Digests - September 2011
- Fear and fragmentation characterise trainees' experience of research during their training.
- Experiencing a 'therapeutic edge' inside the Tardis of the Professional Doctorate.
- Group psycho-education can act as a viable alternative to individual counselling in primary care.
- Despite dilemmas and difficulties, personal therapy in training considered essential for trainees.
- Counsellors-in-training behave differently in online counselling than in face to face sessions.
- A strong therapeutic alliance found to temper the negative impact of cultural ruptures.
- While adhering to treatment emerged as a significant challenge for all participants in this study, their experiences were complex and covered a much broader spectrum than health threats alone.
- Significant distress found in almost a quarter of the incoming undergraduate students surveyed, but no linear relationship between well-being and academic achievement.
- A Delphi study offers a stimulating experience for researcher and participants and comprehensive research findings.
1. Fear and fragmentation characterise trainees' experience of research during their training.
At an intellectual level trainees appreciated the value of research and recognised its place within the psychological therapies. However, they experienced research and practice as fragmented and research as something to be feared rather than enjoyed. These are the findings of Moran's study that aims to examine trainee practitioners' perceptions of research in training.
In this study, 14 trainees participated in two focus groups. Using the Framework approach to analyse the data Moran's findings indicate that while participants appreciated the value of research, most found it challenging and anxiety provoking. Starting research training early and using an experiential approach to research are just two of the ways, according to the participants in this study, in which training in research could be adapted to motivate trainees to engage with research and enable integration. Moran also examines her findings in light of the wider debate about evidence and practice.
2. Experiencing a 'therapeutic edge' inside the Tardis of the Professional Doctorate.
In her introduction, Silvester describes starting a professional doctorate in counselling as entering the Tardis for the first time in which 'reality bears no comparison with the expectation.' This experience inspired this study which aims to explore the experiences of students undertaking a professional doctorate in counselling.
Interviewing students from years one to six on a professional doctorate programme within a UK university, and analysing the transcripts using a thematic analysis approach, Silvester identified various themes such as personal development, passion and voice. That students on this kind of course will be challenged in a number of ways is also evidenced in the literature; what this study shows is that there is a particular characteristic for the participants in this study - what Silvester identified as 'therapeutic edge'. She concludes that by understanding more about the challenges they may face on this kind of course, students may be able to identify good support systems.
3. Group psycho-education can act as a viable alternative to individual counselling in primary care
With little research into the effectiveness of psycho-educational courses provided in primary care, this study aimed to assess the clinical effectiveness of an 8-week course and to examine the results in comparison with individual counselling treatment outcomes from a previous study.
Using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), participants reported significantly lower levels of psychological distress after attending the course. These results are comparable to outcomes measured in the same service
for individual counselling, indicating that group interventions could be considered a legitimate alternative to individual counselling.
Rather than replacing individual counselling in primary care, the authors suggest that group psycho-education might be provided in addition to individual sessions to enable waiting times to be reduced as more economical deployment of clinical time is facilitated. They point out that such a provision could fall in line with Department of Health policies and guidance of improving patient choice.
An outcome evaluation study of a psycho-educational course in a primary
Debi Davis; Stephanie Corrin-Pendry; Mark Savill; Charlotte Doherty
4. Despite dilemmas and difficulties, personal therapy in training considered essential for trainees.
This study reveals that although therapists face dilemmas when providing personal therapy to therapists in training, they consider therapy to be essential for trainees. Difficulties arose as a result of therapy being a course requirement, but despite this participants believed personal therapy should be mandatory.
King aims to explore the dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training by interviewing eight experienced psychodynamic psychotherapists and analysing their responses using a qualitative form of content analysis. Her findings fall into two categories of dilemma: clinical and personal. Through her exploration of the categories in this paper, she demonstrates the dilemmas that face therapists working with therapists in training. She also demonstrates the strategies that were reported to manage the dilemmas and recommends further research into the effectiveness of personal therapy for trainees; the person of the therapist; and
5. Counsellors-in-training behave differently in online counselling than in face to face sessions.
Although the use of counselling interventions were similar to those used in the face-to-face counselling, reassurance and open questions were used twice as often, while interpretation and direct guidance were used less frequently in online sessions. The counsellors-in-training participating in this study reported an increase in their ability to form a therapeutic alliance after conducting an online session. Where the client symptoms represented a single diagnosis, most counsellors reached this correctly, but they had more trouble when the symptoms were mixed. These are the findings of this study designed to shed light on the process of online counselling.
