Inter-professional learning: initial observations of the art psychotherapy tools used in the post-qualifying postgraduate training in counselling children and young people

ABSTRACT

Children and young people (C&YP) counselling training and art psychotherapy training lead to two distinctive psychological therapy approaches; one is informed by British Association for Counselling and Psychotherapy’s Competences for work with children and young people (4–18 years) [BACP. (2019a). Competences for work with children and young people (4–18 years). Retrieved from https://www.bacp.co.uk/media/5863/bacp-cyp-competence-framework.pdf], the other by Health and Care Professions Council’s Standards of Proficiency for Arts Therapists [HCPC. (2013). Standards of proficiency - Arts therapists. Retrieved from http://www.hpc-uk.org/publications/index.asp?id=39#publicationSearchResults]. In this article we outline the training methods utilised on the Postgraduate Diploma in Counselling C&YP at a British University and share initial observations of how creative and arts-based therapeutic tools form an important part of the curriculum delivery. The aim of this paper is also to outline the role of intentionality application in the use of creative interventions in therapeutic practice.     

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.     

Counselling marginalised young people: A qualitative analysis of young homeless people's views of counselling

Aims: This study explored young homeless people's views of counselling, with a view to considering how the counselling profession can better meet their needs. Method: A small scale qualitative research project was undertaken in two residential projects for young homeless people. Data was gathered through focus groups and then analysed using grounded theory. Findings: The study revealed a lack of trust in counsellors and counselling, as well as a dislike of the counselling process. Implications for practice: Some suggestions for how best to work with this particularly marginalised client group are discussed. These include ways of making counselling more engaging, raising the profile of the counsellor in the young person's environment and having an awareness of the needs specific to at‐risk young people.     

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.     

Reliability and validity of an auditing tool for person-centred psychotherapy and counselling for young people: The PCEPS-YP

The present study aimed to test the reliability and validity of the Person Centred and Experiential Psychotherapy Scale–Young Person version (PCEPS-YP). This is a newly developed and adapted 9-item scale which aims to measure counsellor competences in, and adherence to, person-centred practice, when working with adolescents. Counselling practice was assessed for 19 counsellors by randomly selecting 20-min audio segments from 142 recorded counselling sessions. Audio material was independently rated by eight raters using the PCEPS-YP to produce an average adherence rating per counsellor. Scale reliability was assessed via interrater reliability and internal consistency testing. Convergent validity was tested using ratings from the observer-rated Barrett-Leonard Relationship Inventory (BLRI Obs 40), and the scale was subjected to exploratory factor analysis. Results showed a high degree of internal consistency within raters (α = 0.95), marginally acceptable reliability across grouped raters (α = 0.58) and weaker reliability between pairs of raters (α = 0.50). Exploratory factor analysis revealed one strong factor for the scale with no subscales. Small-to-moderate correlations existed between the PCEPS-YP and the BLRI subscales and mean total score (rs = .12 to .40). Our findings suggest that the PCEPS-YP has potential as an effective, reliable and valid tool for assessing competence and adherence in person-centred practice with young people, both for research and for clinical purposes. However, training procedures need to be established that can enhance interrater reliability, and more evidence of convergent validity is needed.     

A journey through languages: A systematic literature review on the multilingual experience in counselling and psychotherapy with children and adolescents

The purpose of this research was to address the gap in the existing literature on the multilingual aspect of language in psychotherapy with children and adolescents. This research aimed at interpreting possible meanings for clients of being multilingual in the therapeutic process as well as reflect on the influence of clients’ multilingualism in the therapeutic relationship. The researcher used a systematic literature review (PRISMA guidelines, 2009) to select articles based on empirical qualitative/mixed studies with participants up to 25 years old or adults referring to childhood/adolescence. The researcher used thematic synthesis (Thomas & Harden, 2008) to extract, analyse and interpret data. The rigour of this study was enhanced by the use of auto-ethnography as a source of evidence (McLeod, 2015). The auto-etnography documents self-reflections on personal experience of being multilingual contributing to deeper contextualised knowledge. The findings confirm previous research on the existence of a link between multilingualism and “identity” (Costa, 2020, p. 5). This research suggests that the meaning a client gives to bilingualism can be co-constructed within an attuned therapeutic relationship. In this co-construction journey, there is a significant opportunity for children and young people in finding their way through languages, hence reaching emancipation and affirmation in the world. The main limitation of this research relates to the fact that there are not many studies with children/young people. This led the researcher to also include studies based on a mixed sample and with adults referring to childhood/adolescence, which might have influenced the interpretation of findings.     

A thematic analysis of young people's experience of counselling in five secondary schools in the UK

Aim: To investigate young people's views on the effects of school‐based counselling, and what they found helpful and unhelpful. Method: Eleven semi‐structured interviews were conducted and thematically analysed. Findings: Participants expressed predominantly positive views of school‐based counselling with changes in three main domains: emotional, interpersonal and behavioural. Participants viewed these changes as having had an important effect on their lives. The most commonly cited helpful aspects of counselling were related to talking or getting things out, and counsellor qualities. Conclusions: School‐based counselling is viewed positively by those who have experienced it, and appears to be an appropriate and valuable intervention for young people.     

