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.     

Person‐centred counsellors' experiences of working with clients in crisis: A qualitative interview study

Aims: This study aims to explore and understand person‐centred therapists’ experiences and work with clients at the pivotal point of crisis. Specifically: how do person‐centred therapists experience working with clients in crisis? Do they identify differences in crisis intervention compared to non‐crisis work? What do they perceive as helpful to crisis clients? How relevant are therapists' own experiences of crisis? Method: Participants were all experienced person‐centred therapists. Qualitative, semi‐structured interviews were conducted and the data were analysed qualitatively using person‐centred/phenomenological methodology. Results: Respondents identified differences in their experiences. Typically, therapists described polarity in their experience of danger and opportunity, also heightened energy levels within themselves, perceived higher levels of engagement, faster pace of work, experiences of reaching ‘relational depth’ earlier, and the importance of assisting symbolisation of clients' experience in awareness. Clients were experienced as vulnerable, unable to access previous coping mechanisms, in a state of breakdown and disintegration, but also as wide open, having dropped their usual defences, and more available to engage in therapy and enter the process of change and potential post‐crisis growth. Discussion: The findings are discussed in relation to prevailing models of crisis intervention, person‐centred theory and theoretical developments in post‐traumatic growth in the aftermath of crisis.     

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.     

A five‐year evaluation of the effectiveness of person‐centred counselling in routine clinical practice in primary care

Counselling is the recommended treatment for individuals with mild to moderate mental health problems of recent onset. In this evaluation of a primary care counselling service offering person‐centred counselling, the Core Outcome Measure (CORE‐OM) was administered at referral and at the beginning and end of therapy. A pre‐post therapy effect size for 697 individuals over a 5 year period was 1.2. This compares with a waitlist (between referral and pre therapy) effect size of 0.24 for 382 individuals over a three year period. The results indicate that person‐centred counselling is effective for clients with common mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate symptoms of recent onset, but extends to people with moderate to severe symptoms of longer duration.     

Beyond resolution of presenting issues: Clients' experiences of an in‐house police counselling service

The availability of counselling services for employees has expanded significantly in recent years. However, despite an increase in appreciation of the value of counselling within the police service, there has been little research into the effectiveness of counselling with police personnel. The present study assesses an in‐house counselling service provided by the welfare and counselling department of a Scottish police force. Thirteen former clients (including both police officers and civilian support staff) were interviewed about their views on four areas of the counselling provision: how they entered counselling, the issues they brought, their experiences during counselling, and their assessment of the impact of counselling on their lives. Interviews were analysed using a grounded theory approach, which identified four main categories: initial engagement, learning by participating, experiencing moments of deep self‐examination, and moving beyond resolution of presenting problems. All of those who were interviewed appreciated the provision of a counselling service within their employment, and the majority reported that they had not only been helped to resolve their presenting problems, but had also made important gains in self‐awareness and work effectiveness. Findings are discussed in terms of implications for service delivery and future research.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

Experiencing gay affirmative therapy: An exploration of clients' views of what is helpful

Gay affirmative therapy is a counselling approach that emphasises an affirming, non‐pathologising approach to therapeutic work with lesbian, gay and bisexual clients. In this study, lesbian and gay clients who had experienced counselling that they defined as affirming identified what they perceived to have been helpful. Questionnaires and interviews were used to collect the views of a sample of lesbian, gay and bisexual informants. The material gathered was analysed using a grounded theory approach, which generated six main categories: communicating a non‐pathologising perspective on homosexuality; the counselling relationship; the counselling space; what the counsellor brought to the relationship; humanity; and the counsellor adopting a holistic approach. Some of these identified affirming elements are unique to gay affirmative therapy and cannot be attributed to other factors. The possible significance of the findings for practitioners is discussed.     

What difference does counselling make? – The perceptions of drug‐using clients on low incomes

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi‐structured interviews with six participants. Findings: Findings included changes in the clients’ internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives.     

Clients talk about their experience of the process of counselling

The purpose of this study was to ascertain clients’ experiences of their counselling. This was done through use of a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in agency located in a mid-sized city in New Zealand. Several themes were identified and discussed in relation to the literature on clients’ perceptions of their own counselling. Specifically, clients were asked to comment on whether their counselling was effective, how much of their improvement was due to counselling versus other factors, the quality of the relationship with their counsellor, specific in-counselling events that were helpful or unhelpful, and how their counselling was terminated. Implications for practice were suggested.     

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.     

Responses to Marriage Counselling

The experiences of clients who received marital counselling from trained volunteer marriage guidance counsellors were investigated. Fifty-one clients from 42 marriages were interviewed and questioned about why they chose the agency, what expectations they held, what happened during counselling, how they felt about the counsellor, and what if anything was achieved through counselling. They were also asked how they had fared since. Rating scales were used after the interview to evaluate satisfaction with counselling, benefit from counselling, aspects of the counselling relationship, etc. The clients were also asked to do a card-sort of statements about counselling to determine what aspects had been valuable and disappointing. Some of the preliminary results of the study are presented and discussed.     

