Mastery or mystery? Therapeutic writing: A review of the literature

Recent developments in online support and counselling suggest that the users of chat rooms, for example, or the Samaritans' e-mail 'listening' service, have already discovered the power of writing as a self-help vehicle. Developments in computer-mediated counselling and therapy are essentially text-based and client-driven. The therapeutic use of expressive and reflective writing is not widely recognised in British counselling and therapy circles. The empirical foundations for the therapeutic uses of the literary arts are, however, well established. This review aims to map the use of 'writing therapy' by drawing together cross-disciplinary research and practitioner reports which might support the place of writing as a creative therapy in its own right, whether as an adjunct to face-to-face counselling or as a self-help tool.     

Writing therapy in brief workplace counselling: Collaborative writing as inquiry

The purpose of this collaborative research was to reflect on one client's experience of using writing therapy during brief workplace counselling. The client/co‐researcher used expressive and creative writing between counselling sessions, the benefits of which are reported. A brief review of the literature on writing therapy is provided. The focus of the study is on investigating the process of writing therapy from the client's point of view. The epistemological assumptions and research methods are influenced by narrative inquiry. Feminist values inform both the therapeutic practice and research.     

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.     

Online counselling: a descriptive analysis of therapy services on the Internet

This study investigated the emerging practice of online counselling. Although the traditional practice of counselling involves face-to-face interaction between counsellor and client, a growing number of practitioners are providing counselling or therapy services via the Internet. In the present study, a total of 67 online counsellors completed a questionnaire exploring the backgrounds, services, fees, and communication technologies of practitioners offering online counselling to the public. Results suggest that online counselling is conducted by relatively experienced, primarily Western-based practitioners and is characterised by the use of email. Online clients are mainly female and receive relatively short-term interventions. Although the field appears to be evolving as its popularity increases, some ethical concerns raised by early research remain inadequately addressed.     

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.     

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 experience of outsourcing transfer: implications for guidance and counselling

Outsourcing can involve the forced transfer of employees to another organisation. During or after the transfer they may find their jobs have changed or go through a process of downsizing. They also often have to maintain a relationship with their previous employer as they continue to work on joint projects. In this paper we review relevant research literature and identify important psychological and organisational processes involved in this process, which are of specific interest to guidance and counselling. We also present data from a longitudinal research study in which employees undergoing an outsourcing transfer discussed their experiences. A number of these employees required career counselling and some were undergoing psychological counselling to reduce depression and anxiety. In conclusion, we summarise important issues to be considered by the counsellor when advising individuals going through this process.     

Counselling children and young people: A review of the evidence for its effectiveness

This paper summarises and presents the results of a BACP commissioned systematic scoping review on the research evidence on counselling children and young people. The methodology was based on a structured, hierarchical, systematic approach to searching and reviewing the research literature. Inclusion criteria defined the scope of the review in relation to a range of issues in counselling children and young people: behavioural problems and conduct disorders; emotional problems including anxiety, depression and post‐traumatic stress; medical illness; school‐related issues; self‐harming practices and sexual abuse. Four groups of counselling approaches were examined: cognitive‐behavioural; psychoanalytic; humanistic; and creative therapies. The findings indicate that the four therapeutic approaches are effective to a greater or lesser degree in relation to the range of issues. Although the findings show that there is little or no evidence for the effectiveness of some therapies for particular issues, this may not reflect the lived experience of children and young people engaged in counselling in a range of community and institutional settings. Instead, the absence of evidence is likely to reflect a lack of published studies that fit the inclusion criteria for this review.     

Dialogical journal writing as ‘self‐therapy’: ‘I matter’

Aim: This case study of one woman's (Jane's) experience of dialogical journal writing presents a way of finding a ‘compassionate image’ for self‐therapy. Various theoretical analyses are indicated with Mindfulness‐based conceptualisations at the forefront. Methodology: Based on three recorded interviews, the narrative inquiry took place over a year. Methodologically, this paper is also one contribution to an ongoing debate about different research approaches in therapeutic writing research. Participants: This study took place in Aotearoa New Zealand, where both Jane and I are migrants. Discussion: This account draws on a report of self‐directed writing for well‐being, seen as an alternative to counselling or medication for depression and anxiety. It focuses on how a particular style of writing evolved and how the motivation to write continues.     

