Digests - March 2010

Counselling important in dealing with emotional impact of sight loss

Sight loss can have a negative effect on mood and lifestyle, leaving many feeling socially isolated. Yet, despite this many patients report negative perceptions of counselling and a lack of counselling opportunities in relation to their sight loss.

This is a key finding of research by Mhairi Thurston of the University of Abertay Dundee, which aimed to explore the emotional impact of sight loss in relation to five areas: mood, self-concept, social connectedness, loss and the role of counselling.

The study found that patients needed to make sense of their diagnosis on three levels - intellectually, practically and emotionally. Participants described a wholesale lack of emotional understanding and support at the time of receiving a diagnosis. In addition they reported an absence of acceptance within society as a whole. Sight loss was experienced as involving a profound sense of loss and a fundamental challenge to the individual's sense of self as a valued and worthwhile member of the community.

Also identified through the research was a process called "the transition from sight to blindness". This was a way of conceptualising the journey that people seem to make after the diagnosis of a serious eye condition. It is hoped that this can be used to draw attention to the difficulties faced by blind and partially sighted persons after diagnosis.

The results of this study have implications for clinicians. During diagnosis therapists can help clients by addressing their intellectual, practical and emotional needs. At present, this does not seem to be happening, with patients complaining particularly about lack of information and a perceived lack of care during the time of diagnosis.

An inquiry into the emotional impact of sight loss and the counselling experiences and needs of blind and partially sighted people
Mhairi Thurston

Mhairi won the CPR New Researcher Prize Winner in 2009 with this paper.

Back to top

Violent clients more likely to drop out of counselling

Clients who have recently been violent to others are more likely to drop out of counselling early. In addition, those who are under 35, have an addiction problem, are under greater psychological distress or have less problems identified by the therapist are also more likely to have an unplanned ending.

This is the conclusion of research by David Saxon, Tom Ricketts and Joanna Heywood. Their study aimed to identify those clients most at rick of unplanned endings to counselling and also to look at ways in which these clients may be kept engaged.

Of the 1254 clients accepted for counselling, 806 had a planned ending and 432 had an unplanned ending. By far the majority of unplanned endings were due to the client not wishing to continue counselling or them losing contact with the service, in effect they chose to stop attending appointments.

It was revealed that clients who at initial assessment scored highly on the question 'over the past week I have been physically violent to others' were about twice as likely to have an unplanned ending than those clients who did not score on it.

Although no data was available on their level of distress at ending, and some clients may have felt they no longer needed counselling, unplanned endings were associated with greater psychological distress and greater risk assessment.

The results of this study would indicate that counsellors should actively seek to minimise unplanned endings, as amongst them may be the more distressed and risky clients referred to primary care counselling.

Who drops out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?
David Saxon; Tom Ricketts; Joanna Heywood

Back to top

Volunteer counsellors less effective than professionals

This is the conclusion of Joe Armstrong of the University of Abertay Dundee. His study aimed to evaluate the effectiveness of a group of minimally trained/experienced volunteer mental health counsellors.

The results of the study showed that professional counsellors produced approximately twice the effect of the volunteer counsellors due to their greater levels of training and experience. It was found that paraprofessionals quickly exhausted their limited repertoire of counselling skills/strategies and felt unable to respond helpfully to clients that were experienced as difficult, ambivalent about change or who did not seem to be responding to counselling.

The findings suggest that minimally trained/experienced paraprofessional counsellors working in mental health settings may benefit from longer and more targeted training programmes before engaging in practice. Such training might, for example, pay particular attention to helping volunteers develop their relational competence, ability to engage and monitor clients' involvement in therapy, and where possible to negotiate planned endings with clients.

Overall the results of this study challenge the general finding from previous research that paraprofessional counsellors can achieve similar outcomes to their professional counterparts.

How effective are minimally trained/experienced volunteer mental health counsellors? Evaluation of CORE outcome data.
Joe Armstrong

Back to top

Managing implementation challenges key to outcome measurement success

Successful engagement with outcome measurement by a psychological therapies service requires attention to be paid to the organisational and professional aspects and personal resonances for clinicians if it is to become established.

This is the conclusion of a paper by the Newham Psychological Therapies Service (PTS) which has been using the CORE system of evaluation to demonstrate effectiveness since 2004.

Routine measurement of outcomes in psychological therapies services has been given increased emphasis recently. The Newham service has gone through a developmental course in establishing routine evaluation with consideration given to national guidelines and local innovation.

Outcome measurement provides a mechanism to improve service quality and accountability. The implementation process at Newham has allowed the service to introduce monitoring systems on health outcomes to improve service quality, which has in turn improved wait times, accessibility, care pathways and interface with other services.

The project at Newham has provided useful learning on managing the challenges of implementation both at an organisational and a practice level. Such challenges are multidimensional; spanning across operational, organisational, and clinical aspects of the service delivery. Despite success at implementing outcome measurement at Newham, challenges therefore remain to the further development of this area of work.

