Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Effect of schizotypy on responding maintained by free-operant schedules of reinforcement

Deviations from otherwise reliable patterns of responding in human performance on schedules of reinforcement could be associated with personality characteristics, such as psychometrically-measured schizotypy. The present study examined differences between high and low scorers on four schizotypy subscales (unusual experiences, cognitive disorganisation, introvertive anhedonia and impulsive non-conformity) on a random-ratio (RR) and random-interval (RI) schedule of reinforcement. Results showed a higher rate of responding on the RR than RI schedule, consistent with the differences in performance normally observed between these schedules. However, these differences were dependant on whether or not participants scored high or low on the schizotypy subscales, as well as the specific schedule parameters between the schedules. Specifically, high scorers on the unusual experiences (UE) subscale of the O-LIFE(B) were the only group in Experiment 1 not to show a difference in schedule performance, suggesting high scores on this subscale are linked to altered RR and RI performance. Experiment 2 explored this finding further using different schedule parameters, and confirmed that high scorers in UE did not differ in response rates between the two schedules.     

Prevalence of pathological Internet use among university students and correlations with self-esteem, the General Health Questionnaire (GHQ), and disinhibition.

Over the last few years, there has been increased interest in the addictive potential of the Internet. The current study was an attempt to replicate common findings in the literature and provide more evidence for the existence of Internet addiction among students--a population considered to be especially vulnerable. A total of 371 British students responded to the questionnaire, which included the Pathological Internet Use (PIU) scale, the General Health Questionnaire (GHQ-12), a self-esteem scale, and two measures of disinhibition. Results showed that 18.3% of the sample were considered to be pathological Internet users, whose excessive use of the Internet was causing academic, social, and interpersonal problems. Other results showed that pathological Internet users had lower self-esteem and were more socially disinhibited. However, there was no significant difference in GHQ scores. These results are discussed in relation to the methodological shortcomings of research in the area as a whole.     

Justice Beyond Borders

Liberal theories of social justicefocus predominantly on the national, ratherthan international, level, and where they doaddress international concerns they insist thatprinciples of justice at the national levelhave priority over principles at theinternational level. We question the coherenceof this arrangement, given liberal theory'scommitment to moral equality of persons as suchrather than to that of particular sets of persons. What isat issue is whether liberal theory can providea coherent basis for international justice atall. If it is to do so, we suggest that it mustbe prepared to theorise beyond the nationstate, and to take a historical perspectivewhich takes into account the ways in whichcolonial power and exploitation have given riseto the problems of international justice weface today. This revised version was published online in July 2006 with corrections to the Cover Date.     

Previous mindfulness experience interacts with brief mindfulness induction when reducing stimulus overselectivity

The current study examined the effects of a brief mindfulness induction on overselectivity. Participants were randomly assigned to a mindfulness, unfocused attention (relaxation), or no‐intervention group. Participants experienced their designated intervention for 10 min, and they underwent simultaneous discrimination training (AB+ CD?) followed by an extinction test (AvC, AvD, BvC, and BvD). Levels of mindfulness were measured by the Toronto Mindfulness Scale, and participants were asked about their previous experience with mediation and mindfulness practice. Mindfulness reduced overselectivity, and previous levels of mindfulness experience identified by a single question moderated this effect, with mindful‐experienced participants showing less overselectivity. Both findings have some practical utility in the ongoing investigation of the possible use of mindfulness in medical settings.     

Use of a reference group in researching children’s views of psychotherapy in Malta

This paper explores the process and outcomes of a children’s reference group within the context of child psychotherapy research in residential care. The reference group was set up to consult children about the design of a research project which seeks to evoke, represent and understand children’s views of psychotherapy. No work to date has explored the experience of reference groups in the context of child psychotherapy in residential care in Malta. The paper contextualises the research within the literature on reference groups in child research, which identifies the potential of reference groups as a participative and co-reflexive activity which can inform research design. The paper critically examines the nature and conduct of the reference group by acknowledging the specific context of this work rather than assuming this is necessarily positive. It does so by specifying and evaluating the outcomes of the reference group in line with its aims. The paper draws on the recordings of the reference group meetings and reference group field notes taken by the researcher as key data which were thematically analysed. The main outcomes of the reference group include children’s contribution to the design of data collection methods especially in terms of not relying only on words during data collection. Children also identified key ethical issues from the point of view of young psychotherapy service users, especially in relation to issues of trust within a residential care context. Children also reviewed and appraised research information material. The reference group process drew from the researcher’s and participants’ contexts and contributed significantly to the researcher’s reflexive process especially in terms of acknowledging his power and positioning as an adult and his dual role as a practitioner/researcher.     

Promoting psychoanalytic understanding in the core professions: The case against establishing a new profession of adult psychotherapist

Currently there is much enthusiastic talk about the possibility of establishing a new National Health Service profession of Adult Psychotherapist. This paper questions the assumption that such a development would be rational and advantageous. Four main points are discussed here: there are problems arising from training in a uni-dimensional context when returning to work in amulti-dimensional context; there are dangers in taking a method-oriented stance rather than one which is service-oriented; there is something peculiar about the notion of a profession based on a single method or mode of treatment; one of the most important contributions of psychoanalysis to the core professions is the creation of an analytic space for thinking.     

The NICE guidelines are misleading,unscientific, and potentially impede good psychological care and help

NICE guidelines have been given the authority to determine what psychological therapies can be provided within the UK National Health Service. This also has implications for private practice. The guidelines are based on a medical model and consider psychotherapy as analogous to a drug. Psychological thinking is discouraged by this approach. A large amount of psychotherapy research evidence is ignored by NICE, particularly the persistent finding that differences in effectiveness between therapies are minimal and elusive. Differences between the skills of therapists are a more significant factor. Practice-based evidence, and learning from the patient's feedback (both conscious and unconscious) may be a better approach. For most forms of psychological distress, none of the main psychological therapies studied in randomized controlled trials can be considered to be clinically effective, even though they facilitate some degree of statistically significant change.     

From research to practice: The first tentative steps

This article traces the history of the Somerset Spirituality Project as it moved from the research findings of Foskett et al. (2003) and Macmin and Foskett (2003) to the application of their findings in practice. It summarizes the results of the research, the attempts to publicize these and to promote better practice within the mental health services and local religious groups. It records the developments already undertaken or planned, the resistance to these encountered along the way and the sacrifices made by those most intimately involved. This is set within a Christian Liberation Theology's analysis of social and political systems, its bias to the poor and their understanding of the human drive to health of mind and soul.     

Rats' Memory for Serially Presented Novel Flavours: Evidence for Non-spatial Primacy Effects

Four experiments examined the effects of serially presenting a number of novel flavours to rats on their subsequent consumption of those flavours. In Experiments 1-4, rats were orally infused with 0.5 ml of flavour over 30 sec for each of five flavours in the exposure phase of the experiment. In these studies, primacy and recency effects emerged, the size of the primacy effect being related to the length of the retention interval, which varied from zero to twenty-four hours. Thus, both primacy and recency effects can be generated using nonspatial stimuli with rats.