Focus on Research

Recording therapy sessions: What do clients and therapists really think?

Ellie Brown, Naomi Moller & Christine Ramsey-Wade

Audio or video recording of client therapy sessions is widely used, particularly during training. The recorded session offers a detailed view of the private exchanges between client and therapist, affording supervisors and trainers a unique opportunity to observe the trainee in practice, and giving the therapist an opportunity to revisit and reflect on part of their work that may otherwise be difficult to recall. Given the widespread use of recording as part of training, it is interesting that there has been little research to date about the impact on therapists and clients of recording sessions.

December’s issue of CPR (13:4) includes a paper by Brown and colleagues that aims to explore this area. Their investigation used a qualitative survey completed by 25 therapists and five clients, the responses to which were then analysed using thematic analysis. Four client themes and five therapist themes were identified. Although this was a small-scale study, some interesting findings emerged.

A notable finding in the study is that clients and therapists both stated that recording was of benefit to the therapist. Clients, for example, recognised that therapy sessions can be very full and for the therapist to have an opportunity to review what was said can help. The therapists in the research identified benefits such as being able to notice things that were missed in the session, using recordings in supervision to reflect more deeply on client work, and the need for recordings in order to complete assignments as part of training. Interestingly, the research also identified a client theme of ‘Is there a lack of understanding about recording?’ based on clients’ responses which suggested that they did not fully understand what the recordings would be used for.

The authors consider the ethical implications of both of these findings. They ask whether it is appropriate to record sessions when there is no reported benefit to the client of agreeing to this. They also highlight the issue of the client’s informed consent – if a client does not fully understand how such recordings will be used, can they really be considered to have consented to having their counselling sessions recorded? With recording of therapy session routinely as part of counsellor training, this is an important issue for training providers to address.

The full paper can be found in the December 2013 issue of CPR, and a practitioner version of the Abstract can be accessed on this website or by subscribing, free of charge, to our quarterly e-bulletin.

Dr Clare Symons
Editor, Counselling and Psychotherapy Research

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide

David Winter, Siobhan Bradshaw, Frances Bunn & David Wellsted

Working with clients who are distressed is the bread and butter of therapeutic work and it is not surprising that therapists so frequently also work with people who, at some point, present with suicidal feelings or who are actively suicidal. The challenges that go hand-in-hand with such work are manifold: seeking sufficiently detailed information with which to assess the level of risk while; balancing the ethical principles of the client’s autonomy with those of beneficence and non-maleficence; and managing our own feelings in relation to life, death and suicide.

In the September issue of CPR (13:3), Winter and colleagues present the first of two papers that systematically review the research literature as it relates to the prevention of suicide, this first paper focusing on quantitative outcome and process studies. The paper examines 15 previous systematic reviews and meta-analyses, provides a meta-analysis of 67 outcome studies and also offers a narrative review of 17 studies of therapeutic process. The papers reviewed span a period from 1981 to 2008.

The value of a systematic review such as this is that it brings together an enormous number and range of studies into one resource, evaluating the research and pulling out the common findings and highlighting unanswered questions. The article demonstrates that there is strong research evidence for the effectiveness of psychological therapies for the prevention of suicide. As such, this paper by Winter and colleagues offers an incredibly valuable source of information that is relevant to all practitioners irrespective of theoretical orientation or practice setting.

Working with suicidal clients can often leave counsellors feeling despairing, hopeless and helpless. This article also brings together literature relating to studies that examined the process of therapeutic work with suicidal clients and highlights the ambivalent feelings that therapists can experience in this work, while emphasising the value and importance of the therapeutic relationship.

The full paper can be found in the September 2013 issue of CPR, and a Digest version of the paper can be accessed on this site or by subscribing, free of charge, to our quarterly e-bulletin.

