Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY

Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.     

Longitudinal Dynamics of Substance Use and Psychiatric Symptoms in Count Data with Zero Inflation

We examine the dynamics of substance use and psychiatric symptoms from childhood to adolescence using a longitudinal study of Mexican-origin families (N = 674). We present a longitudinal model capturing the trajectories of substance use and psychiatric symptoms (depression, conduct disorder), as well as the interrelations between these trajectories over time. Such a model is an extension of latent change score models designed to account for the occurrence of psychiatric symptoms while also accommodating a large amount of zeros for nonoccurrence and characterizing the changes over time in the count data. We compare this model with a more traditional approach based on a log transformation of the data. We describe differences between these approaches and highlight the benefits of using the two-part model when the data include a large amount of zeros for nonoccurrence of the behavior.     

Creating mother and baby therapy groups in prison: emotional valuation

Mothers in prison are at high risk of depression and other mental health issues and yet access to therapeutic services is limited. This paper describes the development by the author of two prison therapy groups: one for pregnant women, the other for mothers and their babies. Called the ‘Born Inside’ project, both groups are currently held in Bronzefield Prison, Surrey. The theory and principles behind the project are discussed, as well as the processes and practicalities involved in providing the therapy and specialised support to the women and their vulnerable infants. In addition, principles of forensic psychotherapy in relation to this specific prison population are described, and the situational and emotional challenges faced are illustrated through narratives of group members.     

Developmental neuropsychological assessment of 4- to 5-year-old children born following Preimplantation Genetic Diagnosis (PGD): A pilot study

The purpose of this pilot study was to evaluate developmental neuropsychological profiles of 4- to 5-year-old children born after Preimplantation Genetic Diagnosis (PGD). Twenty-seven participants received a neurological examination and a battery of neuropsychological assessments including Wechsler Preschool & Primary Scale of Intelligence - Third Edition (WPPSI-III; cognitive development), Preschool Language Scale, Fourth Edition (PLS-4; language development), Wide Range Assessment of Visual Motor Abilities (visual motor abilities), Childhood Autism Rating Scales II (a screening test for autistic spectrum disorders), and the Miles ABC Test (ocular dominance). Parental questionnaires included the Behavior Rating Inventory of Executive Function Preschool Version (BRIEF-P; executive function), Child Behavior Checklist (CBCL) and the Carey Temperament Scales Behavioral Style Questionnaire (socioemotional development and temperament), and the Vineland Adaptive Behavior Scales, Interview Edition, Second Edition (general adaptive behavior). Subjects’ tests results were compared to each test’s norms. Children born after PGD demonstrated scores within the normal or above-normal ranges for all developmental outcomes (mean ± SD): WPPSI-III-VIQ 107.4 ± 14.4 (p = .013), PLS-4-Total 113.2 ± 12.4, p < .001), CBCL-Total 41.1 ± 8.6 (p < .001), BRIEF-P-Global Executive Composite 44.8 ± 9.5 (p = .009). Twelve (44%) of the PGD children had a significant difference between their VIQ and PIQ scores (compared to 27% in the general population). One subject was found to show possible signs of autistic spectrum disorder, although a family history of autism was noted. In conclusion, in this pilot study, children assessed at age 4–5 years and conceived after PGD displayed developmental neuropsychological outcomes within normal limits as compared to their chronologic peers. A larger study is needed to evaluate and follow the neuropsychological development of children born after PGD.     

Does emotional reasoning change during cognitive behavioural therapy for anxiety?

Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world. It is a key interpretative bias in cognitive models of anxiety disorders and appears to be especially evident in individuals with anxiety disorders. However, the amenability of emotional reasoning to change during treatment has not yet been investigated. We sought to determine whether emotional reasoning tendencies change during a course of routine cognitive-behavioural therapy (CBT). Emotional reasoning tendencies were assessed in 36 individuals with a primary anxiety disorder who were seeking treatment at an outpatient clinic. Changes in anxiety and depressive symptoms as well as emotional reasoning tendencies after 12 sessions of CBT were examined in 25 individuals for whom there was complete data. Emotional reasoning tendencies were evident at pretreatment assessment. Although anxiety and depressive symptoms decreased during CBT, only one of six emotional reasoning interpretative styles (pertaining to conclusions that one is incompetent) changed significantly during the course of therapy. Attrition rates were high and there was not enough information regarding the extent to which therapy specifically focused on addressing emotional reasoning tendencies. Individuals seeking treatment for anxiety disorders appear to engage in emotional reasoning, however routine individual CBT does not appear to result in changes in emotional reasoning tendencies.     

Breadth versus depth: Cumulative risk model and continuous measure prediction of poor language and reading outcomes at 12

This study examines whether, and how, multiple risks in early childhood are associated with an increased likelihood of a poor language or literacy outcome in early adolescence. Using data from 210 participants in the longitudinal Twins Early Developmental Study, we focus on the following risk factors at age 4: family risk, and poor language, speech, emergent literacy and nonverbal skills. The outcomes of interest at age 12 are language, reading fluency and reading comprehension. We contrast a ‘cumulative risk’ model, counting the presence or absence of each risk factor (breadth), with a model that also considers the severity of the early deficits (depth). A ‘cumulative risk index’ correlated modestly but significantly with outcome (r = 0.32–0.40). Odds ratios confirmed that having many risk factors (3–6) confers a higher probability of a poor outcome (OR 7.86–17.71) than having one or two (OR 3.65–7.28). Logistic regression models showed that predictive validity is not improved by including information about the severity of each deficit. Even with rich information on children's risk status at age 4, we can make only a moderately accurate prediction of the likelihood of a language or literacy disorder 8 years later (Area Under the Curve = 0.74–0.84; Positive Predictive Value = 0.33–0.55, Negative Predictive Value = 0.86–0.91). Taken together, and consistent with the idea of ‘cumulative risk’, these results suggest that the breadth of risk is a core predictor of outcome, and furthermore, that the severity of early deficits does not add significantly to this prediction.