Beyond beliefs: Challenging obsessive thoughts and compulsive behaviours within a collaborative counselling relationship

Three clients with obsessive‐compulsive disorder were studied using a multiple case study approach. Clients' experiences of cognitive‐behavioural therapy, in particular the impact of having their beliefs challenged, and their responses to self‐monitoring tasks and behavioural experiments were investigated. Data included case notes made during therapy, pre‐ and post‐therapy questionnaires, and post‐therapy semi‐structured interviews. Qualitative analysis of the data identified clients' obsessive beliefs, general negative beliefs and meta‐cognitive beliefs, and explored any post‐therapy changes in these beliefs. The results demonstrated similarities between cases in obsessive beliefs (e.g. inflated responsibility for harm), general negative beliefs (e.g. feelings of failure), meta‐cognitive beliefs (e.g. the need to control thoughts) and affect (e.g. guilt). Questionnaire data from all three clients suggested no clinically significant post‐therapy changes in general negative beliefs and meta‐cognitive beliefs. However, idiosyncratic changes in obsessive beliefs were reported during therapy and at post‐therapy interview, and clients reported improved functioning and decreased levels of distress during therapy and at interview. Responses to challenge were uniformly positive, but reactions to self‐monitoring and behavioural experiments varied across cases. The implications of these findings for the treatment of obsessive‐compulsive disorder using cognitive behavioural techniques are discussed.     

An investigation into the client at the heart of therapy

This paper reports on an exploration of the experience of the client at the heart of therapy. A grounded theory analysis of clients' experiences of therapy provided through a voluntary sector counselling service was undertaken, and generated four main categories: permission, engagement, transparency and restructuring. The results of the study are presented in a way that hopefully retains much of the richness of what people have reported about their experience of counselling. The findings of the study are discussed in terms of the idea that counselling can provide a setting where people can have common therapeutic requirements met.     

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.     

The role of informal social support in needs assessment: proposal and application of a model to assess immigrants' needs in the south of Spain

Needs assessment models have been generally focused on the identification and prioritization of needs, analysing formal resources available in the community as possible solutions for existing problems. These kinds of models have assumed that formal services are the primary source of support for individuals in need. However, a great deal of the investigations in the field of Social Psychology have shown that the main source of help and support when facing a problem is not formal organizations, but people's own informal networks. In this article, we therefore propose a needs assessment model that emphasizes the importance of analysing both formal and informal social resources. The application of this model to assess Moroccan immigrants' needs in the south of Spain shows the anticipated low level of utilization of formal services and programmes, one that contrasts with the high use of informal networks as an essential source of social support for this group of immigrants. These results reveal the limitations of traditional needs assessment models, and the importance of incorporating the analysis of informal social support as a key resource for need satisfaction, particularly in the case of immigrant populations. Copyright © 2004 John Wiley & Sons, Ltd.     

Issues and Strategies for Studying Latino Student Dropout at the Local Level

Latino student dropout is a national concern that must also be addressed strategically in local communities. Although national studies are important for pointing out areas of concern, local studies can provide more specific information for local policy development and implementation. This paper presents an example of local community-initiated needs assessment that addresses issues of Latino access to education. Focus groups and interviews were held with Latino students, parents, and community leaders as well as teachers and administrators. Issues and strategies of the needs assessment process are presented, which include involving key stakeholders, engaging community members as research partners, and engaging school personnel. General findings are presented and linked to accomplishments of the needs assessment process, such as increasing community awareness of issues and building commitment to implement strategies identified to reduce Latino student dropout.     

咨访关系中的客观与主观

咨访关系是种特殊的、动态的、治疗性的人际关系,咨访双方互为主体.其间,咨访双方探求的"客观真实",因时空情境、历史文化、价值观念和个体经验不同而各异.建构主义认为真实是多元的,而在涉及心理现象,尤其是心理咨询与治疗的咨访互动的人际关系过程时,实证主义也显得力不从心,使咨访关系中的主观与客观成为很有争议、有价值的探讨点.     

Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

Basic psychological needs satisfaction,working alliance,and early termination in psychotherapy

The goal of this study was to evaluate the relationship between basic psychological needs satisfaction and working alliance in psychotherapy and to determine whether client ratings of basic needs and working alliance during psychotherapy were associated with early termination of therapy. Former psychotherapy clients (n = 87) completed a semi-structured interview regarding basic needs satisfaction in therapy, working alliance and dropout status. Participant ratings on the Basic Needs Satisfaction in Psychotherapy scale (BNSP) and the Retrospective Working Alliance Inventory – Short (RWAI-S) were significantly correlated (r = .77) in our sample. A comparison of intercorrelations between working alliance subscales and basic needs subscales indicated higher factorial distinctiveness within the basic needs measure. T-tests comparing those who terminated psychotherapy early with those who had planned endings on scores on the BNSP and RWAI-S were significant (Cohen’s d = .65 and 1.82, respectively). Results suggest that the basic needs measure might tap into a wider breadth of the therapist and client interaction than the RWAI-S.     

大学生目标内容与主观幸福感的关系：一个有调节的中介模型

基于自我决定理论考察了目标内容对主观幸福感的影响,以及基本心理需要、自尊在其中的作用。采用欲望指数量表、基本心理需要满足量表、自尊量表、正负情绪量表、生活满意度问卷对535名大学生进行了调查。结果显示：（1）目标内部性显著正向预测主观幸福感;（2）基本心理需要在目标内部性和主观幸福感之间起部分中介作用;（3）基本需要的中介作用受到自尊的调节。因此,目标内部性对主观幸福感的影响是一个有调节的中介效应。     

The experiences of therapists using a new client‐centred psychometric instrument,PSYCHLOPS (Psychological Outcome Profiles)

PSYCHLOPS (‘Psychological Outcome Profiles’) is a newly developed client‐generated psychometric instrument which can be used as an outcome measure. Uniquely, it asks clients to state their own problems, in their own words. As part of its validation, we used it alongside an existing measure, CORE‐OM (‘Clinical Outcomes Routine Evaluation – Outcome Measure’). Based on a qualitative methodology, we report here on the first‐hand experiences of four therapists using both instruments. The key themes that emerged from therapists’ responses were feasibility, validity and usefulness. Both questionnaires were perceived as complementing each other, the qualitative information from PSYCHLOPS balancing the quantitative information from CORE‐OM and that both could contribute to the therapist‐client interaction. The key features of PSYCHLOPS are likely to prove attractive to therapists and should increase acceptance and uptake of outcome measures.