Digests - March 2013
- CORE-10 found to be user-friendly, reliable and ideally suited to help clinical decision-making in a range of primary care settings.
- Working with clients who self-harm has a significant impact on counsellors, with therapist anxiety exacerbated by the complexity of the phenomenon.
- Core therapeutic tasks identified for counselling with people living with a long-term health condition – towards an integrative model?
- Results offer ‘market confidence to support EAP provision in a climate of austerity’ suggest the authors.
- Recording supervision sessions found to be educational, therapeutic and have the potential to strengthen the supervisory working alliance.
- Spontaneous, joint creation of metaphors between client and therapist key to their successful use at the end of therapy.
- Reflections and restatements found to improve counselling as observed by evaluators, but open questions may not.
- Preliminary findings suggest domestic violence clients may benefit from non time-limited specialist counselling services.
1. CORE-10 found to be user-friendly, reliable and ideally suited to help clinical decision-making in a range of primary care settings.
Core-10 was developed in response to a need for a short, user-friendly assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper outlines the development of CORE-10 from the longer, 34-item CORE-OM measure.
In shortening the CORE-OM the authors describe wanting to develop a measure that could be used easily by practitioners and clients at screening as well as used for ongoing review during the course of therapy whilst retaining the CORE-OM’s ability to measure general psychological distress. Ten items were selected from the CORE-OM based on usefulness, coverage of item clusters (problems, functioning and risk) and using statistical procedures. The new measure was then tested using data from primary care populations, the general population and a sample from an occupational health setting.
The CORE-10 was found have ‘good psychometric properties’ according to the authors of this paper, and found to be easy to use by practitioners. The authors distinguish between the use of the CORE-10 and CORE-OM. The longer measure is identified as a detailed measure for use at assessment, and at intervals during medium to long-term therapy. However, the CORE-10 is identified as particularly user-friendly due to its ease of scoring and is suited for use every session.
Michael Barkham, Bridgette Bewick, Tracy Mullin , Simon Gilbody, Janice Connell , Jane Cahill, John Mellor-Clark, David Richards, Gisela Unsworth & Chris Evans
2. Working with clients who self-harm has a significant impact on counsellors, with therapist anxiety exacerbated by the complexity of the phenomenon.
Counsellors experience intense emotions that include shock, sadness, anger and frustration and there is a variation in how they perceive client progression. Managing the complexity of the phenomenon - self harm as ‘a legitimate coping mechanism’ versus ‘therapist agenda for change’ – exacerbates therapist anxiety. These are the key findings of this qualitative research exploring counsellors’ perceptions of client progression when working with clients who self-harm.
Drawing on semi-structured interviews with five counsellors the author used a constant comparative method to analyse the data. Five main categories emerged from the data: impact on the counsellor; necessary requirements of the counsellor when working with self-harm; counsellors’ agenda for change to stop the self-harm; counsellors’ perceptions of client progression; and counsellors’ perceptions of why clients self-harm.
Despite a variety of views of what client progression is, all counsellors agreed that progression was not ‘simply about stopping self-harm’. However, what also emerged from the data was a sense of the struggle to manage the ambiguities and contradictions of working with clients who are intentionally harming themselves. Further research into this area, the authors suggest, may deepen understanding and contribute to increasing the efficacy of therapists working with this client group.
Doreen Fleet & Rita Mintz
3. Core therapeutic tasks identified for counselling with people living with a long-term health condition – towards an integrative model?
Pluralistic Transactional Analysis (TA) counselling emerged in this study as an effective intervention for clients experiencing difficulties coming to terms with long-term illness. The key elements of counselling effectiveness were a flexible, integrative approach, sufficient time, and a strong therapeutic relationship.
Adopting a systematic case study research approach, a rich case record was assembled for three clients receiving pluralistically-informed TA counselling and suffering with major health problems. The rich case record included an Assessment interview, therapist session notes and transcripts of recordings of some sessions, and The Change Interview. Clients were also invited to comment upon the analysis of their case.
Themes that emerged from the three case studies included the quality of the client-therapist relationship, sufficient time for clients to tell their stories and sufficient number of sessions for the client to explore a range issues, flexibility in delivery of counselling to accommodate health issues and goal setting. The emerging themes from this study, the author suggests, could be key therapeutic tasks that could form the beginning of an integrative model of counselling/psychotherapy for long-term health conditions and could be tested through further research.
4. Results offer ‘market confidence to support EAP provision in a climate of austerity’ suggest the authors.
Aiming to profile the quality of Employee Assistance Programme (EAP) counselling service provision against benchmarks published for NHS and Higher Education (HE) counselling services, the results of this retrospective analysis, the authors claim, provide strong evidence that EAP counselling provision is highly effective for employees experiencing common mental health problems like depression, anxiety and stress.
The background to this study is an apparent increase in psychological distress in the workplace paralleled with the growth of EAPs offering counselling. CORE System data profiles of over 28,000 clients were donated by six EAP service providers and a benchmarking methodology was use to assess the quality of the EAP service provision compared with benchmarks for NHS primary care and UK Higher Education student counselling services.