An initial study of transgender people's experiences of seeking and receiving counselling or psychotherapy in the UK

Background: There are no published empirical research studies exploring transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. As a result, counsellors know little about why transgender people seek counselling, who they seek counselling from, and what their experiences are of receiving counselling. Aim: To address this gap in the literature, this study investigated transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. Funding for this study was provided by a BACP Seedcorn grant. Method: A mixed method small‐scale qualitative research design was employed, comprising an online survey and five semi‐structured interviews. Findings: Participants tended to seek counselling on two or more occasions and received between 2 and 12 sessions. Participants sought counselling for common psychological concerns as well as gender identity and coming out issues. A fear of being discriminated against and exploring gender for the first time were significant barriers in seeking help. Participants reported mixed experiences of counselling but valued a therapeutic relationship in which they felt affirmed, listened to and understood. Discussion: The findings from this study mirror aspects of previous research conducted in the USA concerning transgender clients' experiences of counselling. However, these findings point to the importance of recognising the potential vulnerability transgender clients experience when seeking counselling and the need for therapists to develop greater awareness, knowledge and competence regarding working with transgender clients.     

A mixed methods research study on the video‐based counselling method Marte Meo

Marte Meo is a video‐based counselling method founded by Maria Aarts in the Netherlands and now in worldwide use (Aarts, Aarts Production, 2008). Marte Meo has been adopted and put into practice by a large and diverse network of trained and certified counsellors across the world. It was invented, developed and spread by a vanguard of practising counsellors who have adapted it to a variety of contexts. This is a classic example of research and theory emerging from and following practice; we first need to synthesise the lessons the practitioners and families have learned. We need to better understand how it is implemented; how it is viewed by its practitioners and recipients; and the extent to which variability in implementation may be an asset or a drawback in the continuing evolution of the programme, and in any eventual attempt to document its effects. Therefore, the present article aimed to address this important and hitherto unexplored research topic of the Marte Meo method in counselling and to describe the current state of use of Marte Meo. How is Marte Meo used and applied in a counselling and therapeutic context? Who uses Marte Meo in professional practice? Which function and which meaning does Marte Meo have in general practice and especially in counselling and therapy? What are typical concerns, goals or areas of application? We report on an ongoing mixed methods research project which began in 2015. This paper focuses on the research methods. We will explain why an integrated exploratory sequential design (Cresswell, 2017) is best suited to our purposes. The exploratory sequential design of the Marte Meo project has five phases: as the first phase, we conducted a systematic literature review, analysing the status of existing research. The staged qualitative research consisted of designing, conducting and analysing semi‐structured interviews with parents and Marte Meo counsellors (phase 2), and then using that analysis to inform the design, the conduct and the analysis of videotaped observations of everyday situations in day‐care centres to examine the process and effects of Marte Meo interaction elements on children (phase 3). Combining these qualitative analyses then became the basis for the development of an online questionnaire that could enable us to collect quantitative data on the current use of Marte Meo in practice by experts (phase 4). This builds into the fifth phase in the final interpretation. One of the key findings of the qualitative parts is that Marte Meo is perceived as advantageous. The experts reported more joy and success in their work. In particular, in the pedagogical context, the daily, resource‐oriented ‘Marte Meo view’, which was sharpened by the training, seems to be essential, as it enables an awareness of the needs of the interaction partners and the beneficial interaction elements. Moreover, for some interviewees the use of Marte Meo does not seem to be limited to professional practice, but is expressed in a general humanistic attitude towards interpersonal relationships of all kinds. The quantitative survey has confirmed and supplemented these results. On the other hand, we found that Marte Meo is most often used in addition to the systemic approach. A later article will focus more on the findings. This article will conclude with a discussion of the advantages and disadvantages of the research design—concerning this special research project and concerning counselling research in general.     

Developing a research tradition consistent with the practices and values of counselling and psychotherapy: Why Counselling and Psychotherapy Research is necessary

Despite the general acknowledgement that it is important for counselling and psychotherapy practice to be informed by research, it is clear that in recent years a widening gap has emerged between research and practice. This paper briefly reviews some of the factors responsible for the current crisis in therapy research and offers a number of reasons why a healthy relationship between research and practice is necessary. It is suggested that, at present, there exists within psychology and social science a level of acceptance of pluralistic and innovative approaches to research, which may facilitate the emergence of a new genre of practitioner‐oriented inquiry in the field of counselling and psychotherapy. Some of the ways in which Counselling and Psychotherapy Research intends to contribute to this movement are described, for example the promotion of new forms of writing, use of information technology, and the creation of knowledge communities. Readers are invited to participate in this endeavour.     

