Short-term effectiveness of psychotherapy treatments delivered at a university counselling service

This work aimed to evaluate the short-term effectiveness of psychotherapy delivered at the counselling service of the University of Bologna (Italy), by means of a single group longitudinal study including a 6-months follow-up. To this end, sixty-six students completed the 6-months follow-up and filled in the Symptom Questionnaire (SQ) three times, during the first and the last session of the psychotherapy, and 6 months after its conclusion. The majority of students presented a problem concerning mood (n?=?35; 53.03%); students completed a programme of psychodynamic therapy (n?=?38, 57.58%) or cognitive-behavioural therapy (n?=?28, 42.42%). With reference to 10 out of 12 SQ dimensions, significant improvements were observed both after therapy and at the 6-months follow-up, in comparison to pre-treatment; furthermore no significant differences were observed between the end of psychotherapy and the follow-up. The present data indicate the effectiveness of the therapy in reducing students’ distress at the end of treatment and also in the short-term.     

Addressing disparities: The impact of a lesbian,gay, bisexual,and transgender graduate counselling course

Background: Lesbian, gay, bisexual and transgender (LGBT) individuals experience serious mental health disparities and treatment inequities. Counsellor education has been identified as both a contributing factor to these problems as well as an ameliorating mechanism to address these inequalities. Aim: The purpose of the current study was to evaluate the impact of an LGBT‐affirmative counselling course. Method: A total of 23 students enrolled in a graduate LGBT counselling course were administered the Sexual Orientation Counselor Competency Scale (SOCCS, Bidell, 2005) and the Lesbian, Gay, and Bisexual Affirmative Counseling Self‐Efficacy Inventory (LGB‐CSI, Dillon & Worthington, 2003) pre‐ and post‐course. In addition, a comparison group of 23 matched counselling students was obtained from an existing data source in order to make further assessments of the course's effectiveness. Those in the comparison group were not enrolled in the LGBT course, but were administered the SOCCS at analogous time intervals. Results: After completing the LGBT course, enrolled students demonstrated significant improvements regarding their sexual orientation counsellor competency and self‐efficacy. In addition, these students showed significant gains in SOCCS scores versus those in the comparison group. Implications: Results from this study show the positive effect a full‐credit LGBT psychotherapy course can have on graduate counselling students' sexual orientation counsellor competency and self‐efficacy. The findings also indicate that such a course can significantly impact counselling skills, a facet of LGBT cultural competency found to be the most attenuated. Findings are discussed in conjunction with LGBT‐affirmative counsellor training and clinical practice.     

Internationalizing counselling: A Southeast Asian perspective

To learn about our Southeast Asian colleagues’ views on internationalizing counselling psychology to Asian cultures, we interviewed eight counselling psychologists who had received their doctoral training in the United States. Four of the participants were currently practicing and teaching in their native countries and four in the United States. Using the basic principles of Grounded Theory [Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. Chicago, IL: Aldine.], we derived two themes from the data: (1) major assumptions in US counselling psychology that may limit its transferability to Southeast Asian cultures and (2) practices in learning, training, and cultural adjusting for future development and internationalization of counselling psychology. The participants emphasized the need for indigenization and knowledge sharing in the efforts to internationalize counselling psychology.     

The therapeutic effect of peace counselling among Nigerian secondary school teachers

This study examines the therapeutic effect of peace counselling among Nigerian secondary school teachers. 450 Nigerian secondary school teachers voluntarily participated in this study; 225 teachers (103 male and122 female) were used as control group while 225 teachers (103 male and 122 female) were exposed to peace counselling. Those in the treatment group participated in smaller groups made up of 25 teachers each. The teachers in the control group were also given peace counselling after the completion of the study. Two research questions were raised to guide the direction of the study. Teaching related Element of Peace Disturbance Scale (TEPDS) was used as the research instrument to collect pre‐ and post treatment data. Analysis of covariance was employed in the data analysis. The results showed that a significant difference existed between the control and the treatment groups with the latter ascertaining a higher degree of peace than the former. Also a significant difference was recorded between the male and female teachers who were exposed to peace counselling in their expressed peace level. Implications for peace counselling among all teachers functioning at all levels of education and their students were discussed.     