Recovering Identity from Anorexia Nervosa: Women's Constructions of Their Experiences of Recovery from Anorexia Nervosa Over 10 Years

There is little consensus about the meaning of recovery in anorexia nervosa with most studies focusing on researcher selected variables of weight gain and improvement in eating disorder symptomatology. There is also a paucity of research that focuses on how the experiencing person themselves define recovery and whether this term is useful to them to depict their journey of reclaiming their life and identity from anorexia nervosa. This article explores 21 Australian women's experiences of anorexia nervosa (AN) over 10 years and the ways they negotiated their identities in relation to the question of recovery. The research interviews sought to provide a context for these women to speak on their own terms, terms not confined to the medical discourse. The discursively constructed category of recovery was troublesome for the majority of these women, despite the researcher inadvertently taking up this category in lines of questioning, particularly in the earlier interviews. Most troubling for the women was the assumption that recovery erased their experiences with the expectation that they should return to a pre-illness state. On the other hand, speaking on their own terms—including the use of metaphor and (re)authoring their experiences as an identity journey—was significant in scaffolding the women toward narratives of reclaiming their lives and identities from AN and its effects. The women in this study refused to confine the terms of their speaking to a recovery discourse; instead, they honored the narratives of their experiences and histories as profound in their identity formation. The implications of this research are significant given that the majority of research and many treatments to date confine the terms of speaking to the “anorexia” discourse.     

Theory in counselling: Using content knowledge

An underlying theoretical principle of person‐centred counselling is that this approach has no requirements for a content knowledge base in terms of client groups and client issues. This is also the position implicit in UK professional accreditation criteria. Yet counsellors do acquire and do use content knowledge in addition to knowledge of process. Thus professional ethos and professional practice are, it is suggested, at variance.     

How common is sexual attraction towards clients? The experiences of sexual attraction of counselling psychologists toward their clients and its impact on the therapeutic process

This study investigated counselling psychologists' experiences of sexual attraction to their clients. Self-reported incidence of this phenomenon, the reaction that it provokes in therapists, the way they manage their feelings, and the potential impact of their sexual attraction on the therapeutic process, were assessed. On the basis of previous studies of psychotherapists, it was hypothesized that sexual attraction toward clients is common, and that these perceived feelings are not necessarily negative to the therapeutic process or professional relationship; also, it was hypothesized that the disclosure of these feelings to the client could nevertheless lead to a positive therapeutic outcome. Questionnaires were sent to the 286 chartered counselling psychologists included in the British Psychological Society Register. The results showed that significantly more therapists were attracted to at least one client than not. Furthermore, half of the respondents who reported attraction to clients believed that their feelings had a positive impact on the therapeutic process. Therapists who had disclosed their feelings to their clients found significantly more frequently that the impact of their sexual attraction had been positive to the therapeutic process (87.5%), than therapists who did not disclose their sexual attraction (47.1%). The implications of these results for training, supervision and professional issues are discussed.     

Spiritual emergency and counselling: An exploratory study

Growing up in a multicultural community in England brought me into close personal contact with the beliefs and perceptions about healing held by people of many different cultures. In many cases, no strong boundary was seen between physical, psychological and spiritual aspects of an illness, and experiences of hearing voices or seeing visions were accepted as normal everyday occurrences. During my training as a counsellor, I came into contact with the work of Stanislav Grof on the concept of spiritual emergency, which, together with the work of African and European authors who were exploring transpersonal aspects of psychology, provided a theoretical framework for researching how counsellors respond to clients wishing to explore experiences of spiritual crisis. This paper describes an exploratory study into the phenomenon of spiritual emergency within counselling. Questionnaires were distributed by post to people known to have been in counselling relationships, and interviews were conducted with three informants reporting different types of spiritual experience. All respondents who completed questionnaires reported having at least one of the ‘non‐ordinary’ experiences classified by Stanislav Grof as characteristics of a ‘spiritual emergency’. Several participants felt unable to explore this experience with their counsellors, some for fear of being labelled as mentally ill, while others found their counsellors helpful and sympathetic. Differences in dealing with spiritual phenomena were apparent between European and non‐European participants. These findings are discussed in relation to theory and practice.     

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.     

Men's experience of considering counselling: ‘Entering the unknown’

Agency statistics in the UK and North America reveal that fewer men than women attend counselling, at a ratio of about 1:2. This study investigated men's experience of considering counselling, with the aim of gaining further understanding of factors that might contribute to the existing gender discrepancy in utilisation of counselling. Following responses by 47 men to written questionnaires, 10 men who had considered and ultimately attended counselling were interviewed, and a grounded theory method of analysis was used to generate and analyse the participants' experiences. Three interconnected categories emerged: societal perceptions of counselling and gender roles; change of experience over time; and knowledge — ‘knowing’ and ‘not knowing’ the protocols of counselling. The implications of these findings are discussed. It is recommended that prospective male clients should be provided with information about the counselling process, and that there needs to be increased awareness by counsellors and referring agents of male gender issues.     

Avatar‐based counselling for young people within school counselling. Qualitative analysis of client experience

Background

This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world ). The intervention was piloted in eight secondary schools in the UK in 2016.

Aims

Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness.

Materials and Methods

Interviews were semi‐structured and were analysed using thematic analysis.

Results

The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness.

Discussion

There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds.

Conclusion

Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling.