Digests - December 2010

1. Workplace counselling reduces sickness absence

Workplace counselling reduces sickness absence rates in clients by up to 60%, and is effective in alleviating symptoms of anxiety, stress and depression. It also has a moderate impact on job commitment, work functioning and job satisfaction.

This is the conclusion of a review carried out by John McLeod of the University of Abertay Dundee, which looked at all the English language studies of the effectiveness of workplace counselling published between 1980 and 2005.

The review revealed that workplace counselling represents an effective means of assisting employees to cope with psychological, emotional and behavioural problems, and that the successful resolution of these issues can have a constructive impact on work behaviour, in terms of reduced sickness absence and enhanced work functioning.

It was also highlighted that counselling is effective, not only for employees with high levels of job control, but also for those engaged in manual and clerical roles.

It appears that while workplace counselling may have an impact on anxiety, stress and depression for some clients, there are many (perhaps the majority) who do not initially present with deficits or issues in these areas. The research suggests that a range of therapy approaches and treatment lengths may be effective. However, the research base is not sufficiently extensive to determine whether different approaches, numbers of sessions or models of service delivery (e.g. external EAP vs. in-house service) are associated with differential levels of effectiveness. 

More research is recommended in order to reinforce the evidence base for workplace counselling.

The effectiveness of workplace counselling: A systematic review
John McLeod

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2. Lone counsellors experience isolation and stress in the workplace

Lone counsellors feel isolation and stress in the workplace, and in the absence of likeminded others, they adopt a ‘lone battling’ stance and develop coping strategies aimed at trying to ‘fit into’ the organisation, and to form and maintain meaningful relationships with likeminded others in the counselling community.

This is the conclusion of research by Fiona Janet Winning to explore and understand lone counsellors’ experiences of working in organisations, and to indicate ways of enhancing this.

The study revealed interface challenges between the world of counselling and the world of the organisation. Each has different values and goals that are not easily reconciled and can be a source of tension and conflict.

Lone counsellors described numerous challenges faced in the course of their work. These were grouped under four categories: environmental isolation, social isolation, professional isolation and organisational structures.

The findings confirm the hypothesis proposed by Baumeister and Leary (1995) that states that the need to belong is a fundamental motivation. However, the ‘lone battling’ behaviour adopted in an attempt to seek acceptance within the organisation and meaningful relationships with others in the counselling community was only partially successful.

The findings have relevance to the training and employment of counsellors and other lone workers and reveal areas for further research.

In addition, it is highlighted that basic training for counsellors in organisational dynamics and the development, management and administration of a counselling service would enable lone counsellors to work more confidently in organisational settings. 

Counselling in organisations: What is the experience of the lone counsellor?
Fiona Janet Winning

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3. Public perceive ‘counsellor’ to differ from ‘psychotherapist’

Around two thirds of the public perceive the professional title ‘counsellor’ to be distinct from the professional titles ‘psychotherapist’ and ‘psychological therapist’ and for these latter two titles to be almost identical.

This is the key finding of study to investigate public opinion concerning the differentiation between the professional titles ‘counsellor’ and ‘psychotherapist’.

The results have implications for the debate concerning the structure of the Health Professions Council (HPC) Register in the regulation of counsellors and psychotherapists.

On the one hand, it might be argued that the finding that the majority of the public perceive a difference between the professional titles ‘counsellor’ and ‘psychotherapist’ supports the present recommendations by the PLG to differentiate between these titles on the HPC register.

On the other hand, it should not be forgotten that the HPC’s primary purpose is to protect the public (Crown Copyright, 2002); consequently, it must be seriously considered whether the decision to differentiate or not will bring clarity to the public’s mind about the roles and purpose of the different professionals or could actually increase confusion.

It might be considered that not differentiating between the titles on the register may have the potential to bring about increased clarity rather than confusion to the two thirds of the public who currently perceive the titles to be distinct. 

Based on the findings of this study further research upon the topic of public understanding of the professional titles ‘counsellor’, ‘psychotherapist’, and ‘psychological therapist’ is recommended.

