SETTING UP A COUNSELLING SERVICE FOR PARENTS,INFANTS AND YOUNG CHILDREN

In this paper a brief model of working psychotherapeutically with children under 5 years of age and parents is explored. The psychoanalytic principles that guide the work are looked at and the practical aspects of setting up a service within NHS clinics is considered. The authors trace the history of this model, its aims, technique and the use of telephone counselling for parents. They discuss referrals, the setting, the structure and content of this counselling using clinical vignettes.     

Posttraumatic growth in trauma survivors: Implications for practice

The study of positive sequelae to trauma is increasingly a focus of attention in the trauma research literature. This paper describes the construct of posttraumatic growth, a phenomenon that involves positive changes and benefits gained through coping with traumatic experiences. Variables associated with posttraumatic growth are summarized. Specific interventions for counselling psychology practice are described.     

Counselling in a Hospital setting: An introduction to the care project

Various research projects have investigated the efficacy of counselling in medical settings. To date, there is no conclusive proof that counselling is an effective form of therapy. But previous research projects have often been limited in scope and design, and have not represented an appropriate means of making an accurate assessment. The study introduced here seeks to establish whether or not group counselling is a therapy for patients suffering from rheumatoid arthritis. The research aims to use the most effective elements of both scientific and new-paradigm methodologies to determine whether atherapeutic relationship exists. The paper outlines the background to the research and describes its development so far.     

Genograms in counselling practice: A review (Part 1)

Genograms are an important clinical tool for many counsellor, therapists and other health care professionals and can be used for assessment, gathering information on family relationships and exploring themes in counselling practice. This article reviews the recent literature on genograms and examines the efficacy and use of this tool from a number of perspectives including the use of genograms in health care, psychological counselling and in genetic counselling. The predictive value, and future development of the use of the genogram in counselling are also discussed.     

Pilot randomised controlled trial of counselling in a community mental health setting: Pitfalls and learnings

The establishment of counselling and psychotherapy as “evidence‐based” interventions is contingent on the effective implementation of randomised controlled trials (RCTs) in real‐world clinical settings. This paper identifies some of the pitfalls that led to the termination of a practical RCT in a community mental health setting. It reflects upon the significance of the lessons learned by drawing on similar challenges that are documented in the wider literature. Issues surrounding staff turnover, counsellor engagement and procedural clarity are discussed, as is the conflict between the time required for research procedures and counsellors’ clinical time constraints. In our recommendations, we recognise the decisive role of collaboration and counsellor motivation in research partnerships, and the significance of clinical relevance, communication, training and research co‐production in achieving them. Time commitment is identified as the pivotal challenge in the formation and maintenance of collaborative research, but one that also must be overcome for the advancement of the counselling and psychotherapy field.     

Reflexive action research: Developing knowledge through practice

This paper gives an overview of different ways of conducting counselling and psychotherapy research. An approach to research is described which overcomes the research‐practice gap: reflexive action research. It is argued that this approach to research is particularly appropriate and relevant for practitioners since it draws upon skills and awareness necessary for clinical work, and can complement positivist methods of research which are already well established in the profession. The wider use of systematic clinical case studies is suggested as a means of promoting the reflexive action research approach. Further consideration of issues of validity and reliability is required on the part of those intending to apply this approach within the field of therapy research.     

Lesbian Youth Support Information Service (LYSIS): Developing a Distance Support Agency for Young Lesbians

The Lesbian Youth Support Information Service (LYSIS) was established in 1991 as a result of research conducted into the needs and experiences of young lesbians. This research found that young lesbians are vulnerable to mental health problems, including depression, attempted suicide, self-harming behaviours and alcohol misuse, as well as isolation and social rejection. There were also strong indications that young lesbians are most vulnerable when they are coming to terms with their sexual orientation. LYSIS offers support to young lesbians in four main ways: correspondence counselling; telephone counselling; peer support; and information. LYSIS is part of an umbrella organization, the Lesbian Information Service (LIS), which provides indirect support for young lesbians including publishing, education and training, projects and campaigning.     

