Digests - June 2011

  1. A toolkit for developing practice-based evidence in clinical supervision
  2. More experienced supervisors endorse techniques from their own orientation
  3. Counselling a 'life-line' for drug-using clients on low incomes
  4. Relationships emerge as key in in-patient treatment for anorexia nervosa
  5. Adventurous outdoor experiences appear to enhance the therapeutic process
  6. Reflection and protest innovative moments emerges as the pattern in a case study of a poor outcome in narrative therapy
  7. Thought recognition linked to improved mindfulness as well as psychological wellbeing in principle-based correctional counselling
  8. Having personal therapy in training produces more professional counsellor
  9. Reducing anger key to change for perpetrators of domestic violence in abuser schema therapy

1. A toolkit for developing practice-based evidence in clinical supervision

Using the Brief Supervisory Alliance Scale in all studies, together with the other recommended measures, would aid collaboration and make comparison between studies easier. Having a functional, user-friendly method of gathering, storing and scoring information would enable practitioners to collect data in everyday practice. These are just two of the initiatives of the Supervision Practitioner Research Network (SuPReNET) which are presented in this paper by Sue Wheeler, Mark Aveline and Michael Barkham.

Not only presenting a model for the future of research into supervision, this paper outlines how the team evaluated a range of measures to recommend five core measures that are free for anyone to use and accessible through the SuPReNET website.

Pointing to a lack of practitioner research into supervision and a lack of consistency in the research that is there, the authors recommend a practice-based evidence approach to supervision research which they view as complementary to classic trials methodology. They recommend this as providing the best route for achieving a rigorous and relevant knowledge base for supervision.

Practice-based supervision research: A network of researchers using a common toolkit
Sue Wheeler, Mark Aveline and Michael Barkham

 

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2. More experienced supervisors endorse techniques from their own orientation

Supervisors more experienced within a given orientation tended to give a greater endorsement of techniques within that orientation in this study. This tendency was found to be more significant in cognitive behavioural supervisors than in psychodynamic-interpersonal supervisors.

Aiming to examine the relationship between expert supervisors' professional experiences and their views about the importance of different psychotherapy techniques, 43 supervisors were asked to rate 20 therapeutic techniques according to how characteristic they are of an ideal session within their theoretical orientation.

The findings in this research seem to contradict studies that have found that as experience increases, attitudes about what constitutes an ideal therapeutic relationship become more similar across theoretical orientations. Given that supervision plays a central role in helping therapists develop therapeutic values, these findings are important for outcomes both in supervision and therapy.

Experiences related to expert supervisors' views of ideal therapeutic practice
Jenelle M.  Slavin-Mulford, Mark J. Hilsenroth, Mathew D. Blagys and Mark A. Blais

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3. Counselling a 'life-line' for drug-using clients on low incomes

 

This paper looks at drug-users' perceptions of the difference that counselling can make and illustrates how counselling can play an effective part in improving the quality of life for individuals on low income who are using drugs.

Research suggests that drug-using clients on low income are difficult to reach and retain, and that outcomes in counselling are disappointing. Six clients who had engaged in therapy for over six months were interviewed and Jane Edwards and Sarah Loeb used Grounded Theory methodology in their qualitative study to demonstrate that clients experienced considerable change through counselling.

Exploring factors that both helped and hindered within the counselling process, findings include changes in the clients' internal world and changes in their perception of the relationship with the counsellor. This study documents how participants were able to use counselling to improve their lives.

What difference does counselling make? - The perceptions of drug-using clients on low incomes
Jane Edwards and Sarah Loeb

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4. Relationships emerge as key in in-patient treatment for anorexia nervosa

This paper seeks to consider the question of whether inpatient admission for anorexia nervosa was a therapeutic experience for two women. In doing so, the authors conclude that relationships are key in therapeutic gain and suggest that psychodynamic and attachment theories should be used to inform overall treatment models for chronic anorexia nervosa.

Responding to an urgent need for more research evidence for the treatment of anorexia nervosa this study builds on research that examines client experience and also seeks to understand the therapeutic elements of treatment from a psychodynamic perspective. James Ross and Charlotte Green's method was characterised by listening to women's own stories. They captured rich data from in-depth interviews and, using narrative thematic analysis, found 'relationships' to be the central theme of the research.

Inside the experience of anorexia nervosa: A narrative thematic analysis
Alistair Ross and Charlotte Green

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5. Adventurous outdoor experiences appear to enhance the therapeutic process

Introducing an adventurous outdoor activity into the counselling process was found to enhance the positive effects of the therapy in this study. Alex Kyriakopoulos also found that having the therapeutic framework of the counselling space was perceived by participants as an equally important part of the intervention.