Dr Clare Symons
Editor, Counselling and Psychotherapy Research

The development of CORE-10: A short routine outcome measure

Many counsellors and psychotherapists have used CORE-OM, a 34-statement outcome measure used in benchmarking service delivery, and are familiar with its value not only as a benchmarking tool, but as a therapeutic one too.  It has the capacity to provide both therapist and client alike with insight into aspects of the client’s psychological distress, as well as helping to structure dialogue into important areas of functioning, coping and risk.

While CORE-OM is designed to be used at the beginning and end of therapy it can, of course, be used during therapy or even session-by-session.  Such use helps therapists gather rich data that can inform their own practice and also the wider strengths or otherwise of their therapy service.  For those therapists moving towards session-by-session use, either because they are required to do so or, like me, chose to do so, the benefit of a shorter version of the CORE-OM, which is still valid and has therapeutic value, is clear.

In the March 2013 (13,1) issue of CPR Barkham and colleagues report on the development of CORE-10 for the routine measurement of psychological distress in therapy in their paper, The CORE-10: A short measure of psychological distress for routine use in the psychological therapies.  CORE-10 draws on 10 statements from the full CORE-OM tool, is still statistically valid and perhaps most importantly for counsellors and psychotherapists with clients, can be administered quickly with little intrusion into the main space of therapy.  At the same time it still provides important insight into client function and coping.  As a therapist myself, I now use CORE-OM pre- and post-therapy, and CORE-10 on a session-by-session basis.  After initial anxiety about doing so, my own experience is that clients gain great value in reviewing their scores and discussing the relevance or otherwise of their CORE outcomes against their own subjective experience.

The Barkham paper takes the reader through the development of CORE-10 and its application in a primary care setting.  Obviously, while the paper looks specifically at primary care use, its conclusions can be applied to a whole range of settings.  They conclude in the Abstract that, ‘The CORE-10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings’.

The full paper can be found in March 2013 issue of CPR, and a practitioner version of the Abstract can be accessed by subscribing, free of charge, to our quarterly e-bulletin.

Dr Andrew Reeves
Editor, Counselling and Psychotherapy Research

  • The full paper is currently available free to access throughout February 2013 via rapid online publication.

'Coming out' in therapy? Perceived risks and benefits of self-disclosure of sexual orientation by gay and lesbian therapists to straight clients

Jo Moore & Peter Jenkins

A paper by Moore and Jenkins, in the forthcoming issue of CPR in December (12,4), touches on a couple of important dynamics in the therapeutic process: namely the exploration of sexuality and self-disclosure, in this particular instance the impact of gay and lesbian therapist self-disclosure relating to their own sexuality with heterosexual clients and the impact that might have on the therapeutic process.

The researchers undertook eight semi-structured interviews with a non-random, purposive sample of gay and lesbian counsellors and psychotherapists to explore their experience. The sample group were required to meet a number of criteria:

  • Self-identified as having a gay or lesbian sexual identity.
  • Were currently in therapeutic practice.
  • Were able to indicate that a substantial amount (+50%) of their therapeutic work was with heterosexual clients.
  • Were prepared to take part in a recorded interview.

Interviews lasted between 40 and 90 minutes and focused on:

  • Feelings around therapist self-disclosure (TSD) generally.
  • Whether they felt heterosexual clients would be aware of their sexuality through their website listing, etc.
  • If they felt heterosexual clients generally assumed they were also heterosexual.
  • Feelings around therapist self-disclosure of orientation (TSDO) and when they might initiate it.
  • Client variables, e.g. gender, age, religion etc. that might affect their decisions around TSDO.

A number of important findings are outlined in the paper, including high levels of anxiety and vulnerability identified by therapists in relation to their self-disclosure of sexual orientation because of a feared judgement by their clients and a subsequent need for therapist self-protection. The need for further research is indicated, in addition to an exploration of the role and place of supervision in the process of such self-disclosure.

The full paper can be found in the latest issue of CPR (December 12,4), together with a number of other papers exploring research into the form and nature of the therapeutic process.

