Digests - September 2010

Special Section: Training in Counselling and Psychotherapy

"Counsellors in the making"

Therapist development is important not only for students, trainers and supervisors, but also for clients and society at large. It is a complicated area to study, however advances in understanding and provision of training are essential to further research in the field.

It is important for this research to provide a better understanding of the training process and its impact on counsellors' overall development. There is therefore a need to study this more closely and to look at the factors that are relevant and meaningful to counsellors-in-training (e.g. interpersonal skills development, coping strategies, self-reflection and awareness).

This special section of three papers focuses on transformation and the development of professional identity. It is hoped that it will contribute to an understanding of some of the challenges counsellors encounter during their training years, and that it will highlight the importance of continuing to expand knowledge of the effective ingredients in counsellor training.

"Counsellors in the making": Research on counselling training and formative experiences of trainee counsellors
Soti Grafanaki

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Dilemmas of identity created by CBT training

Many therapists' who feel coerced into training in cognitive behavioural therapy (CBT), for reasons such as compliance with current Government policy, tend to hold highly negative views of the modality and are initially resistant to engaging with the training.

This is the conclusion of work by Valerie Owen-Pugh, which sought to explore the dilemmas of identity experienced by qualified psychodynamic counsellors studying cognitive behavioural therapy (CBT).

Participants were initially preoccupied with anxieties over loss of face and loss of their core theory. They were very conscious of the differences between the two modalities, could find nothing positive to say about CBT and were caught up in various uncomfortable forms of emotion, including an anxiety to defend psychodynamic therapy.

However, over time, participants were increasingly able to appraise CBT as an effective and ethical modality and find ways of integrating their new learning with their core theory.

The study reveals the sorts of problems that counsellors training in CBT might encounter in the current political climate, illustrating the ways in which the macro-political interventions, such as the Improving Access to Psychological Therapies initiative, can impact on the student experience.

It also demonstrates that more should be done to help counselling students move from a resistant to an integrative position. There are a number of ways in which they might be encouraged to take additive positions towards their new learning.

The dilemmas of identity faced by psychodynamic counsellors training in cognitive behavioural therapy
Valerie Owen-Pugh

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The challenge of becoming an integrative counsellor

Learning to be an integrative counsellor can be an ambiguous and anxious process, with individuals navigating their way through their training without a clear theoretical guide and with numerous hurdles in their path. To overcome this more should be done to ensure that trainees have relevant support in place to enable them to deal with these issues.

This is the conclusion of work by Lisa Lowndes and Terry Hanley, which explores newly qualified counsellors' reflections of undertaking professional training in integrative counselling.

The study identified one core category - 'The challenge of becoming an integrative counsellor'. Embedded within this were four sub-categories: 1) 'training issues', 2) 'applied issues', 3)'the development of an integrative theory and identity', and 4)'the impact of integrative training post qualification'.

At the heart of the study, participants reported the impact of not having one clear and solid theoretical framework to guide the way through their therapeutic training. Specifically it was noted that the absence of a shared discourse, such as those that surround established pure models, made it difficult to communicate and share approaches.

Resulting from this work, recommendations are made that trainers and practice supervisors are mindful of the distinct struggles that integrative trainees encounter. Additionally, in response to the isolation that some trainees report, greater use of peer support networks is encouraged.

The findings from this work will hopefully help inform training programmes and provide insight into the understanding of the integrative practitioners' development.

The challenge of becoming an integrative counsellor: the trainee's perspective
Lisa Lowndes and Terry Hanley

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The value of solution focused counselling models

Solution focused models of counselling, which are brief, collaborative, positive and future-oriented, are favoured by graduates as providing them with the opportunity to integrate other counselling models and add complementary professional development education.

This was the conclusion of research to discover whether or not teaching a solution-focused model of counselling is worthwhile, and to gain some insight into graduate views of the relevance and usefulness of their training.

62% of participants in the study indicated recognition that their sense of competence and identification as professional counsellors develops over time, and is assisted by relevant feedback and supervision from lecturers and practical counselling experience.

The counsellors involved rated their experience in placements as the most influential factor in their learning, with many noting how helpful it was for them to observe senior counsellors. Also, counsellors frequently mentioned critical incidents that occurred outside academic life as influential.

Additional factors rated by graduates as being important to their development included their ability during training to reflect on issues and help themselves, and to engage in supervision, live or delayed, of their solution-focused practice. It is particularly important to note that many counsellors recognise the considerable influence that their clients have on their development.