Clients presenting to EAPs do so with levels of distress similar to those seen by NHS or HE student counselling services. Clients accessed counselling quickly with an average waiting time of nine days. EAP clients in this study were more likely to complete treatment than their NHS or HE counterparts. Improvement and recovery rates are comparable with NHS and HE counselling benchmarks. These results, the authors suggest, demonstrate both efficiency and effectiveness that should ‘offer market confidence in a climate of austerity’.
John Mellor-Clark, Elspeth Twigg, Eugene Farrell & Andrew Kinder
5. Recording supervision sessions found to be educational, therapeutic and have the potential to strengthen the supervisory working alliance.
Re-experiencing emotions and thoughts, discovering events that had been forgotten or unnoticed, accepting what had been unacceptable and gaining self-awareness that was therapeutic. These are some of the key findings of this qualitative study exploring the impact of listening to an audio recording of a supervision session upon supervisees.
Fifteen participants from a range of therapeutic approaches and with up to 20 years’ experience of counselling and psychotherapy were interviewed after recording their last supervision session and the data were analysed using grounded theory.
North presents his findings as a process: when a supervisee listens to a recording of their latest supervision session they notice what was previously unnoticed about themselves, their supervisor and how the two are interacting. While potentially educational to the supervisee, North’s findings suggest that the observations also enable the supervisee to accept what they previously couldn’t accept, which in turn can become therapeutic. Ultimately, concludes the author, listening to a recording of a supervision session has the potential to strengthen the supervisory working alliance.
Graham Joseph North
6. Spontaneous, joint creation of metaphors between client and therapist key to their successful use at the end of therapy.
The language at the end of therapy described improvement with metaphors drawing on travel (how they had moved), cleaning (sorting things out), sensing (grown stronger) and receiving something (gifts or tools). The authors of this paper found such metaphors to be widely used. The authors hope that the narratives described in this paper are recognisable to therapists and offer the opportunity for therapists ‘to enrich their methods of practice when similar situations occur.
Drawing on data from an intensive process-outcome study at the University of Oslo, Norway, this study examines audio-recordings from all therapy sessions and post therapy interviews with clients and therapists from 12 therapeutic dyads selected because they had ‘good enough’ endings. The data were analysed using a hermeneutical-phenomenological approach.
While the authors present the metaphors found in their study, they do not wish to provide a list of metaphors suitable for therapists to introduce as therapy moves towards the end. Rather, they found that it was the ‘creative spontaneity’ and the fact that metaphors are captured and created in a dialogue between therapist and client to ‘establish a unique sense of shared emotional meaning’. It was this shared process, the authors suggest, that creates metaphors that both the client and therapist can take with them after therapy ends.
Marit Råbu, Hanne Haavind & Per-Einar Binder
7. Reflections and restatements found to improve counselling as observed by evaluators, but open questions may not.
Reflections and restatements, at a rate of one or two a minute, may improve counselling because counsellors appear interested and supportive. However open-ended questions may not improve counselling. These are the key findings of this paper that testing these specific aspects of non-directive counselling using two experiments.
In experiment one, evaluators assessed audio recordings of counselling sessions in which counsellors used a varying frequency of restatements, reflections and open-ended questions. These recordings were assessed using free description and the Working Alliance Inventory. Evaluators also self reported their social skills by completing the Social Skills Inventory. Experiment two was the same as experiment one but with a different set of evaluators, who additionally reported on their cognitive ability using Raven’s Standard Progressive Matrices (a measure of ‘educative ability’ using a series of puzzles).
In suggesting implications for practice, the author of this paper notes that the ratings were modified by the evaluators’ social skills and cognitive ability with evaluators with higher cognitive ability showing a preference for open-ended questions. The author suggests in the Abstract that this ‘can be understood as an issue of matching between conceptual level, social skills and counselling structure’.
8. Preliminary findings suggest domestic violence clients may benefit from non time-limited specialist counselling services.
Domestic violence clients valued a therapeutic relationship built not only on a strong emotional bond between counsellor and client, but also on the provision of information and support in understanding the individual’s situation. Participants also specifically valued understanding about how abuse had impacted upon them individually and how it might explain some of the symptoms that brought them to counselling.
Seeking to identify a client-preferred domestic violence approach to counselling, this pilot study examined the perceptions of four domestic violence clients on counselling they had concluded. The qualitative research drew data from semi-structured interviews focusing on significant events during counselling. The transcripts were analysed using an adapted grounded theory and narrative methodology.
Results highlight characteristics of the early therapeutic relationship that included clients managing and withholding information for a number of sessions; counsellor characteristics which helped included being consistent, non-judgmental, highly empathic and able to share their understanding of domestic violence. Among her implications for practice, Roddy suggests that counsellors would benefit from specific training on domestic violence and concludes that further research is required to explore these preliminary findings.
Jeannette K. Roddy
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