Telephone counsellors' conceptualising abilities and counselling skills

Telephone counsellors must make accurate assessments of callers' needs so as to provide appropriate counselling help or referral. But few researchers have examined counsellors' conceptualising abilities in relation to their counselling skill. Two studies involving telephone counsellors were carried out. The first relied on counsellors' post-interview conceptualisations of callers' problems and needs and found no link between the accuracy of these conceptualisations and counselling skill. The second used Kagan's Interpersonal Process Recall (IPR) to retrieve counsellors' conceptualisations made during the course of their interviews. The accuracy of these conceptualisations-in-action was related to level of counselling skill. Implications for training and research are discussed     

Some ethical dilemmas in counselling and counselling research

This paper raises a number of dilemmas in relation to the ethical practice of counselling, counsellor training and research and evaluation of counselling which reflect the author's increasing concerns about therapeutic ethics. A number of relevant issues are explored to develop awareness and understanding of ethical matters, though this is in the spirit of exploration and inquiry rather than having definitive answers to offer. These issues include: use of training videos of therapists with real clients; informed consent; how research and evaluation changes the therapeutic process; how sensitive and ongoing consent for counselling and counselling research could be best obtained; publication of research in ways that respect the research participant; and the value and implications of the new British Association for Counselling and Psychotherapy ethical framework. Finally, the concept of 'ethical mindfulness' is considered as a creative, if demanding, response to a concern to be ethical in research and practice.     

Representing narrative process in therapy: Qualitative analysis of a single case

In recent years, there has been increasing interest in an approach which views counselling and psychotherapy as being concerned with giving clients opportunities to articulate, examine and re-author aspects of their life-stories. However, most of the literature associated with this approach has been based on observations of clinical practice, and there is a need to develop more systematic research in this area. The present study uses qualitative methods to identify and categorize different types of narrative events occurring in therapy discourse. A representation is offered of the process by which experience is narrativized during therapy. The data for this analysis is drawn from an intensive study of one session of person-centred counselling. The issues involved in applying this method of qualitative analysis are discussed, and the implications of these findings for research and practice are outlined.     

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.     

‘A preparation for practice?’ Students experiences of counselling training within departments of higher education

The literature has identified a gap between the education and practice in the education and training for the practice based professions based within traditional Departments of Higher Education. In the education and training in counselling it is suggested that this gap is primarily between those who view practice as the rigorous application of formal ‘science’ and those who see it as more holistically embedded in ‘tacit knowledge’ and artistry of the practitioner. This paper reports on a small scale qualitative study (Scanlon, 1993) which investigated the experience of students undertaking Counsellor training courses within Departments of Higher Education. Analysis of interview data revealed three main categories of concern. The first categoy describes the adverse effects of the theory-practice gap on the students. The second catego y describes the importance of clinical supervision in acquiring practice skills and the third catego y describes the participants' concerns about the quality of outcome for such training, particularly in relation to the perceived lack of ngour in the assessment of clinical competence. In the light of these findings a number of suggestions about how the professional education and training of counsellors could be better integrated into a more ‘practice led’ curriculum model are discussed.     

Evaluation of counselling in primary care: How can research be made more useful for practitioners?

The paper presents a literature review of research on counselling in general practice critiqued from the perspective of the Practice Counsellor. It is noted that existing studies all focus primarily on outcome of psychological interventions in comparison to routine GP care. The contributions and limitations of these studies are discussed, and the methodological difficulties of conducting controlled trials in this context are explored. It is proposed that future research on counselling in primary care needs to draw on the paradigm shift in psychotherapy and a range of alternative research methodologies which will be more likely to produce research of relevance to Practice Counsellors.     

Telephone counselling for adolescent suicide prevention: changes in suicidality and mental state from beginning to end of a counselling session

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact. Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.     

The client as expert: Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.     

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 in primary care: a review of the practice evidence

This paper describes the level of mental health problems that are encountered in primary health care. The limitations of using randomised control trials (RCTs) in evaluating effectiveness of psychological therapies in primary health care are described. Although the RCT may be useful in evaluating interventions in highly controlled situations, its use in evaluating clinically representative service delivery research is limited. A three-stage model of psychological therapies research is described to show that distinct stages require different methodologies in order to evaluate them, and this model is used to structure the review. The literature on research carried out in more naturalistic circumstances is then reviewed. Evaluating psychological interventions in this way shows there is considerable evidence that psychological therapies are effective in a number of ways in a primary care setting. The naturalistic studies that are more typical of clinical practice support the use of psychological interventions. The theme of the grey literature is almost entirely positive from the point-of-view of patients and GPs alike. However, there is considerable diversity in the sophistication of the methodology of the latter studies. Some were comprehensive evaluations, while others were more akin to audit. A major shortcoming is that few described their qualitative methodology. This said, the themes arising from the reports are very consistent and, had they been supported by a more robust qualitative methodology, would have added even more support, financially and clinically, for the arguments for counselling provision in primary health care. The level of referred clients' distress, measured by a variety of measures, was shown to be moderate to severe and similar to the level of patients referred to Community Mental Health Teams (CMHTs). When they were measured, there was a considerable reduction in subsequent psychiatric symptoms.     

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.