Facilitating the client's experience of relational depth in counselling and psychotherapy: A thematic review

Aim

There is increasing interest in relational depth and its relevance and benefits for clients receiving therapy in a number of different therapeutic orientations. This research set out to draw together the available evidence from a wide range of therapies about clients' experiences of relational depth. The aim was to identify approaches that create the conditions where relational depth is more likely to be facilitated. The research focused on clients' views, given the increasing emphasis on their experiences in therapy.

Methodology

A systematic search of papers published in English between January 1996 and September 2022 was conducted using EBSCO Host, Google Scholar and citation chaining. Twenty-seven papers met the inclusion criteria, and a thematic analysis was conducted on these papers.

Findings

Six themes were identified: (1) establishing dialogue with the client's inner world, (2) working with attachment in therapy, (3) responding sensitively to the client's beliefs and values, (4) deepening the client's understanding of the therapist, (5) addressing ruptures in therapy and (6) the client's role in meeting at relational depth.

Conclusion

Facilitating the client's experience of relational depth can support and enhance many aspects of therapeutic practice and in itself may contribute to healing. Therapists who offer warmth and genuine engagement are more able to build confidence and trust, as long as these conditions are received by their clients. It is the clients who ultimately decide whether or not to share their deepest feelings.     

An integrative review of the person-centred and experiential therapy literature on delivering individual video counselling and psychotherapy

Based on an integrative review of the relevant literature in and on person-centred and experiential (PCE) therapy, this study identifies and discusses the findings of 13 articles on the delivery of individual video counselling and psychotherapy. Six overarching themes were identified: the discrepancy of the experiences of clients and practitioners; the possibility of good-quality PCE therapy (psychotherapy and/or counselling); “doing” PCE therapy online; “being” online; the role of technology; and implications for training and practice. It is suggested that all these have implications for ongoing practice and education/training, and need to be considered by practitioners, educators/trainers, and professional bodies.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies

Scope of review: The paper reports a meta‐review of 15 previous systematic reviews and meta‐analyses of the literature concerning the outcome of counselling and psychotherapy with people at risk of suicide; a meta‐analysis of 67 outcome studies in this area; and a narrative review of 17 studies of the therapeutic process. Publication time span: The literature reviewed was published between 1981 and 2008. Publication origin: The majority of the literature reviewed was by authors from the USA or the UK, but there were also authors from other European countries, Australia, Canada, India, and Sri Lanka. Findings: There is evidence of the effectiveness of dialectical behaviour therapy, cognitive‐behavioural therapy, and problem solving therapy, but also for other forms of therapy. Therapist and client variables, as well as the therapeutic relationship, appear to be related to treatment outcome. Conclusions: People at risk of suicide should have access to psychological interventions, including, but not necessarily limited to, those within the cognitive‐behavioural spectrum. Therapies for which there have been promising findings, but which are under‐researched, should be a research priority.     

The impact of the socio-economic crisis on intrapsychic and intersubjective processes within the therapeutic relationship: Implications for the ethical practice of counselling psychology and psychotherapy

Using attachment and mentalisation theories as a framework, the present paper aims to explore the impact of the current socio-economic crisis on the micro-processes and interpersonal dynamics that emerge between client and therapist as well as the ethical dilemmas that surface within the context of the therapeutic relationship. The first part of the paper focuses on the intrapsychic level and the subjective appraisal and experience of the crisis, as this may differ from individual to individual as well as the unique meaning-making processes that take place for clients and therapists alike. It is argued that the socio-economic crisis itself cannot be seen as an entity that is entirely independent and external to the individual but as a phenomenon that interacts in unique ways with the individual’s inner current and past experience. The second part focuses on the exploration of intersubjective processes that emerge between client and therapist, in particular the transference-countertransference dynamic, as this develops within conditions of increased arousal and anxiety. The role and responsibility of counselling psychologists in preserving reflexivity, empathy and a mentalising stance (through supervision and personal therapy) are highlighted in order to safeguard the ethical and competent practice of counselling psychology.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Ethnicity and the therapeutic relationship: views of young people accessing cognitive behavioural therapy

Few studies have explored the views of black and minority ethnic (BME) adolescents engaging in cognitive behavioural therapy. This study aimed to examine BME adolescent service users' perceptions of how ethnicity featured in the therapeutic relationship and its relevance to their presenting difficulties. Interpretative phenomenological analysis was used to explore the experiences of five young people using an adolescent mental health service. Four interrelated themes emerged from the analysis and are considered in detail. The complexities of participants' views are discussed and recommendations are made for therapists as to how to enquire about, acknowledge and remain attuned to the client's ethnicity.