Responding to a call from Universities UK for the development of innovative frameworks that would improve students' mental health and wellbeing, one UK University piloted the Adventure Therapy Project. This project drew on adventure therapy which involves the combination of individual psychotherapy with an adventurous outdoor group experience and sought to reduce self-reported anxiety and depression in a group of students.
Using Interpretative Phenomenological Analysis (IPA) to record and analyse the experiences of six students this research finds that participants perceived improvements in the ways they related towards themselves and other people, and that the intervention helped them to develop inner resources to achieve personal change in their lives.

How individuals with self-reported anxiety and depression experienced a combination of individual counselling with an adventurous outdoor experience: A qualitative evaluation
Alex Kyriakopoulos

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6. Reflection and protest innovative moments emerges as the pattern in a case study of a poor outcome in narrative therapy

This paper provides a detailed case study analysis of a poor outcome of narrative therapy with a woman who was a victim of intimate violence for many years.

Good outcomes in narrative counselling tend to include innovative moments (i-moments). These are the narrative details in therapeutic conversations that are not influenced by the problematic narrative.  Recurrence of i-moments in therapy can enable clients to reconceptualise problematic narratives.
By tracking  i-moments in this poor outcome case, this study shows two types of i-moment emerging: reflection and protest. While i-moments were present in the therapeutic dialogue, any gain was surpassed by a return to the problematic narrative. Indeed, the authors demonstrate how over the course of the therapy, two voices mutually emerge - one in the i-moment and one that supports the problematic narrative - and the therapy is characterised by an oscillation between the two. The authors suggest that practitioners may recognise this mutual in-feeding process and providing practitioners with the tools to spot such patterns may help therapists to adjust or plan their intervention in order to promote the narration of other i-moment types.

Innovative moments and poor outcome in narrative therapy
Anita Santos, Miguel M. Gonçalves, Marlene Matos

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7. Thought recognition linked to improved mindfulness as well as psychological wellbeing in principle-based correctional counselling

Principle-based correctional counselling (PBCC) proposes that increasing offenders' thought recognition improves thinking, leading to increased psychological wellbeing and more functional behaviour. The findings in Thomas Kelley's study support this proposition and he found explanations for his results in current research. But while reflecting on the data, Kelley realised that there was another possible explanation for the results: that thought recognition could lead to increased mindfulness in the participants. In his follow-up study he finds evidence that thought recognition and mindfulness are linked.

The participants in this study were 54 adult prisoners on probation in a large midwestern state of the USA and Kelley describes using two measures of thought recognition and the Well-Being Inventory to test PBCC's proposition. In his follow-up study he uses the Mindful Attention Awareness Scale.

In drawing out implications for practice Kelley suggests that therapists can increase effectiveness by helping clients better recognise and understand their thinking processes, allowing clients to let go of dysfunctional thinking and begin trusting their innate wisdom as their guide.
Thought recognition and psychological wellbeing: An empirical test of principle-based correctional counselling
Thomas M. Kelley

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8. Having personal therapy in training produces more professional counsellors

According to the participants in this study, experiencing personal therapy in training, even when prescribed, seems to produce more self-aware and confident and thus more professional counsellors. Therapists are better able to use core and advanced skills and build appropriate relationships with their clients.

These are the conclusions of Carmen Von Haenisch who interviewed six practising counsellors and used Interpretative Phenomenological Analysis (IPA) to analyse her interview data. She found that the compulsory nature of the therapy had an impact on the trainees and their experience of the training course. For some participants the physical impact of therapy in training was significant. In this study, there is greater emphasis on different aspects of the therapeutic relationship than was found in other studies. This study shows that counselling trainees feel better equipped and more aware and accepting of self and others when they have experienced personal therapy in training. This gives them a valuable first hand insight into the purpose of personal therapy to help individuals onto the path of better mental health.

How did compulsory personal therapy during counselling training influence personal and professional development?
Carmen Von Haenisch

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9. Reducing anger key to change for perpetrators of domestic violence in abuser schema therapy

Reduced anger - therapy has helped me to change anger - was identified as an area of change by all the participants in this study. It is one of four areas of perceived change identified in Margaret Smith's paper which aims to discover what perpetrators of domestic violence think has changed in them following abuser schema therapy (AST).

Other key areas of change identified by perpetrators are increased communication and assertiveness skills, reduced aggression to anger provoking events, and enhanced personal responsibility for personal power. Smith suggests these are useful areas of focus for therapeutic interventions regardless of therapeutic approach.  She also suggests that therapeutic interventions focussing on changing the meanings developed in childhood that influence how perpetrators perceive contemporary experiences could be beneficial to change.
Using a qualitative methodology and interviewing 18 male perpetrators of domestic violence this study also highlights the potential for time-limited and frame-worked psychotherapeutic programmes as a means of reducing aggression in perpetrators of domestic abuse, which can ultimately help victims/survivors and children.

A qualitative review of perception of change for male perpetrators of domestic abuse following abuser schema therapy (AST)
Margaret Elizabeth Smith

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