Examining patients' and other group members' agreement about their alliance to the group as a whole and changes in patient symptoms using response surface analysis

There is a lack of research examining patients' and other group members' agreement about their therapeutic alliance. In the present study, the person-group (P-G) fit model was adopted to predict that the group member symptom reduction will be greater when the group member's and the other group members' perceptions of their alliance to the group-as-a-whole fit and are high. In addition, the effect of disagreement between the group member and the other group members in their perceptions of the group alliance on the individual's outcome was investigated by using response surface analysis. Thirty-two patients from 5 long-term (> 1 year) psychodynamic group treatments were studied. Participants filled out the California Psychotherapy Alliance Scale-Group (CALPAS-G; Gaston & Marmar, 1993) and the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) monthly over the course of group treatment until termination. As hypothesized, patient's symptom reduction was greater when there was agreement between the group member and the other group members that their alliance to the group as a whole was strong. Contrary to the authors' hypothesis, a lack agreement on alliance to the group as a whole between the patient and the other group members was not related to less symptom reduction, as lack of fit increased, symptom reduction decreased. Also contrary to the authors' hypothesis, when other group members saw their alliance to the group as a whole as stronger than did the patient, there was increased symptom reduction. The findings suggest that the P-G fit model may be a useful strategy to examine group process variables in the psychotherapy context.     

Kosteneffektivität ambulanter Psychotherapie

Background

There is a lack of cost-effectiveness analyses (CEA) of psychotherapeutic treatments.

Material and methods

Cost-effectiveness analysis was applied to a sub-sample of 122 psychotherapy outpatients who participated in a large longitudinal study on outpatient psychotherapy (TRANS-OP study). Participants received either psychodynamic psychotherapy (PD, n=69) or cognitive behavioral therapy (CBT, n=53). Effectiveness (change in symptomatic impairment over 2 years) was assessed via the German version of the Outcome Questionnaire (OQ-45.2). Direct health care costs during a 2-year period (psychotherapy and other health care utilizations) were obtained from health insurance claims. Cost-effectiveness analysis methods included incremental cost-effectiveness ratios (ICER) and the net benefit regression approach.

Results

Cost-effectiveness analyses showed no significant differences between the two treatments, neither head-to-head, nor with regard to advantages in certain subgroups of psychotherapy outpatients. A slight dominance of CBT in costs was not maintained after controlling for covariates.

Conclusion

Provided that pivotal covariates such as treatment need are taken into account, cost-effectiveness analyses can contribute to a more equitable distribution of psychotherapeutic resources.     

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.     

Overcoming Negative Aspects of Perfectionism through Group Treatment

The tendency to hold and pursue excessively high standards for oneself and for others can interfere with academic achievement. Counsellors who work in university settings are often presented with students whose capabilities do not reflect their levels of achievement. This study reports on the evaluation of an eight-week group intervention designed to help university students shift from negative and often debilitating perfectionism to positive and enhancing perfectionism. The group treatment focused on changing attitudes, beliefs, feelings, and interpersonal interactions affected by perfectionism using combined cognitive-behavioral and interpersonal approaches. Standardized measures, including the Beck Depression Inventory (Beck et al., BDI-II manual. San Antonio: The Psychological Corporation, 1996), the Beck Anxiety Inventory (Beck and Steer, Beck Anxiety Inventory: Manual. San Antonio: The Psychological Corporation, 1993), and the Multidimensional Perfectionism Scale (Hewitt and Flett, Journal of Personality & Social Psychology, 60, 456–470, 1991a), provided data for pre- and post analysis of a treatment group (n = 30), and comparison groups of students attending group programs on career planning (n = 30) and attending psychology classes (n = 30). Results show that students participating in the treatment group significantly reduced their levels of depression, anxiety, and perfectionism in comparison to students who did not attend the treatment program. Implications of the findings suggest the importance of considering perfectionism on a continuum of negative and positive influences while helping students to address the intrapersonal and interpersonal dimensions of perfectionism.     

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.     