Writing in therapy: a participatory approach

This paper explores the potential of writing with rather than to or about clients, an approach which may foster new responses to clients' dilemmas in the face of institutional, cultural, ethnic, class and gender discrimination. A selective review of literature about writing in therapy and vignettes from my own work in a community mental health clinic support this enquiry. Some implications for training are also addressed.     

The influence of personality and theoretical models on applicants to a counselling psychology course: A preliminary study

We examined whether personality variables in prospective condidates for a postgraduate program in counselling psychology were associated with an interest in models of counselling or therapy. The models were classified as directive models or non-deiective models of counselling. Using the Millon Index of Personality Styles we found that subjects who expressed an interest in the directive models of counselling (e.g. cognitive behavioural therapy) scored higher on scales measuring interpersonal boldness, systematizing and conforming in comparison to subjects who expressed an interest in non-dieective counselling (e.g. psychodynamic) who scored greater on intuitiveness (a perference for intangible, unstructured and symbolic). Implication for training and future research in this area are discussed.     

Clients' experiences of online therapy in the early stages of a COVID-19 world: A scoping review

The emergence of the COVID-19 pandemic in 2019 forced an abrupt shift in the modality through which psychotherapy was delivered and online therapy became the only viable option for clients. Research regarding experiences of online therapy during the early stages of the COVID-19 pandemic is minimal, however, and has largely focussed on therapists' experiences of delivering online treatment, as opposed to clients' experiences of receiving it. A scoping review was undertaken to establish what is known from the existing literature about clients' experiences of online therapy during the initial stages of the COVID-19 pandemic and identify gaps in the current knowledge. Searches were conducted across four academic databases: Scopus, EBSCO CINAHL Complete, EBSCO MEDLINE and OVID PsycInfo; the literature was excluded based on established PICOS criteria. Data were summarised through data charting and synthesised by way of inductive content analysis. A total of five articles were identified. All articles focussed on online therapy using video or audio conferencing, and four of the five studies examined clients with eating disorders. Inductive content analysis identified seven categories, as follows: preference for face-to-face therapy; appreciation of accessibility and convenience; online format hindered connection; positive experience of online therapy; individual client differences impacted experience; strong therapeutic alliance indicative of positive experience; and gratitude for continuation of treatment. Future research could explore clients' experiences of online therapy in a “post-pandemic” world and include a broader range of client populations and online therapy approaches in the COVID-19 context.     

Textual Appropriation in Engineering Master’s Theses: A Preliminary Study

In the thesis literature review, an engineering graduate student is expected to place original research in the context of previous work by other researchers. However, for some students, particularly those for whom English is a second language, the literature review may be a mixture of original writing and verbatim source text appropriated without quotations. Such problematic use of source material leaves students vulnerable to an accusation of plagiarism, which carries severe consequences. Is such textual appropriation common in engineering master’s writing? Furthermore, what, if anything, can be concluded when two texts have been found to have textual material in common? Do existing definitions of plagiarism provide a sufficient framework for determining if an instance of copying is transgressive or not? In a preliminary attempt to answer these questions, text strings from a random sample of 100 engineering master’s theses from the ProQuest Dissertations and Theses database were searched for appropriated verbatim source text using the Google search engine. The results suggest that textual borrowing may indeed be a common feature of the master’s engineering literature review, raising questions about the ability of graduate students to synthesize the literature. The study also illustrates the difficulties of making a determination of plagiarism based on simple textual similarity. A context-specific approach is recommended when dealing with any instance of apparent copying.     

‘Does class count?’ Social class and counselling

This article explores the importance attached to social class by experienced practitioners taking part in a co‐operative inquiry group. A review of the literature from the last thirty years indicates that there is very little research on class in relation to counselling and psychotherapy reported in the UK. Both authors position themselves as coming from working class origins. Nine co‐researchers from both middle and working class origins joined the group. Eight meetings took place over a period of nine months. Extracts from the group's discussions are represented and integrated with ‘presentational knowing’ drawn from contemporary culture, including poetry and popular music. This study suggests that social class is a neglected aspect of diversity in the counselling field. Implications of the study have relevance for the language of counselling and psychotherapy and class based values; social class and its impact on initial education; and ongoing counselling practice and access to therapy for working class people.     

Five women talk about work‐related brief therapy and therapeutic writing

Therapeutic writing can play a valuable role in brief, workplace counselling. The present study explores the experiences of five women who used therapeutic writing in this context. Ethical and methodological dilemmas in carrying out this research are highlighted. The study also demonstrates the use of ‘fictionalist’ accounts as a way of overcoming some of the difficulties associated with the dual role of practitioner/researcher, especially confidentiality.