Analysing the transcripts from 54 online sessions, Mallen et al investigate the dynamics of an initial online counselling session held in a synchronous chat environment between counsellors-in-training and a trained confederate posing as a client. This study provides new insights into issues that may need to be addressed for the training of counsellors to work in this area.
Online counselling: An initial examination of the process in a synchronous
Michael J. Mallen; Indria M. Jenkins; David L. Vogel; Susan X. Day
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6. A strong therapeutic alliance found to temper the negative impact of cultural ruptures.
This study shows that clients can experience microaggressions in any therapeutic dyad, regardless of the ethnicity of the client or the therapist and clients reported that microaggressions impacted upon the therapy process and outcome. But what the researchers found most striking is the extent to which a strong alliance can temper the negative impact of microaggressions.
Recruiting clients from a large university counselling centre in the United States, and using a range of measures, the aim of this study was to: determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity; whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. The results suggest that therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. But perhaps most importantly, therapists should attend to the therapeutic relationship.
Cultural ruptures in short-term therapy: Working alliance as a mediator
between clients' perceptions of microaggressions and therapy outcomes
Jesse Owen; Zac Imel; Karen W. Tao; Bruce Wampold; Amanda Smith; Emil Rodolf
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7. While adhering to treatment emerged as a significant challenge for all participants in this study, their experiences were complex and covered a much broader spectrum than health threats alone.
The authors of this paper were driven to carry out their research in the hope of advising better multi-disciplinary care and treatment for HIV/hepatitis C virus (HCV) co-infected gay men. In their clinical work they found the existing treatment model did not seem to be working towards preventing reoccurrences of patients presenting with severe and traumatic HCV treatment experiences.
Thirteen HIV-infected gay men who had undergone HCV treatment were interviewed and a qualitative analysis was conducted. Participants described HCV and its treatments in the context of their relationships and lifestyles and reported coping with a range of significant psychological and social threats which can impact on adherence to treatment. The authors make a range of recommendations, including that psychological services be available at an earlier stage to help patients make informed choices about whether or not to begin a course of treatment.
Another dragon in the kitchen: Psychological experiences of hepatitis C treatment among HIV-hepatitis C co-infected gay men
Michael Sinclair; Susan McPherson; Robert Bor; Lisa Orban
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8. Significant distress found in almost a quarter of the incoming undergraduate students surveyed, but no linear relationship between well-being and academic achievement.
Despite finding quasi-clinical distress to be associated with low self-esteem and social anxiety, no statistically significant links were found between student well-being at the beginning of the first year and academic achievement at the end of that year in this study.
Aiming to profile the well-being of first year students entering one UK university, Topham and Moller explored whether initial well-being was related to year-end academic performance. A total of 117 students completed the Rosenberg Self-Esteem Scale, Clinical Outcomes in Routine Evaluation-General Population and Liebowitz Social Anxiety Scale before starting their first term at university; their academic achievement data were collected from academic records. The findings suggest a more complex relationship between well-being and academic achievement and a need for further research.
9. A Delphi study offers a stimulating experience for researcher and participants and comprehensive research findings.
This paper highlights the reflection needed and the potential difficulties around participant preparation, questionnaire design, sampling, data analysis and research administration in a Delphi study. However, West finds these areas were more than compensated by the stimulating experience of conducting this kind of research and the comprehensive quality of the findings.
Popular in the health and social care domain, Delphi studies are used to elicit views and opinions from experts in the field on specific topics, without the need for face-to-face interviews. Aiming to bring Delphi methodology to the attention of potential researchers in counselling and psychotherapy, West describes her experience of undertaking a Delphi study using email and incorporating participant feedback. In this paper she discusses the advantages and disadvantages, as well as the complexities and limitations of the Delphi methodology. She incorporates recommendations from her own experience of completing a Delphi study looking at the aspects of supervision that require consideration when supervising counsellors and psychotherapists working with trauma.