Dr Andrew Reeves
Editor, Counselling and Psychotherapy Research

  • This paper is currently available online via rapid online publication where you can view the full abstract.
  • BACP members can access all CPR’s papers online by first logging in to the BACP members' area at www.bacp.co.uk. When you're logged in to BACP: Connect click on Features and under the Useful links list, click on CPR online and follow the link.
  • CPR’s quarterly e-bulletin includes Digests of all the papers in the forthcoming issue of the journal delivered straight to your inbox. Subscribe to CPR e-bulletin.

Developing research-informed practitioners – an organisational perspective

Liz McDonnell, Peter Stratton, Sheila Butler and Nick Cape

September 2012 12(3)

Two current trends are making it increasingly important for counsellors and psychotherapists to be more engaged with research. Evidence of effectiveness is being increasingly demanded by those who fund our therapies and also by our clients. Meanwhile therapy research is offering practicable ways for therapists to improve their practice.

The authors of this study argue that therapy organisations have an opportunity, perhaps even a duty, to meet the research needs of their members. Their article reports on a survey conducted by the UK Council for Psychotherapy (UKCP) to help it plan the activities of its Research Faculty. Key findings from the survey were that the most common ways of UKCP practitioners engaging with research were through reading, discussions with colleagues and doing research. Engaging with research collaboratively with other therapists, having more time, and access to user-friendly web-based research resources and updates, were the factors most commonly cited as supporting practitioner engagement with research. Conversely lack of time, difficulties accessing resources and materials and feeling not competent were the major barriers to practitioner engagement with research. This study has implications for clinicians, but also for training organisations and professional bodies such as the UKCP and the BACP, who have a crucial role in promoting best practice and in supporting their members to integrate research with their clinical practice in meaningful ways.

  • This paper is currently available online via rapid online publication where you can view the full abstract.
  • BACP members can access all CPR’s papers online by first logging in to the BACP members' area at www.bacp.co.uk. When you're logged in to BACP: Connect click on Features and under the Useful links list, click on CPR online and follow the link.
  • CPR’s quarterly e-bulletin includes Digests of all the papers in the forthcoming issue of the journal delivered straight to your inbox. Subscribe to CPR e-bulletin.

Counselling in the workplace: How time-limited counselling can effect change in well-being

June 2012 12(2)

At the start of the above study, the authors cite the UK Health and Safety Executive saying that, in 2008, an estimated 415,000 people, 'believed that they were suffering from stress, depression or anxiety caused or made worse by their current or past work' (p. 13). This statistic alone raises the imperative of the need for high-quality, responsive and appropriate support provision in the workplace, supported by a sound evidence-base. This latter point is particularly pertinent in these times of financial austerity where organisations across a range of settings have to account carefully to safeguard their financial future.

Of course, the evidence-base for counselling and psychotherapy in workplace settings has been in place for some time. There is growing evidence that such provision helps reduce absence as well as providing for a quicker return to work following a period of absence due to psychological problems (McLeod, 2010).

In the Collins et al. study, the authors invited clients of a university staff counselling service to complete the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) prior to, and after their counselling, as well as post-counselling follow-up at three and six months – 182 clients agreed to participate. Additionally, a comparison group was established that reflected the general demographic of the client group. They found that counselling intervention had positive effects on those attending, even though therapy had been time-limited (approximately seven sessions per client). Outcomes included an increased sense of well-being, which was maintained during the follow-up period. Significant statistical differences were found in the analysis of the WEMWBS data, with consistently higher scores post-counselling.

The authors conclude, based on their findings, that time-limited counselling can be an effective support option of members of staff. Given these findings and the wider evidence-base, there is a robust argument for the provision of such services by employers as a cost-effective means by which absence can be reduced, well-being increased and thus, presumably, overall profitability enhanced.

Further details of this study can be found in the forthcoming June issue of CPR.

