Evidence based practice: A guide for counsellors and psychotherapists

There has been an increasing tendency for healthcare policy makers and managers to require that all forms of therapy are supported by rigorous research evidence. This paper, which has also been distributed as an Information Sheet to all members of the British Association for Counselling and Psychotherapy (BACP), provides a practitioner‐oriented introduction to evidence‐based practice, with suggestions for further reading on this topic.     

The concomitants of system orientation in secondary school counsellors

Counsellors resolve their working dilemmas in terms of an orientation which they bring to the system in which they work. This ranges from extremes of acceptance and close co-operation, to extremes of challenge and independence. Evidence is given to indicate that the position which an individual adopts on such a continuum is related to factors in his personality, to his experience of inter-role conflict between teaching and counselling, to his experience of intra-role conflict with colleagues, to the designation of his role, to the amount of time available for its fulfilment, and to the length of the counselling training he has received. The findings tend to indicate that counselling is beset by internal philosophical tensions, and that the introduction of counselling is not necessarily part of a historically inevitable movement towards more openness in schools.     

Supervision and career counsellors: a little-explored practice with an uncertain future

While the supervision of counsellors has received much attention in the literature, there is a dearth of empirical and conceptual literature about the supervision of career counsellors. Career counselling has not to date followed other helping professions towards increased requirements for supervision or compulsory supervision. Recently there has been slight evidence of change and some advocacy of supervision for career counsellors in the literature. However, no previous studies related to supervision and career counsellors have been conducted. The Australian study reported here gathered information from members of a professional career counselling association about supervision through survey and focus group interviews. The findings revealed that supervision is not widely practised and that there are varying levels of understanding of and commitment to supervision.     

Where do counsellors in private practice receive their support? A pilot study

Background: Previous research suggests that independent practitioners should ensure that they attend to self-care, and the requirement for self-care is written into ethical practice requirements. Aims: To explore whether or how counsellors in private practice received support, and if so from where. Method: A survey questionnaire containing 29 questions was sent to 525 recipients. Results: 31 questionnaires were completed. The results from these questionnaires indicated that support was primarily received through supervision. Discussion: The support needs of private practitioners are discussed in the context of a very low response rate. The researcher considers factors that might have led to this response rate, as well as reflecting on the study design.     

Comorbidity of anxiety-depression among Australian university students: implications for student counsellors

ABSTRACT

The incidence, factor structure and scale item differences in anxiety-depression comorbidity were investigated in a sample of Australian university students defined according to the presence of anxiety and/or depression. The incidence of anxiety-depression comorbidity was over 32%, about four times that for anxiety or depression alone. Participants with comorbidity had significantly higher Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) total and factor scores than those with anxiety or depression alone. The major differences between the comorbid and unitary disordered subgroups were for self-disintegration and autonomic arousal. Comorbidity of anxiety and depression is a more serious disorder than either anxiety or depression alone, and appears to exist in large proportions among university students. Assessment and treatment plans might benefit from inclusion of this comorbidity.     

Personal sources for theories of psychotherapy: A bid for eclecticism

Personality and psychotherapy theorists choose certain elements to emphasize in their theories. A major, though usually unrecognized, source for such elements is the personal life of the theorist. Examples are drawn from nine theorists in the areas of family experiences, personal relationships, special experiences, and significant clients. The overall thesis is that an eclectic orientation to psychotherapy may be most appropriate since: (a) all theories emphasize certain elements (and ignore others), which is (b) often aided by (and limited by) the theorist's own life and experiences. Thus, if the client's personal life resembles the theorist's personal life, then the emphases developed by that theorist are most likely to be helpful to that client.     

Integration and eclecticism in counselling and psychotherapy: Cautionary notes

Obstacles on the path to integration and eclecticism are illustrated in three realms of endeavour: the therapeutic relationship, the constitution of knowledge, and visions of reality. The strands of three major systems of psychotherapy - the psychoanalytic, the behavioural and the humanistic - are examined as to the desired nature of the therapist-client relationship, their sources and understanding of data, and the worldviews they encompass from among the romantic, ironic, tragic and comic. Differences among these theories of psychotherapy are seen to limit the possibilities for integration and eclecticism. This conclusion is tempered, however, by a recognition of the value of each approach assimilating some views of the others in a considered way.     

Duty orientation: Theoretical development and preliminary construct testing

We develop and test the construct of duty orientation that we propose is valuable to advancing knowledge about ethical behavior in organizations. Duty orientation represents an individual’s volitional orientation to loyally serve and faithfully support other members of the group, to strive and sacrifice to accomplish the tasks and missions of the group, and to honor its codes and principles. We test the construct validity and predictive validity of a measure of duty orientation across five studies and six samples. Consistent with the conceptualization of duty orientation as a malleable construct, we found in separate field studies that duty orientation mediates the relationship between ethical leadership and ethical and unethical behaviors, and between transformational leadership and ethical behavior. In predicting ethical and unethical behavior, duty orientation demonstrated incremental predictive validity beyond the effects of affective organizational commitment, organizational identification, experienced job responsibility, collective self-construal, and organizational values congruence.     

Holism and eclecticism in the theory of concepts

Abstract

Howard (1992) defines concepts as the information that a person has about a category, and argues for an eclectic theory of concepts on the basis of this definition. We argue that this definition is unacceptable and hence that eclecticism does not follow. First, the definition is circular as it stands. Secondly, when it is modified to avoid circularity, it implies conceptual holism, according to which concepts are not useful explanatory constructs in psychology. Thirdly, we argue that Howard's argument relies essentially on this unacceptable definition: alternative accounts of concepts, namely categorisational or representational views, do not support it. Having countered the argument for eclecticism, we then argue against it directly on methodological grounds.     

