Digests - June 2012
- The provision of time-limited counselling by employers is an effective support for employees experiencing personal difficulties affecting work.
- Young people who are 'sent' to counselling may benefit as much as those who decide to engage with it or who self refer.
- Single and teenage women identified as particularly in need of support when experiencing premature menopause.
- A case study exploring how ambiguities may be settled in a process where ending is initiated by the therapist and resisted by the client.
- 'Relational and collaborative therapeutic activities and psychological interventions, experientially developed and tested, are given credence by CBT and psychodynamic therapists working in the NHS.'
- The transition to postgraduate study identified as significant, and experienced as difficult, by the majority of students on a counselling/psychotherapy course.
- Personal therapy in counsellor training: both important for trainee development and 'a double-edged sword'.
- Review identifies a lack of UK-based research into adult survivors' of childhood sexual abuse perceptions of services.
1. The provision of time-limited counselling by employers is an effective support for employees experiencing personal difficulties affecting work.
Although many employers provide counselling services for employees experiencing work and personal issues, in times of economic pressure services may be at risk if they are not able to demonstrate their effectiveness. The aim of this study was to evaluate whether a workplace counselling service can bring about sustained change in well-being.
Carried out in a university staff counselling service, the project aimed to evaluate the time-limited counselling offered to staff. Using the Warwick-Edinburgh Mental Well-being Scale at the beginning and end of counselling and at three and six months afterwards, it asked whether counselling is effective in bringing about improvement in employees with low levels of psychological well-being, and it looked for evidence of the longevity of any improvement . Additionally, a comparison group reflecting the demographic of the treatment group was used to understand whether the well-being of a similar group of employees who had not received counselling differed from those who had.
The authors suggest that this study carries two main implications for other workplaces. Firstly, it provides evidence that workplace counselling is an effective way of improving the well-being of staff by reducing distress, dysfunction and under-performance. Secondly, it demonstrates how research within the workplace is able to contribute to the counselling evidence base.
Counselling in the workplace: How time-limited counselling can effect change in well-being
Jill Collins, Alison Gibson, Sarah Parkin, Rosemary Parkinson, Diana Shave & Colin Dyer
See also Focus on Research
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2. Young people who are 'sent' to counselling may benefit as much as those who decide to engage with it or who self refer.
'School counselling services should be wary of concentrating the delivery of service only to those students who appear motivated or keen to attend counselling.' This is one of the key implications of this study aiming to assess the relationship between young people's motivation for counselling and its effectiveness, within a secondary school setting.
Motivation has been found to be one of the strongest predictors of therapeutic outcomes in adults and the authors of this paper hypothesised that motivation may also be a predictor of outcome for young people. Eighty-one young people who attended school-based humanistic counselling completed a Motivation for Counselling Questionnaire and YP-CORE at the beginning and end of counselling.
Contrary to some of the authors' expectations, motivation for counselling was not found to be significantly related to the outcome of therapy. Although this result could suggest that the association between motivation and outcome may be weaker in young people, the authors of this study discuss a number of design factors that may also account for the non-significant findings. They suggest that the relationship between motivation and therapeutic outcome in young people is a question for further exploration.
Motivation as a predictor of outcomes in school-based humanistic counselling
Carin Killips, Mick Cooper, Elizabeth S. Freire & Susan McGinnis
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3. Single and teenage women identified as particularly in need of support when experiencing premature menopause.
'Effective therapy is likely to depend on being well-informed on the physical and psychological implications of diagnosis in addition to traditional skills, alongside encouragement to connect with similarly placed others. In this way young women can be supported to move towards a renewed and more empowered sense of self.' These are some of the implications of this study investigating women's experiences of premature menopause and its impact on their psychological well-being.
Premature menopause, the author states, affects up to 6% of women aged between 14 and 40. Using a questionnaire study design drawing on both quantitative and qualitative methods, Singer's findings demonstrate that women's experiences of this condition vary but have common themes. The theme 'Experience' incorporates Information, Diagnosis, Fertility and Premature Ageing; while the theme 'Support' explores Medical and Psychosocial factors. Alongside identifying that young women with premature menopause would benefit from counselling, the author also suggests that therapists need a good understanding of the physical aspects of the condition and identifies single and very young women as particularly vulnerable.
'It's not supposed to be this way': Psychological aspects of a premature menopause
Dani Singer
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4. A case study exploring how ambiguities may be settled in a process where ending is initiated by the therapist and resisted by the client.
How much therapy is enough is a question that has long-permeated counselling and psychotherapy literature. As Råbu and Haavind outline 'when the duration of therapy is not preset and the outcome is a matter for negotiation, the decision to end will be an experiential concern' for both client and therapist.
The authors identify the case explored in this paper - which is part of a larger psychotherapy research project - as exceptional. Despite the client and therapist having developed a 'good enough' alliance (measured with the Working Alliance Inventory) and having reached a 'good enough' outcome (measured using the Outcome Questionnaire 45) the client still felt she was not finished.
Drawing on a close analysis of data from audio recordings of all sessions, and from post-therapy interviews with both the client and therapist, the authors identify a complicated experiential process. This process incorporates both content - not addressing the discrepancy between therapist and client but postponing it - and structural elements like reducing the frequency of sessions. The authors ultimately suggest that an answer to the question of when therapy stops may be that: 'therapy stops when client and therapist find a "good enough" way to resolve the basic ambivalence concerning ending.'