Public perception of the professional titles used within psychological services
Pavlo Kannellakis and Jennefer D’Aubyn

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4. E-counselling as effective as face-to-face practice

E-counsellors believe their practice is as effective as face-to-face practice and are generally satisfied with their online work.

This is the finding of a study by Jerry Finn and Azy Barak which sought to examine the process, perceived outcomes, and ethics of therapists who provide counselling and therapy online.

The study demonstrates that e-counselling offers promise as a supplement prior to treatment, and as a source of support in follow-up to treatment, or may provide another avenue for concurrent treatment.

However, it was also revealed that most e-counsellors have no formal training or supervision in online practice and that there is little agreement on attitudes, practice, ethical issues, and knowledge of regulations related to e-counselling. In addition there is confusion about which issues are appropriate for e-counselling practice.

The lack of consensus about ethical obligations and practice highlights the need for both institutionalised and mandatory education and training in e-counselling, and for stricter laws and regulations related to it.

The future will no doubt see an expansion of e-counselling services, providing unprecedented access to psychotherapeutic services and development of new models of practice. Both practitioners and consumers must be educated about the unique aspects of these services, and professional organisations must take steps to ensure that the ethical requirements of practice are met.

A descriptive study of e-counsellor attitudes, ethics and practice
Jerry Finn and Azy Barak

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5. Therapists benefit from mindfulness training

Mindfulness training leaves therapists more able to cope with stress and tension, as well as improving their well-being and increasing their mindfulness in clinical work.

This is the conclusion of a study to examine the training outcomes of a standardised eight-week introductory mindfulness programme for mental health professionals.

The study evaluated mindfulness training in relation to measures of therapist well-being, skill and knowledge acquisition, programme acceptability, and attitude change.

The results provide evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists, aiding their therapeutic practice.

Stress management and compassion fatigue are particularly pertinent issues for health professionals. Consistent with predictions, reductions in the perception of stress and tension were large in this study with participants feeling more relaxed after training sessions. The therapists involved also reported an increased capacity to let go of unsettling thoughts, feelings, or images as they arose.

The research shows that therapists can benefit from relatively brief training programs in mindfulness that focus on clinical work. The implication for practice is that clinicians seeking mindfulness training may gain additional benefit by the therapy specific approach used in this study.

Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme
Cameron Aggs and Matthew Bambling

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6. Mindfulness role-play increases empathy towards clients

Mindfulness-based Role-play (MBRP) supervision can enhance therapists’ empathy with their clients’ emotional experiences, whilst also giving them a greater sense of how to proceed in therapy.

This is the finding of an Australian pilot study, which aimed to investigate MBRP supervision to find out how therapists would experience the approach, and to what extent they would find it useful, particularly in relation to empathy toward clients.

It was revealed that participants predominantly had positive emotional and cognitive responses to their supervision experiences, and also that they felt safe and less judged or criticised in the MBRP supervision than in other supervision experiences.

In addition, all participants except one reported enhanced awareness of their functioning as therapists indicating that, not only did the MBRP supervision lead to enhanced therapist empathy, but it also, concurrently, fulfilled the more traditional expectation of supervision – of providing the supervisees with insights into their functioning as a therapist.

Whilst practice implications should be viewed with caution at this stage, these findings nevertheless suggest that when MBRP supervision is facilitated by a supervisor who is experienced in the approach, it can be considered as a viable complement or alternative to conventional approaches to clinical supervision.

The findings of the research are therefore promising and suggest that further research into the MBRP supervision approach is warranted.

Dialogical mindfulness in supervision role-play
Lars Andersson, Robert King and Lloyd Lalande

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7. BMA is effective for anxiety/depression and medically unexplained symptoms

The BodyMind Approach (BMA) is an effective intervention for patients suffering from anxiety/depression and at least one chronic medically unexplained symptom (MUS), increasing well-being and reducing anxiety/depression.

This is the conclusion of a pilot study to evaluate the outcomes of a 12-week group BMA intervention programme with patients suffering from anxiety/depression with at least one chronic (over two years) MUS.

The study also found that the intervention increased activity levels; provided more effective coping/functioning strategies; and reduced GP consultation, medication usage and symptom distress. All changes were maintained at three-month follow-up.