Gender role orientation and physical health: A study among young adults

The purpose to this study was to examine the relationship between gender role orientation and physical health among young adults. One hundred forty-five undergraduates (103 females, 42 males) completed a measure of gender role orientation (Bem Sex Role Inventory), self-reported physical health (Personal Health Questionnaire), health related behaviors (Health Behaviors Inventory), and neuroticism (Eysenck Personality Inventory). The sample consisted of European-American (89%), African-American (8%), and Asian-American (3%) individuals. Results showed that gender role orientation was significantly related to health-related behaviors (e.g., smoking, exercise), but not to self-reported physical health (e.g., upper respiratory infections). Overall, androgynous individuals had better health-related behaviors than masculine, feminine, and undifferentiated individuals.We thank Karen Hooker and Randall Jorgensen for their useful advice regarding this article. We also thank Sue Rosenberg Zalk and an anonymous reviewer for their comments on previous drafts of this article. This work was supported in part by the Graduate Student Committee of the Psychology Department at Syracuse University.     

Life story research: A relevant methodology for counsellors and psychotherapists

Aims: This paper introduces, describes and proposes life story research as an important, relevant and appropriate contribution to counselling and psychotherapy research. It shows how narrative knowledge is created and constructed through the stories people tell about their lived experiences and explores the concept of ‘narrative knowing’ (Bruner, 1986). Methods: Drawing on life story research with people who linked their history of problematic drug use with experiences of historic trauma/abuse, the paper contributes to the ongoing discussion related to the similarities/differences between therapy and research and what we might learn from each that informs the other. Implications for practice: The paper offers narrative ideas and practices as ways of researching matters of social and psychological importance. It suggests that therapists (and counselling researchers) could learn from what participants tell us about the therapeutic value of using life story methods which one participant described as helping him to face ‘out into the world, without unduly or specifically delving into, or focusing on [my] emotional state’. This learning may be particularly relevant for therapists working with traumatised clients.     

A longitudinal analysis of loneliness among older people in Great Britain

Longitudinal studies of loneliness among older people are comparatively rare. At 8 years after the initial survey in 1999-2000, we followed up on the 999 people aged 65+ years who were living in the community in the United Kingdom. We found that 583 participants were still alive, and 287 (58%) participated in the follow-up survey. The overall prevalence of loneliness at both time points was very similar, with 9% reporting severe loneliness; 30% reporting that they were sometimes lonely, and 61% reporting that they were never lonely. We developed a 12-category typology to describe changes in loneliness across the follow-up period and report that 60% of participants had a stable loneliness rating, with 40-50% rating themselves as never lonely, and 20-25% rating themselves as persistently lonely; 25% demonstrated decreased loneliness, and approximately 15% demonstrated worse loneliness. Changes in loneliness were linked with changes in marital status, living arrangements, social networks, and physical health. Importantly improvements in physical health and improved social relationships were linked to reduced levels of loneliness. This result suggests that strategies to combat loneliness are not confined to the arena of social interventions such as befriending services, which aim to build and support social embeddedness, but may also result from the treatment of chronic and long-term health conditions.     

Suicidal behaviour and suicidal ideation in adolescents: A problem for counsellors in education

Some of the research findings on the prevalence, causes and possible prevention of suicidal behaviour and suicidal ideation in adolescents, including students, are reviewed. Both completed and attempted suicide (parasuicide) in teenagers is increasing. A number of factors appear to be associated with suicidal behaviour: cultural factors such as those arising from the stresses of discrimination; disorganised and unstable family life, especially that which involves the child in early separation from a parent; sexual imbalances in educational institutions; and an increase in anomie which is associated in the young with a variety of self-indulgent behaviour. Some data on suicidal ideation in a sample of English adolescents are reported, with suggestions for using such questionnaire data for identifying teenagers in need of counselling.     

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.     

Risky riding behaviours among motorcyclists in Malaysia: A roadside survey

Motorcyclists are over-represented in fatal crashes in Low- and Middle-Income Countries (LMICs). In Malaysia, motorcyclists comprise about 60% of all fatalities in road crashes. However, the prevalence and determinants of risky riding behaviours have been rarely studied in the country. This study aims to investigate motorcycle-related risky riding behaviours at signalised intersections. A total of 72,377 observations were made during six days at six different signalised intersections in Terengganu, Malaysia. Four risky riding behaviours were observed together (i.e. helmet non-use, red-light running, mobile phone use, turn signal neglect) along with additional demographic and contextual factors. The most prevalent risky riding behaviour was turn signal neglect (29.7% of all observations), and the least prevalent was mobile phone while riding (0.2% of all observations). Four logistic regressions were fitted to predict the four risky riding behaviours using the demographic and contextual explanatory factors. The results suggest that helmet non-use increases among female riders, riders wearing industrial uniforms, carrying passengers, riding during the weekend, during off-peak hours, during clear weather, at T-junctions, on multi-lane roads, and on minor road approaches. Red light running increases among female riders, riders wearing industrial uniforms, carrying passengers, during clear weather, at T-junctions, on multi-lane roads, and on major road approaches. Mobile phone use increases among female riders, riders wearing industrial uniforms, carrying passengers, and at cross-junctions. Turn signal neglect increases among male riders, riders not wearing industrial uniforms, solo riders, on weekends, during off-peak hours, during clear weather, on single-lane roads, and on minor road approaches. The findings of this study have significant implications for the development of targeted countermeasures such as education programs and road policing.