The research supports the view that the constructs of personal and professional development of counsellors overlap; a view that requires further exploration in terms of evaluating counsellor competence.

The research supports the view that the constructs of personal and professional development of counsellors overlap; a view that requires further exploration in terms of evaluating counsellor competence.

Does teaching a solution-focused model of counselling work? A follow-up of graduates
Judi H Miller

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End of Special Section

The challenge of counselling and psychotherapy research

By questioning and challenging assumptions, research findings can help counsellors and psychotherapists to be less rigid in their beliefs; and more open to the unique experiences, characteristics and wants of each individual client.

This is the conclusion of a commentary by Mick Cooper which seeks to argue that the value of counselling and psychotherapy research lies, not only in what it teaches therapists, but also in its ability to challenge them and their assumptions.

The paper demonstrates that research findings can help therapists stay open to the multifaceted and ever-changing nature of their clients' experiences – attuned, not to any one set of assumptions, but to the unique, unpredictable, indefinable individuals they meet in the therapeutic encounter.

If the aim is to engage with, and relate to, clients as the unique human beings that they are, then the process of constantly questioning assumptions is a profoundly important one.

While many beliefs may hold true for some clients some of the time, the research evidence suggests that they are unlikely to be true for all clients all of the time. It also indicates that different clients change in different ways, and being open to a multiplicity of explanatory frameworks may, ultimately, prove more useful than attempting to identify a single 'silver bullet' that accounts for it all.

The challenge of counselling and psychotherapy research
Mick Cooper

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Counsellors have valuable role to play in lives of people who self-harm

All counsellors who encounter self-harm in their professional and personal lives have a pivotal role to play in improving the lives of people who self-harm. This is done by embodying confidentiality and so facilitating a sense of trust, by opening minds through acceptance, and by expanding knowledge through participation in research.

This is the conclusion of a study by Maggie Long and Mary Jenkins, which aimed to explore counsellors' perceptions of working with people who self-harm and to gain an insight into their experiences of and ideas about self-harm.

Two major categories emerged from the findings: 1) the activity of self-harm; 2) the therapeutic relationship with people who self-harm.

It was revealed that in terms of the activity of self-harm itself, contextualising the act, not only culturally but individually in terms of the distressing life experiences that can predate the behaviour, could encourage a more open-minded approach on the part of the therapist.

In terms of the therapeutic relationship, the findings indicate that for people who self-harm this is vital, complex, long-term and multi-dimensional. It is also revealed that the therapeutic relationship is fundamental to therapeutic outcomes for clients.

Counsellors' insight into the breadth and depth of self-harming behaviour can foster understanding and acceptance, while also challenging negative attitudes. By raising awareness of the issue amongst counsellors, the study forges a small but important step towards achieving this aim.

Counsellors' perspectives on self-harm and the role of the therapeutic relationship for working with clients who self-harm
Maggie Long and Mary Jenkins

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Group therapy effective for females who self-poison

Group-based problem-solving therapy is effective in the management of deliberate self-poisoning.

This is the conclusion of a pilot study undertaken to assess the effectiveness of a time-limited, group-based problem-solving therapy intervention compared with a treatment as usual control group, in females who self-poison.

A total of 18 clients were randomly assigned to treatment or control groups. All clients were assessed using standardised questionnaires for depression, hopelessness, suicidal ideation and social problem-solving skills, at pre-treatment, post-treatment and two months follow-up.

The study revealed that the treatment group experienced significant reductions in levels of depression, hopelessness, suicidal ideation and improvements in self-assessed social problem-solving skills. These improvements continued for the treatment group, as was revealed at two months follow-up. However, the control group did not change significantly over time on mental health measures or social problem solving abilities.

It is felt that this change occurred as the intervention taught clients problem-solving techniques (PST) rather than merely offering solutions to specific individual problems, thus enabling them to enhance their problem-solving skills over time. It was concluded that PST also appears to hold promise as a beneficial intervention for suicidal clients.

Further research is now needed to confirm the results of this study, including a longer follow-up period in order to make firm conclusions regarding the maintenance of affective functioning and problem-solving abilities.

Group-based problem-solving therapy in self-poisoning females: A pilot study
Noreen Bannan

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Group therapy can help to treat OCD

Although not a common form of treatment for clients suffering from obsessive compulsive disorder (OCD), group-based interventions can be particularly helpful as they challenge isolation and can help to normalise feelings.

