Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.     

Working with suicidal clients: The person‐centred counsellor's experience and understanding of risk assessment

Background: Client risk assessment within the person‐centred paradigm is traditionally seen as squarely opposed to its ethos. Aim: To determine how the person‐centred counsellor experiences and understands the issue of risk assessment within the confines of their work ethos. Method: Semi‐structured interviews with seven person‐centred counsellors using thematic analysis were conducted. Findings: Three main themes emerged following thematic analysis: The impact of the risk assessment process on self; The counsellor's experience of self, and The therapeutic process in relation to risk assessment. Discussion: The findings suggest that person‐centred counsellors conduct risk assessments taking a holistic approach involving not only individual risk predictors and characteristics of the client but also individual factors related to self.     

家庭近乎完美量表中文版的信效度分析

在大学生群体中选取三个样本进行集体施测。选取500名大学生作为样本一,使用家庭近乎完美量表中文版、自尊量表、一般自我效能感量表和Beck抑郁问卷对其施测,对数据进行验证性因素分析、内部一致性信度分析和效标效度分析;六周后在样本一中随机抽取71名大学生作为样本二,使用家庭近乎完美量表对其施测,对数据进行重测信度分析;另选取500名大学生作为样本三,使用家庭近乎完美量表中文版、近乎完美量表修订版的中文修订版和Frost多维完美主义量表对其施测,对数据进行聚合效度和区分效度分析。结果表明,家庭近乎完美量表中文版     

儿童期虐待对大学生公正世界信念的影响:有调节的中介模型

为探讨儿童期虐待对公正世界信念的作用及心理机制,本研究采用问卷法对929名大学生进行了调查,并采用潜变量模型对数据进行了分析。结果发现:(1)儿童期虐待显著负向预测大学生公正世界信念;(2)控制感在儿童期虐待与公正世界信念之间起完全中介作用;(3)家庭社会经济地位调节了儿童期虐待与控制感的关系,高家庭社会经济地位放大了儿童期虐待与控制感间的负相关。研究结果表明,可以通过预防儿童虐待和增强控制感等干预措施来提升公正世界信念,并且需要对高社会经济地位家庭的儿童虐待加大关注。     

The Relationship Between Neuropsychological Functioning and Mental Health Outcomes of Chronic Alcohol Users Involved in Counselling: Prediction of Treatment Outcome

This study examined the neuropsychological profile, mental health outcomes, and coping strategies of chronic alcohol users involved in drug and alcohol counselling and investigated whether these factors could predict treatment outcome. The findings indicated that as compared with controls, chronic alcohol users demonstrated significant deficits in visuospatial, memory and executive functioning, and a higher level of emotional distress. At a 3‐month follow‐up, memory ability was found to significantly predict the percentage of goals achieved in counselling, the likelihood of dropout from therapy, and the likelihood of remaining abstinent. The value of further research into the influence of additional factors, such as executive functioning, mood, and coping strategies, on treatment outcomes in a larger sample was also supported.     

The application of a domains‐based analysis to family processes: implications for assessment and therapy

Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action. We describe the features of three domains of family life – safety, attachment and discipline/expectation – and contrast them with exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction. We argue that everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain. However, sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in the same domain (there is a domain mismatch). This may result in misunderstandings, irresolvable arguments or distress. We describe how it is possible to identify domains and judge whether they are clear and unclear, and matched and mismatched, in observed family interactions and in accounts of family processes. This then provides a focus for treatment and helps to define criteria for evaluating outcomes.     

Family crisis intervention in war contexts: a case study of a traumatised Palestinian family

The aim of this study was to analyse the phases of an innovative in vivo exposure intervention in which all family members were present at the scene of a traumatic incident. Clinical practice has borne out the efficacy of family intervention and its benefits for traumatised individuals and family groups. The intervention discussed here was conducted with a Palestinian family that had suffered trauma in a missile attack during the Israeli–Lebanese war of summer 2006. Narrative and meaning-reconstruction methods were combined with cognitive-behavioural techniques. The study highlights the limitations of the intervention as well as suggesting future directions for integrated models of crisis intervention; development of an evidence-based model is recommended.