This study bears out the indication in the literature that integrating non-verbal and verbal approaches in therapeutic interventions for this population might be effective.

It is considered more socially acceptable to present with a variety of bodily symptoms than mental health ones. The BMA values the bodily symptom and enables understanding of symptoms by encouraging participation in a programme that does not solely address mental health or physical health, but a combination of both.

The BMA conducted within a non-stigmatising environment appears to give easier access to benefits, particularly for patients with chronic bodily symptoms and accompanying mental health needs.

By emphasising the body-felt sense from an experiential body-mind perspective, within a safe, supportive, skilfully facilitated group, participants with MUS can benefit in terms of well-being and reduction in symptom perception.

The intervention has much to offer this often termed ‘hard to reach’ population of patients. The contribution to the field emphasises that an integrated approach using both verbal and non-verbal psychotherapeutic techniques within a safe, learning group in a non-stigmatising setting can be particularly helpful to this population.

Change in the moving bodymind: Quantitative results from a pilot study on the use of the BodyMind Approach (BMA) to psychotherapeutic group work with patients with medically unexplained symptoms (MUSs)
Helen Payne and David Stott

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8. School counsellors require greater understanding of dyslexia

Counselling has a positive effect on the self-esteem of dyslexic students. However, more specialised training is needed to give school counsellors a full understanding of dyslexic clients, enabling them to successfully help them.

This is the conclusion of a Maltese study which sought to understand whether Maltese school counsellors are equipped to deal with dyslexic clients, consider whether specific strategies need to be used, and identify what positive effects, if any, counselling has on these clients.

The study indicated that Maltese school counsellors were aware that they needed more specific training to deal with dyslexic clients, because they felt that their training did not equip them with the necessary skills and information.

It also highlighted that counsellors must understand that dyslexic clients are not problematic, but simply that they learn differently from their peers.

Effective counselling helps children enhance self-esteem and improve performance, as has been concluded by the participants of this study. When counsellors and teachers work in collaboration, dyslexic students can have a positive experience in schools and their performance is enhanced.

Although more research is needed in this area, this study showed that counselling did have a positive effect on the self-esteem of dyslexic students. However, it cannot be viewed as an isolated intervention strategy, but must be part of a concerted effort – supported by appropriate attitudes, teaching pedagogies and an appropriate school ethos of inclusion.    

Dyslexia and the school counsellor: A Maltese case study
Ruth Falzon and Stephen Camilleri

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9. Family therapy key for adolescents who have a sibling with a life-threatening illness

Adolescents who have a sibling with a life-threatening illness would benefit from both family and individual therapeutic support to enable them to cope with the issues such a situation creates for them. Not only would this ease stress for the young people themselves, it would also aid their families and the professionals they work with.

This is the conclusion of a study by Marcia Burton which explored the issues encountered by adolescents who have a sibling with a life-threatening illness, and also among those who work therapeutically with them.

The research revealed that young people may adapt to their sibling’s illness by over-achieving or pleasing. There is potential for members of families experiencing serious illness to become isolated from each other, in an attempt to avoid causing each other upset. Adolescent siblings are particularly prone to feelings of isolation, making it all the more important that they have encouragement to communicate and integrate with their families.

Confusion caused by contradictory emotions, survivor guilt, difficulty relating to a peer group, and fear of upsetting other family members, all contribute to this perceived isolation.

In investigating the emotional impact on professionals, the study found that professionals accepted emotional impact to be an inevitable aspect of their work, and although it was demanding, most found it had a positive effect on them. Those interviewed unanimously named the inclusive, accepting and compassionate quality of empathic relationships within their teams, and especially those among co-workers, as a main feature of their support system.

The result of this research suggest that organisations working with families experiencing a life-threatening illness would benefit from attending to the quality of support offered to their staff, as well as the families they work with.

Future research might develop longer-term studies, interviewing people in their 20s, to explore the impact of having had a seriously ill sibling as a teenager, and the effect that counselling had on their grieving process. Research could be conducted to explore, in depth, the qualities within a team which create an empathic, supportive environment.

Supporting adolescents who have a sibling with a life-threatening illness: An exploratory study
Marcia Burton

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