Measuring psychotherapy outcomes in routine practice: Examining Slovak versions of three commonly used outcome instruments

This study examined the Slovak mutations of three outcome measures for routine practice i.e. the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), the Outcome Questionnaire – 45 (OQ-45), the Outcome Rating Scale (ORS), and one control measure the Symptom Checklist 10 Revised (SCL-10R), with regard to their concordance or differences in outcome classification of pre-post change, when used by the same patients and when the criteria used for establishing recovery and improvement status are based on the same sample. Method: Non-clinical (252) and clinical (202) samples were used for the standardisation of all instruments. A portion of the clinical participants (N?=?140) completed all measures at the end of their treatment. Results: The CORE-OM, and the SCL-10R indicated a higher number of recovered and improved clients. With regard to the pre-post differences as expressed in the effect size, the CORE-OM showed the highest pre-post difference (pre-post effect size .98), followed by the ORS (.87), the SCL-10R (.83) and finally with the OQ-45 (.69). Conclusion: Even very similar instruments developed on the basis of similar theoretical conceptualisations and empirical findings may report different pre-post outcomes.     

Formative evaluation of the transition to postgraduate study for counselling and psychotherapy training: Students' perceptions of assignments and academic writing

Background: Transition to postgraduate study has received little attention and it is often assumed that little adjustment is needed. Focus: This article focuses on the academic writing aspect of the transition to postgraduate study for counselling and psychotherapy students on a British Association for Counselling and Psychotherapy (BACP)‐accredited course. Method: A two‐year formative evaluation was used to elicit students' views on how they experienced the transition to postgraduate study, and to identify what was most and least helpful to students in managing this transition. Results: The findings showed that there was a significant transition, which 63% of students found difficult. Timetabled and integrated, subject specific, academic support is recommended to assist students with their learning needs.     

Predictors of university students’ willingness in the USA to use clergy as sources of skilled help

This exploratory study investigated U.S. university students’ perceptions (N = 186) and the predictor variables associated with their willingness to use clergy as a source of help. In the final regression analysis using the predicted variable of willingness to use clergy as a source of help (R = 0.816, R ²= 0.665, Adjusted R ²= 0.650), there were seven significant predictor variables: (a) trust of clergy, (b) empathic ability of clergy, (c) having previously sought help from clergy, (d) respondents’ dominant/minority cultural identification, (e) attendance at religious services at least once a year, (f) believing that spiritual counselling is as effective as psychotherapy, and (g) receiving religious/spiritual education as a child. An eighth variable was retained in the final regression model because of its proximity to significance (Friendships between clergy and people, p = 0.051). Accusations against clergy and the belief that clergy are held to a higher standard did not predict willingness to use clergy as a source of help. A general linear model (F = 125.696, df = 10, p < 0.001) revealed that those who self-identified with Protestant Christianity, Catholic/Orthodox Christianity, and Judaism were more likely to consider seeking help from clergy than those who self-identified with another religious tradition (Hinduism, Islam, or Buddhism), or adherence to spiritual not religious belief. Further, those who self-identified as Jewish or Christian were also more like to perceive clergy as trustworthy and empathic. Finally, African American/Caribbean Black respondents were more likely than either Latino/Latino American respondents or European American respondents to seek help from clergy, to perceive clergy as empathic, and to believe that spiritual counselling is as effective as psychotherapy (F = 1495, df = 12, p < 0.001).     

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.     

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.     

Exploring Associations Between Therapy Factors and Post-therapy Development After Naturalistic Psychotherapies

Earlier research on what contributes to long-term outcome after psychotherapy is scarce and scattered. Responding to this, the current study explores potential associations between therapy factors reported as salient by clients in naturalistic psychotherapy and variation in post-therapy-movement. Material from different codes and categories derived from an earlier content analysis was explored in relation to post-therapy-changes on OQ-45. In the first part of the study, two overarching themes (relational aspects and therapeutic operations) were included in a regression analysis of data from 32 clients. In the second part, more nuanced associations between material from different change- or process categories and post-therapy-movement were explored using data from 20 clients that showed reliable improvement at treatment termination but varied in later development. Reports of material related to relational aspects were recurrently associated with post-therapy improvement. Material suggesting that therapy was experienced as not fully complete (e.g., changes being superficial or wish for more treatment), as well as reports of more positive affect, correlated with later deterioration after improvement at termination. Different processes and changes appreciated by clients during therapy seem to vary as predictors of lasting gains.     

