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 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.     

Chinese college students' general and relationship‐specific representations of adult attachment: Variable‐centred and person‐centred analysis

Formerly, researchers often treated adult attachment as a trait‐like construct with consistency across relationship contexts. However, recent studies have shown that people possess multiple relationship‐specific attachment representations, and inter‐correlations among them are only in a small‐to‐medium range. The aim of this study is to test whether these variable‐centred results could be replicated in China and further supplement them with a person‐centred analysis focusing on identifying prototypical patterns of multiple working models across relationships. We administrated measurements of general and four relationship‐specific (mother/father/best friend/romantic partner) working models and indicators of psychological adjustment upon 302 Chinese college students. Results from variable‐centred analysis demonstrated the cross‐relationship variability in working models. Furthermore, global indicators of psychological adjustment were better predicted by general models, while relationship‐specific indicators were better predicted by corresponding relationship‐specific models. These results largely replicate previous Western studies, supporting the existence of multiple attachment representations in China. In person‐centred analysis, a latent profile analysis identified four typical classes of working model profiles: all‐average, all‐secure, romantic‐insecure and peer‐secure. These classes differed not only in the cross‐relationship variability of their working models, but also in their levels of psychological adjustment. These interesting patterns may have theoretical implications and are worthy of further examination.     

Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling.     

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.     

Women,alcohol, self‐concept and self‐esteem: A qualitative study of the experience of person‐centred counselling

This study explores the self‐concept and self‐esteem of women with alcohol problems from a client perspective, and relates the findings to person‐centred theory and practice. Eight women with severe and long‐standing alcohol problems, who had received person‐centred counselling, were interviewed in relation to their sense of self over time. The data were analysed using grounded theory methodology, resulting in the emergence of five key categories. Examples from the interviews are used to illustrate the complex relationships between life experience, self‐concept, self‐esteem and drinking. The possible significance of the findings for counsellors working with this client group is discussed.     

Evaluating the effectiveness of counselling in primary care: Taking a fresh look

One criticism voiced by counsellors and psychotherapists is that research does not reflect either the culture or values of therapy. Researchers, on the other hand, accuse practitioners of not attending to their findings, and the implication is made that the latter engage in treatment processes that are ill‐informed. These polarised understandings give rise to the situation where the client — and his or her development — fall into the practice‐research gap. In more recent studies of counselling in primary care, an attempt has been made to offer new perspectives for interpreting and understanding findings, and the relative value — and limitations — of different research questions and methods. They provide just a few examples of how practitioner‐researchers in the future may ask more precise questions, yet reflect on their findings from a broader set of viewpoints.     

How person-centred counselling trainers understand and experience their role in the current British context

This article reports the findings of a qualitative study into the experience of person-centred training from the viewpoint of the trainer. Interpretative phenomenological analysis was the adopted approach. The researcher conducted a series of in-depth semi-structured interviews with five person-centred trainers with experience across a range of settings. The findings demonstrate the commitment of person-centred trainers to a relational approach with the facilitation of individual potential at its heart. The intrinsically rewarding nature of the role is highlighted alongside its substantial demands. Participants demonstrated a primary identification with themselves as counsellor trainers rather than academics and some lack of reconciliation with current developments within counselling.     

Counselling in primary care: a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost‐effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non‐specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost‐effectiveness trials are needed together with surveys of more typical users of primary care services.     

Emotion regulation and psychopathological symptoms of Chinese school‐age children: A person‐centred and multi‐informant approach

Emotion regulation (ER) is a critical component of children's development. Many previous studies have utilised a single‐assessment method to reflect child ER, which might result in losing important information regarding the unique contribution of each informant. With a person‐centred approach and multi‐informant reports (mother, teacher and child), the current study examined 196 children's (age M = 9.21, SD = 1.10, range = 7–11 years; 51% girls) ER patterns and their associations with psychopathological symptoms in a Chinese sample. A model‐based clustering procedure resulted in 3 ER groups: the poor family ER group (n = 36), poor school ER group (n = 120), and overall good ER group (n = 40). Significant differences were found among ER clusters on teacher‐reported child psychopathological symptoms compared on the levels of withdrawn depression, somatic complain, thought problems and attention problems. No significant differences were found on the mother‐reported psychopathological symptoms. Compared with children in the poor school or poor family ER clusters, children in the overall good ER group demonstrated fewer psychopathological symptoms at school. Our results confirmed the advantage of adopting multi‐informant assessments to fully capture children's emotional profiles and linked these profiles with children's emotional and behavioural functioning at school.     

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.     

Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

Moments of empowerment: A qualitative analysis of positively experienced episodes in brief person‐centred counselling

38 positively experienced episodes in brief person‐centred counselling with six clients were analysed. The Interpersonal Process Recall (IPR) method was used as the prime research tool. Clients were asked to identify positively experienced moments in the counselling session during a post‐session review interview. Clients and counsellors were invited to report on the feelings, perceptions and intentions they recalled experiencing during these moments. Three analyses were used to categorise the meaning and feeling quality of these moments, and a taxonomy of types of positively experienced episodes was also created. The most frequently reported positive client experiences were associated with empowerment, safety and insight. Other significant themes emerging from the analysis included: freedom in the relationship, shortcomings of the relationship, assurance of the relationship, unfolding of the client's personal meaning, and the importance of the counsellor's presence. Taxonomy of episodes revealed nine categories: four of them focused on the strengthening of the therapeutic relationship, and five focused on the empowerment of the client's self. These findings are discussed, and implications for theory and practice explored.     

Working with suicidal clients: The person‐centred counsellor's experience and understanding of risk assessment

Background: Client risk assessment within the person‐centred paradigm is traditionally seen as squarely opposed to its ethos. Aim: To determine how the person‐centred counsellor experiences and understands the issue of risk assessment within the confines of their work ethos. Method: Semi‐structured interviews with seven person‐centred counsellors using thematic analysis were conducted. Findings: Three main themes emerged following thematic analysis: The impact of the risk assessment process on self; The counsellor's experience of self, and The therapeutic process in relation to risk assessment. Discussion: The findings suggest that person‐centred counsellors conduct risk assessments taking a holistic approach involving not only individual risk predictors and characteristics of the client but also individual factors related to self.     

Research in person‐centred,experiential and humanistic counselling and psychotherapy: Meeting new challenges

As a result of the programme of research into client‐centred therapy led by Carl Rogers, the humanistic therapies could claim, in the 1950s, to possess a comprehensive evidence base. Over the following decades, however, there was a marked decline in the productivity and influence of research into person‐centred and humanistic therapies. The present paper celebrates the publication of three books that mark a resurgence in research into these approaches, and comments on emerging themes and trends.     

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups – frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months post-intervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.     

Experiential congruence: Qualitative analysis of client and counsellor narrative accounts of significant events in time‐limited person‐centred therapy

The concept of congruence represents a core theoretical construct in the development of client‐centred therapy, and remains fundamental to the practice of experiential approaches to psychotherapy. This study explores the ways in which congruence is experienced during significant moments of therapy. Client and counsellor accounts of moments of congruence/incongruence were collected from six cases of person‐centred counselling, and were analysed using a method of narrative analysis. It was found that participants experienced congruence in a variety of ways, suggesting that the construct does not describe a unitary phenomenon. Congruence was experienced as simultaneously intrapsychic and relational. The effective negotiation of episodes of incongruence comprised a necessary element of effective therapy. Further research into the nature of congruence may be valuable in contributing to new understandings of how therapeutic alliances are made, broken and repaired.