of research over 13 years in the Centre for Educational Development, Appraisal and Research at the University of Warwick. This has comprised large‐scale studies across all areas of England, both programmes targeted at parents whose children are presenting or at risk of developing behavioural difficulties: the Parenting Early Intervention Pathfinder and Parenting Early Intervention Programme; and universal programmes aimed at all parents, as a positive contribution to behavioural development across the population: the CANparent trial. All were funded by the Department for Education plus the continuation of the CANparent trial was funded by the Department of Health. In addition, I consider studies that have built on this research to examine the use of parenting programmes with parents of children and young people with special educational needs; and also the effectiveness of programmes during sustained implementation, beyond formal trials and similar research initiatives, that is, as day‐to‐day practice. I show that well‐constructed parenting programmes that are acceptable to parents are effective, that these positive effects on parents can remain over time, and also that the positive effects found in well‐organised trials can be maintained when programmes are delivered by community services as part of their normal practice.     

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.     

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

Making a difference for young people with learning disabilities: A model for inclusive counselling practice

The prevalence of mental health problems in young people with learning disabilities and the disability rights movement provide the background to this paper. The aims are to investigate the inclusivity of counselling; gain insight into inclusive practices; and put forward a model for inclusive counselling practice. Mixed methodology provides quantitative and qualitative data through a survey of counsellors (n = 396) and a series of semi‐structured interviews (n = 15). The results produce six indicators of inclusive counselling, which are used to build a model for inclusive counselling practice: proactive approach to inclusion; focus on building relationships; operationalising equal opportunities policies; inclusive initial assessments; adopting flexible and creative approaches to counselling; and training and awareness raising. The implications for research and practice are to acknowledge the exclusive nature of the profession and address the issue of inclusion through training, professional development and further research in the field. The model for inclusive counselling practice is put forward as a tool for auditing existing counselling provision and as guidance for counsellors and policy makers in increasing inclustion of young people with learning disabilities in mainstream counselling.     

The evidence base for family therapy and systemic interventions for child‐focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multi‐modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self‐harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.