Pragmatic Psychodynamic Psychotherapy—Bridging Contemporary Psychoanalytic Clinical Practice and Evidence-Based Psychodynamic Practice

Pragmatic psychodynamic psychotherapy (PPP; Summers & Barber, 2009 Barber, J. P. 2009. Toward a working through of some core conflicts in psychotherapy research. Psychother. Res, 19(1): 1–12. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) describes the therapeutic principles and approaches found in many forms of manualized psychodynamic psychotherapies, which are being used in research studies with the aim of building an evidence-based psychodynamic practice. This article focuses on one such treatment, Supportive-expressive psychotherapy (SEP; Luborsky 1984), which employs the Core Conflictual Relationship Theme (CCRT) method to formulate core interpersonal problems and treatment goals and identify therapeutic interventions. To illustrate SEP, we describe the 40-session treatment of a patient who met diagnostic criteria for several personality disorders. The case illustrates how complex ego-syntonic character pathology is expressed in CCRT terms and worked through in the transference, gradually becoming ego-dystonic and amenable to modification. In this case, the patient became more aware of his interpersonal wishes and vulnerability. Although his anxiety increased somewhat, he had an improvement in psychosocial functioning.     

The Treatment of the Young Delinquent by J. Arthur Hoyles

On the rationale that group psychotherapy focuses on interaction processes in close relationships, our study sought to investigate the hypothesis that small group therapy would be effective in enhancing intimate friendship in a dyadic relationship. The study group consisted of 102 elementary school students who had been referred for counseling help. Matched by age, sex, and similarity of problem, each pair of students was divided into an experimental group (N = 55) and a control group (N = 47). The experimental group contained eight small treatment groups and the control group contained seven matching small groups, leaving one special education group with no control. The results support our hypothesis that group psychotherapy positively affects intimate friendship of girls and boys. They further suggest the boys' need for such an experience, since without it they markedly deteriorate in intimate friendship. Implications for the group leader are derived from the correlations between gains in intimate friendship and group intimacy.     

Counselling in the workplace: How time‐limited counselling can effect change in well‐being

Background: Many employers provide counselling support on work and personal issues for their employees, but in times of economic pressure such services can be at risk if their effectiveness is not demonstrated. Aim: To evaluate whether time‐limited counselling in a workplace can effect sustained change in well‐being. Method: The study was carried out by a staff counselling team in a university setting. The Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS) was completed by clients at the beginning and end of counselling, and at three and six months following. A non‐treatment comparison group completed the survey at the same intervals. Results: The results of our investigation show clearly that the effect of time‐limited counselling (average seven sessions) on distressed clients is positive. The evidence of our treatment group suggests that they acquire an increased sense of well‐being as a result of the experience of counselling with a significant statistical difference between pre‐and post‐counselling treatment group scores on the WEMWBS and consistently higher scores found post counselling. The improvement was maintained at the same level for at least six months following the end of counselling. Conclusions: The provision of time‐limited counselling by employers is an effective support for personal difficulties affecting work.     

Psychological Distress in Australian Clients Seeking Family and Relationship Counselling and Mediation Services

There is little published data on the prevalence of psychological distress among individuals and couples seeking counselling and mediation services from non‐government organisations (NGOs). This national cross‐sectional study establishes the prevalence of psychological distress among clients seeking family and relationship counselling and mediation services from Relationships Australia. A national sample of 1,365 clients attending services in April to May 2012 completed the 10‐item Kessler Psychological Distress Scale (K10) after their first counselling or mediation session. Individual counselling (M = 23.01, SD = 8.97, 95% CI [22.05–23.97]) and couple counselling (M = 21.63, SD = 8.10, [20.86–22.41]) clients reported a mean K10 score comparable to those reported by clinical studies of clients with anxiety or affective disorders. One quarter to one fifth of these clients reported very high psychological distress. Clients accessing mediation services had a mean score of 18.13 (SD = 7.76; [17.51–18.75]), and one tenth of clients reported very high distress. These elevated rates of very high psychological distress suggest that mental health issues may be a significant problem for a large proportion of clients accessing counselling and mediation NGO services provided under Family Support Programs (FSP) funding. Implications for screening for mental health and appropriate treatment planning are discussed.