The implementation of routine outcome measures in a Tier 3 Psychological Therapies Service: The process of enhancing data quality and reflections of implementation challenges.
Amra S. Rao, Gemma Hendry and Robert Watson

Back to top

Neuro-linguistic psychotherapy improves perceived quality of life

Neuro-linguistic psychotherapy (NLPt) is an effective method in supporting people to resolve psychological difficulties and develop a more positive perception of their quality of life.

This is the finding of a study which aimed to examine the effects of NLPt on psychological difficulties and perceived quality of life of clients who went for psychotherapy.

After therapy, participants reported a significantly smaller overall number of psychological difficulties. Therapy strengthened their resources and reduced dysfunctional ways of mental or emotional experience.

It was found that there was a significant increase in perceived quality of life after therapy, as compared to the wait-list control group. Participants reported a greater satisfaction with current life circumstances, and also a more positive overall view of their lives. Therapeutic improvements were still present five months after the end of therapy, showing further development in the same direction.

The study adds weight to the assertion that NLPt therapy not only helps people resolve current difficulties, but can also help foster new learning and personal development.

Effects of Neuro-Linguistic Psychotherapy on psychological difficulties and perceived quality of life
Melita Stipancic, Walter Renner, Peter Schutz and Renata Dond

Back to top

Developing coding skills key in psychotherapy training

Structured training to develop techniques to rate therapists during psychotherapy sessions increases training benefits, and may have a positive effect for students in learning how to conduct psychotherapy.

This is the conclusion of a study which aimed to address the effects of structured training on the development of coding skills to rate therapists in psychotherapy process research. The study involved reviewing a course outline for training and examining it in relation to ratings of therapist techniques used during psychotherapy sessions.

The results reveal that novice graduate trainees with limited psychotherapy and no short-term psychodynamic psychotherapy (STPP) specific experience can obtain good to excellent reliabilities rating therapist technique. In fact, good to excellent reliability can be achieved in a short period of time (5 to 30 hours), which is substantially less than other training programmes.

A potential advantage to teaching graduate students without clinical experience to rate psychotherapy process is that they have the opportunity to view sessions and learn process components prior to seeing their own patients. This may have a positive effect on learning how to conduct psychotherapy.

The present study might be used as a guide to help outcome researchers develop strategies and modules to ensure treatment integrity and adherence for therapists.

A training example for conducting psychotherapy process ratings: An example using therapist technique
Michelle B. Stein, Frank P. Pesale, Jenelle M. Slavin and Mark J Hilsenroth

Back to top

Both group and individual therapy important for bereaved clients

Both group work and individual counselling are valuable tools for bereaved clients. Groups have a normalising influence, helping members make new social contacts and practice social skills, while individual counselling facilitates the initial telling of the story and the expression of extreme emotion.

This is the conclusion of work by Christopher Vlasto, which explored therapists' perceptions of the relative benefits and pitfalls of group work and individual counselling for bereaved clients.

The findings suggest that individual counselling may be useful as a primary intervention easing the 'emotional loneliness' caused by the death of a spouse or attachment figure. It was perceived as a safer experience providing clients with a chance to tell their story in depth, and to release deep feelings without embarrassment.

Group work on the other hand may be of more benefit later in the bereavement process, facilitating an engagement with the outside world and alleviating 'social loneliness'. Being primarily a social intervention, groups were thought to help clients feel less isolated and to see how other people grieve.

The study reveals that bereavement services might usefully combine group and individual provision. Initial assessment could help clients clarify their needs and facilitate their choice of service. This would be more cost effective and potentially ease clients' bereavement experience.

Therapists' views of the relative benefits and pitfalls of group work and one-to-one counselling for bereavement
Christopher Vlasto

Back to top

Discourse analysis: rich pickings for therapists

Through the critical analysis of counselling sessions, research interviews, written texts and other materials, discourse analysis can provide insight into ways in which counselling operates as a social practice, and so help counsellors to contextualise their work within broader social structures and processes.

This is the conclusion of a paper by Sheila Spong of the University of Wales Newport, which looks at ways of understanding discourse analysis and discusses what the approach can offer counselling research and practice.

Discourse analysis suggests that people are at least partly shaped and limited by the discourses that are available to them. It can aid counsellors to develop understanding about how the things that they say, write and do help to create and recreate the world. The way things are spoken about does not merely describe the world, but it makes the world what it is.

This paper shows that discourse analysis is useful to counsellors. The reasons lie in the richness of explanation and the variety of challenges which discourse analysis research can offer. It can raise questions about the particular words or explanations used in a given situation; be used to explore the structural and social implications of the activities engaged in; and provide a keen critical edge to aid understanding of the profession as a set of social practices with implications beyond those which are immediately obvious.

Discourse analysis is therefore an approach which can examine the social in combination with the psychological.

Discourse analysis: Rich pickings for counsellors and therapists
Sheila Spong

Back to top