Coming to an end: A case study of an ambiguous process of ending psychotherapy
Marit Råbu & Hanne Haavind
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5. Relational and collaborative therapeutic activities and psychological interventions, experientially developed and tested, are given credence by CBT and psychodynamic therapists working in the NHS.
Building trust, being honest, working collaboratively with doctors and other professionals; treating understandings as working hypotheses; interventions based on knowledge of what works for each client; and more integrative therapy models: these are some of the implications for practice identified by Maria Luca in her qualitative study exploring how therapists work with clients experiencing Medically Unexplained Symptoms (MUS).
Little is known about the interventions used by therapists working with clients in primary care with MUS. The focus of this paper is to report on therapeutic interventions used by experienced Cognitive Behavioural Therapists and Psychodynamic therapists working in the NHS in Britain. The author conducted twelve semi-structured interviews with therapists recruited from two NHS departments. The transcripts of these in-depth interviews were analysed using Grounded Theory.
Luca found that therapists from the two modalities used modality specific interventions in their work with MUS clients but that they also shared a range of therapeutic activities and interventions which included 'working together with clients, sensitive, empathic responding and building trust'. The authors conclude that while therapists from both modalities retain their own, modality specific practices, their shared common practices have been found to be effective through experience.
Therapeutic activities and psychological interventions by cognitive behavioural and psychodynamic therapists working with medically unexplained symptoms: A qualitative study
Maria Luca
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6. The transition to postgraduate study identified as significant, and experienced as difficult by the majority of students on a counselling/psychotherapy course.
In this evaluation students strongly expressed their need for academic instruction in order to successfully manage their study at Masters' level. Subject-specific academic support was identified as particularly helpful. The author recommends 'timetabled, subject specific, academic writing workshops with IT instruction and academic tutorials' to help students manage the transition to postgraduate study.
Focusing on the academic writing aspect of postgraduate study, this paper draws on a two-year formative evaluation of students' views from a BACP accredited course in one university. The evaluation sought views on how students experienced the transition to postgraduate study and sought to identify what was most and least helpful in managing this transition.
West adds that the findings 'indicate the importance of acknowledging the potential difficulties apparent in the transition to postgraduate study for counselling and psychotherapy students and highlight the need for effective, time efficient ways of preparing students for this transition.'
Formative evaluation of the transition to postgraduate study for counselling and psychotherapy training: Students' perceptions of assignments and academic writing
Angela West
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7. Personal therapy in counsellor training: both important for trainee development and 'a double-edged sword'.
In identifying personal and professional benefits of personal therapy during training, the challenges of therapy and also the key elements of therapy, the authors of this study suggest that 'close consideration should be given to the potentially adverse effects of reducing requirements for personal therapy in clinical trainings.'
The authors report the relaxation of requirements for counsellors and psychotherapy trainees to have personal therapy during training as the background to this qualitative study exploring the effect of personal therapy on female volunteer counsellors. Participants were drawn from counsellor volunteers at a women's community centre where to be in weekly therapy was a requirement. Nineteen counsellors of different theoretical orientations were interviewed using semi-structured interviews and the data were analysed using thematic analysis.
All nineteen participants expressed that their personal therapy had professional benefits and was an 'integral part of their training' but five participants also reported negative experiences. It was noted by the authors that personal therapy can be a 'double-edged sword' particularly for female volunteers. The authors suggest that research has shown that unpaid volunteers are generally women who often also have the main household care-giving responsibilities thereby potentially struggling to be able to find the time or the money to engage in therapy.
Women counsellors' experiences of personal therapy: A thematic analysis
Karen Ciclitira, Fiona Starr, Lisa Marzano, Nicola Brunswick & Ana Costa
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8. Review identifies a lack of UK-based research into adult survivors' of childhood sexual abuse perceptions of services.
Although survivors of childhood sexual abuse (CSA) have been identified as likely to require medical, social and counselling/psychotherapy services, the experiences of using such services have rarely been explored from their perspective. Aiming to summarise and evaluate the existing evidence regarding counselling/psychotherapy services for CSA from the survivors' perspective, the authors of this paper identified nine studies from systematic literature searches that met their inclusion criteria.
Findings from this review highlight the importance of the therapeutic relationship for survivors. Awareness about issues specific to survivors was also identified as a core requirement of a positive therapeutic experience. Negative experiences included taking a sexual interest in clients, dealing ineffectively with errors, being unresponsive, and being prescribed heavy medications. However, findings were limited due to the poor to moderate methodological quality of the papers, which in turn was due to selection bias, inconsistencies in recruitment and procedure and ill-described samples and analysis.
Alongside implications for practice that include CSA/trauma focused teaching in training and CPD, the authors of this study identify a range of key questions that could be addressed by future research. These include survivors' perspectives across genders, sexual orientation and ethnic background, and a focus on survivors' negative experiences.
Adult survivors' of childhood sexual abuse perspectives of services: A systematic review
Zoë Chouliara, Thanos Karatzias, Georgia Scott-Brien, Anne Macdonald, Juliet MacArthur & Norman Frazer
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