This is the conclusion of Hamilton Fairfax and Jane Barfield of the Devon Partnership NHS Trust, following their development of such an intervention over the last five years.

Participants reported that being in a group with other people suffering from OCD was of significant benefit. It helped them to normalise their feelings, challenge isolation, disclose difficult feelings and emotions, and support behavioural challenges.

The results add some support to the hypothesis that the group format encourages participant disclosure and engagement in treatment processes. The integration of neuropsychological theories, mindfulness and family groups were also highly rated by participants.

This exploratory study presents evidence to consider working with the challenging diagnosis of OCD within a group framework in a secondary care service. It also suggests that it could be beneficial to explore more community-based options such as developing a local support network, a client run self-help group, and a family support group in the general treatment of OCD.

A group-based treatment for clients with Obsessive Compulsive Disorder (OCD) in a secondary care mental health setting: Integrating new developments within cognitive behavioural interventions – An exploratory study.
Hamilton Fairfax and Jane Barfield

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Personal therapy – a key learning experience for therapists

Personal therapy is extremely valuable for therapists, providing both personal and professional development - helping the professional to function effectively whilst also enabling them to experience the world of the client.

This is the finding of a study by Vicky Oteiza, which aimed to explore therapists' descriptive accounts of their experiences of personal therapy.

The study indicated that participants' experiences of personal therapy had a positive impact on them to the point that all participants would recommend it. They focused on its relevance for personal and professional development, from learning about one's emotional blind spots and hypersensitivities, to extending one's awareness of the personal impact one tends to have on other people, as well as increasing the ability to recognise, accept, and work to correct one's inevitable human weaknesses and limitations.

Participants agreed sufficient time must be allocated for therapy, especially for those who want to become therapists, to allow deep exploration and change. Most agreed personal therapy should be time limited; contrary to personal development which they considered should be ongoing while practising.

The findings parallel those of previous research undertaken, supporting the general acceptance of personal therapy as important amongst therapists to increase effectiveness and maintain well-being.

Therapists' experiences of personal therapy: A descriptive phenomenological study
Vicky Oteiza

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Supervision an essential support mechanism for independent practitioners

97% of independent practitioners see support and self-care as an integral part of their work, and access such support from a variety of sources, including supervision (overwhelmingly), self-reflection, peer support, and personal therapy.

This is the conclusion of a study by Pamela Savic-Jabrow, which aimed to explore whether, how and where counsellors in private practice received support.

The research revealed the importance of supervision as a key support factor as it found that 100% of participants receive support primarily through this method. This clearly demonstrates the importance of the supervisor role and reflects the ethical requirement for ongoing supervision for all BACP member counsellors and psychotherapists.

Support from colleagues, perhaps in the form of peer support, was also found to be important with 80% seeking support by this means, affirming the value of and need for local networks of practitioners.

Other key methods of support identified through the study included the use of 'self', e.g. self-reflection; books and further reading; and other therapeutic methods, e.g. massage, and personal therapy. One respondent noted that 'being able to talk freely, feeling supported, (and receiving) verification with regard to work' was important, while another stated that support was a means of 'enabling me to get an outside perspective on work, emotional support when working with difficult issues'.

The emotional demands made on all counsellors and psychotherapists in their work are particularly so for practitioners without immediate access to support options. The study therefore demonstrates a clear need for support mechanisms to be in place for independent practitioners.

Where do counsellors in private practice receive their support? A pilot study
Pamela Catherine Savic-Jabrow

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Psychological mindedness improves empathy with clients

Therapists with higher levels of psychological mindedness (PM) have stronger empathy toward clients, increased self-understanding, and a greater ability to develop a working alliance.

Becky Daw and Stephen Joseph discovered this through their study to examine the association between PM and adaptive therapist attributes, clinician empathy, self-understanding and the therapeutic relationship in practitioners.

Psychological mindedness involves an interest in and ability to extract and make sense of psychological information (thoughts, feelings and behaviours) from a situation. The nature of the psychotherapeutic role and training demands therapists think about motives, distortions and inner experiences of others.

The research revealed that psychological mindedness was related in predicted ways to therapist self-understanding, working alliance, and clinician empathy. It was negatively associated with self-understanding recognition scores, as expected, and consistent with other research which suggests PM is associated with better psychological well-being and emotional adjustment.

It is therefore suggested that PM is not an issue only relevant to the trainee therapist, instead it should also be central to the continuing professional development of experienced therapists.

Psychological mindedness and therapist attributes
Becky Daw and Stephen Joseph

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