Specialist counsellors in primary care: The experience and preferences of general practitioners

This paper reports the results of a postal questionnaire, pre-coded by practice, which was sent to all 484 Leicestershire general practitioners. Practitioners who could and who could not refer to an in-house counsellor were compared in terms of their views about counselling provision, both within the practice and by agencies outside, such as mental health teams and specialist counselling services. General practitioners having access to a counsellor belonged to practices which were larger and had fundholding status. No signijicant dafference was found between rural and urban practices in their employment of an in-house counsellor, although those doctors working in rural areas were less likely to see this service as having a high priority. General practitioners without in-house counsellors estimated a referral rate (for counselling) in excess of twice that of the actual rate reported by those with practice counsellors. Those having an in-house counsellor were more likely to agree with statements that emphasized the benefits of this form of provision as against that offered by either mental health teams or specialist counselling services.     

Clinical and demographic features of the online counselling client population

The purpose of this research was to determine the demographics and characteristics of clients seeking online counselling over an eight‐month period of clinical online practice. Two hundred and seventeen clients seeking Internet counselling completed a Counselling Application and a Life History Questionnaire. The characteristics of the relatively new client population include the following categories: gender, age groups, martial status, education, primary reason for seeking online therapy, secondary issues, frequency of email exchanges, and online vs. face‐to‐face counselling preferences. Implications for online counselling practice are discussed.     

Weighing up the evidence: A qualitative analysis of how person‐centred counsellors evaluate the effectiveness of their practice

Research into the effectiveness of counselling and psychotherapy has great practical significance, as a means of collecting evidence that may potentially enhance the quality of services delivered to users. In recent years, the evidence base for counselling and psychotherapy has increasingly relied on data derived from self‐report questionnaires completed by clients, with relatively little attention being paid to therapists’ evaluations of outcomes. To make full use of therapist estimates of outcome, it is important to develop an understanding of the processes and criteria that therapists employ when making such judgements. However, little is known about the evaluation strategies used by therapists in their everyday practice. The aim of the present study was to explore the implicit and informal construction of outcome evaluation by experienced practitioners. Person‐centred therapists were interviewed about their approach to evaluation. The interview data were analysed using a grounded theory approach. These practitioners reported that they engaged in a process of evaluation based on a range of different sources of evidence, which was then “weighed up”. Evaluation was a continuous activity that was embedded in the counselling process itself rather than arising from discrete measurements carried out at particular times. The findings of this study suggest that practitioners may possess a sensitivity to the complexity of outcome that is missing in much current research. Implications for training, research and practice are discussed.     

Cybertherapy or psychobabble? A mixed methods study of online emotional support

ABSTRACT

The provision of online counselling and emotional support is a subject of intense debate among service providers. The subject is explored here by triangulating data from a statistical analysis of data from a children's helpline, interviews with practitioners and a focus group. Despite practitioners' concerns relating to misinterpretation, misrepresentation and the lack of non-verbal cues, online conversations are shown to span a greater variety of topics and focus on more sensitive issues than verbal sessions. Online services have potential for reaching clients in accessible and meaningful ways. However, practitioners need to consider online-specific issues, undertake specialised training and become comfortable with these new communication formats.     

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.     

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.     

ICT – the new frontier? Pushing the boundaries of careers practice

Much progress has been made in integrating information and communications technology (ICT) into careers practice, but there is still room for improvement. An international lens is adopted to examine some key elements that contribute to the successful integration of ICT into careers practice. We start by exploring the role of policy, using the UK as a case study. Next, the perceptions that Finnish career practitioners have of ICT are reviewed using research findings into the different ways they think about social media and its purpose in career services. Finally, lessons learned from the design and integration of online services within career development programming in Canada are discussed that ensure accessibility both to practitioners and their clients.     

Voluntary sector counselling: Has inadequate research resulted in a misunderstood and underutilised resource?

Although much counselling already takes place in the voluntary sector, little is known about the nature of the work being done or about its effectiveness or the training and experience of its practitioners. Given the gap between the demand for and supply of psychological therapies in Britain today, lack of research into the effectiveness of this work could mean that a valuable resource is being under‐utilised. This paper describes a study of a large, generic counselling centre and, using the CORE monitoring and evaluation system, makes comparisons between its work and that of a number of NHS psychological therapy services. It shows; that it is of at least as complex or severe a nature; and that it is as effective. It also shows that the therapy carried out in this agency is done by appropriately qualified and experienced practitioners.     

Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions

With reports continually demonstrating increased demand and severity of student mental health needs, it is important to gain a fuller understanding of the impact on embedded student counselling services. The aims of this research were to identify (a) service similarities, (b) factors which impact on services, (c) characteristics of service users, and (d) the use of therapeutic technology (e.g. online self-help). An online survey was completed by 113 heads of UK student counselling services across Higher Education (HE), Further Education (FE), and Sixth Form Colleges (SFCs), to capture service data from the academic year 2013/14. Students predominantly received high-intensity support (e.g. counselling) and referrals increased over 3 years. Challenges to embedded counselling services and their implications for development are discussed.     

Kenneth Gergen’s Social Constructionist Contributions to Counsellor Education

Kenneth Gergen??s seminal contributions to social constructionist thinking have substantial implications for the practice of counselling and psychotherapy, and thus for the training of practitioners as well. This article takes up the latter point, exploring the many deviations from traditional approaches to foundational counselling skills training that arise when educators are informed by constructionist philosophy. The article is written in the form of a dialogic exchange in recognition of Gergen??s emphasis on the relational aspect of knowing, with contributions from two educators accustomed to training graduate level practitioners in basic counselling and psychotherapy practice.     

Online counselling in secondary schools: would students seek help by this medium?

Students in secondary schools experience problems that can impact on their well-being and educational outcomes. Although face-to-face counselling is available in most Australian secondary schools, many students, particularly boys, do not seek appropriate help. Research suggests that online counselling can be effective and increase engagement. This study of 215 secondary school students sought to assess students' intention to use online counselling if it was made available in schools. The results found no gender difference in the likely intentions to seek online help though year level was significant and students experiencing psychological distress had a preference for online counselling. If students did use online counselling it was more likely they would discuss sensitive topics rather than for career issues. Implications for school counselling are discussed.     

Grief counselling in context: Multiple roles and professional compromise

The issues involved in the use of counselling skills and approaches by members of professions such as nursing and social work have received relatively little research attention. Grief counselling represents an appropriate area in which to explore these issues, since members of many diverse professional groups may be called on to work therapeutically or supportively with the bereaved. This paper explores the use of grief counselling in a variety of professional and voluntary contexts, through an analysis of the experience of students who had undertaken a bereavement counselling course. The aim of the study was to explore the level of awareness shown by employing organisations to the 'loss' element of client experience, and the implications of organisational context for the role of counsellor as a worker responding to client grief. A range of practice characteristics emerged. At one end of the spectrum was clearly focused and contracted grief counselling, usually within the context of specialist voluntary agencies. By contrast, there were practitioners whose counselling response to grief was concealed within a multi-professional perspective characterised by compromise, usually working in complex organisational contexts in the statutory sector. It is argued that the range of practitioner activity cannot be understood simply by describing some activities as counselling and others as the use of counselling skills; it seems that there is a real and sometimes subtle middle ground which lies between the two. This is territory which is determined by the context of practice and needs to be understood and defined as such     

The experience of working with refugees: counsellors in primary care

The provision of counselling services for refugee and asylum-seeking patients is relatively new in the UK and their complex needs may present considerable challenges within primary care, where access to specialist support resources is often limited. As far as we know, no previous research has attempted to look at the experiences of the counsellors who do this work. We undertook in-depth interviews with 13 counsellors who provide counselling to refugees in primary care in north London. The findings of this study suggest that counsellors who work in a primary care setting find themselves conflicted, troubled and out of their depth by the experiences, narratives and distress presented by refugee and asylum-seeking patients. They also report an erosion of usual counselling boundaries. Thus, the problems presented by refugees seem to demand approaches which go beyond standard counselling practice and which create ambivalence and uncertainty. These counsellors express feelings of isolation and impotence. The paper concludes with implications for counselling practice and suggestions for further research.     

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.     

Online counselling: learning from writing therapy

Online counselling is new and still contentious, with little UK-based research available to practitioners, providers or potential clients. This article aims to extend an earlier review of some of the research into writing therapy \[Wright &; Chung (2001) Mastery or mystery? Therapeutic writing: a review of the literature, British Journal of Guidance and Counselling, 29(3), 277-291] and to indicate how it could be applied to online counselling. It also refers to some of the literature on online counselling, which, together with the writing therapy research, informed the decision to offer an online service to staff in a university setting.     

Understanding the online therapeutic alliance through the eyes of adolescent service users

Aims: The therapeutic alliance is a concept that has received a great deal of attention within face‐to‐face counselling. Furthermore, links have been made between the creation of strong alliances and successful therapeutic outcomes. This study examines the therapeutic alliance when counselling services are offered online to young people. Method: Fifteen young people took part in online interviews (utilising synchronous and asynchronous methods), and Grounded Theory techniques were utilised to analyse the data. Findings: A core category of ‘Client‐Service Match’ and three subcategories pertinent to the individuals’ experiences of creating good quality relationships with the counsellors were identified: (1) initial engagement, (2) developing rapport, and (3) establishing control. Discussion: The themes elicited are all relevant to the matching process and viewed as a chronological process similar to face‐to‐face counselling. However, unlike face‐to‐face work, specific nuances related to the online work arise that counsellors should be mindful of, including the rationale behind each individual's choice to approach services online, their own computer‐mediated communication skills, technical hurdles, and the perceived ‘power’ of the counsellor.     

Counselling psychology in primary health care: A review

This paper reviews the development of counselling psychology within the field of primary health care. Issues discussed include liaison between counselling psychologists and other professionals, evaluation of treatment in primary care, family therapy in general practice and general practitioners’ skills in counselling. The need for training and evaluation of counselling are discussed and suggestions are made for further research.     

Applying the principles and techniques of solution-focused therapy to career counselling

Career counselling aims to help clients become more effective agents in solving problems in their vocational aspects of life. To achieve this goal, theorists and practitioners are called upon to form useful helping approaches that can help clients in a more efficient and effective manner. This article proposes an alternative model toward this end by considering and adopting principles and techniques from the solution-focused therapy in career counselling practice. After a very brief introduction of the basic features of the solution-focused counselling, the paper reviews some key theoretical principles of the solution-focused therapy, and connects these principles to career counselling context. It then illustrates several solution-focused counselling techniques that are particularly applicable to career counselling intervention.