Dr Andrew Reeves
Editor, Counselling and Psychotherapy Research

  • Health and Safety Executive. (2010). Self reported work-related illness and workplace injuries in 2008/09: Results from the Labour Force Survey. Retrieved from http://www.hse.gov.uk/statistics/lfs/lfs0809.pdf
  • McLeod, J. (2010). The effectiveness of workplace counselling: A systematic review. Counselling and Psychotherapy Research, 10 (4), 238-248.

For more details:

  • Counselling in the workplace: How time-limited counselling can effect change in well-being will appear in the June 2012 12(2) issue of CPR. It is already available online via rapid online publication. See the abstract and access the full paper.
  • John McLeod's article, The effectiveness of workplace counselling: a systematic review, is currently free to access from Taylor and Francis. See the abstract and access the full paper.

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To Record or Not Record Counselling Sessions for the Purposes of Training: Qualitative Research

June 2012

Over the years working as a supervisor of counselling and psychotherapy trainees, the issue of audio-recording therapy sessions for the purposes of training has frequently caused much anxiety.  How to introduce the possibility of audio-recording, when, or indeed whether to record at all has led to much discussion as to the relative gains and costs of the process.  While some supervisees have viewed this as simply another important aspect of their training, others have doubted its efficacy for learning and wondered whether the very process of recording a session changes it.

It is, of course, very possible to integrate the process of recording into the therapeutic relationship itself.  I recall during my own training making use of audio-recording for the purposes of my course, but also bringing sections of transcript back to the client for further exploration, facilitating great therapeutic change.  Neither does the perceived benefit or concern of audio-recording seem linked to the model of training , with trainees across a range of paradigms wrestling with the concept in equal measure.

One of the papers in the March 2012 (12,1) issue of CPR'The third person in the room': Recording the counselling interview for the purpose of counsellor training - barrier to relationship building or effective tool for professional development? by Marion Gossman and Judi H Miller, explores these very issues through the use of semi-structured interviews and focus groups with counselling students from five educational settings in New Zealand; the data was analysed by the means of constant comparison and NVivo.

All participants reported initial concerns about how the use of audio-recording may affect the therapeutic process by inhibiting the therapist's sense of being present during a session and, in turn, how it might impair the client's ability or willingness to use therapy effectively.  However, most of the participants noted that, over time, their confidence in using audio-recording increased and that the benefit in supporting the acquisition and development of counselling skills was noticed.  Overall the perceived benefits of audio-recording were seen to outweigh the costs.

If you are interested in the outcomes of this research you can find it in the forthcoming March 2012 (12,1) issue of CPR, where the research process and outcomes are described in more detail.

Andrew Reeves
January 2012

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A Toolkit for Developing Research in Supervision

June 2011

In the June 2011 issue (11, 2) of Counselling and Psychotherapy Research (CPR), Wheeler, Aveline and Barkham report on the development of research in supervision in their paper, Practice-based supervision research: A network of researchers using a common toolkit. They discuss the need for a prescribed common set of measures to help compare research into supervision, and to facilitate the development of future supervision research. They note that previous systematic reviews of supervision literature have demonstrated three key things: very little is known about the efficacy of supervision; studies that have been undertaken are general not based within practice; and a range of different measures are used making viable comparison particularly difficult.

Their own study was located within a Supervision Research Practice Network (SuPReNet) (funded by the British Association for Counselling and Psychotherapy (BACP)). In this study the authors selected and reviewed a number of potential measures that could be used in a standardised way. Having assessed the available evidence the authors yielded five core measures. These are now available for anyone to use, free of charge, and are accessible through the SuPReNet website.

This is an exciting development and illustrates how high quality, practitioner-based research can be undertaken at comparatively low cost.  It provides a gateway for practitioners/supervisors who might be interested in participating in research, but previously had few opportunities to do so. For more information about the particular aspects of this paper, contact the corresponding author, Prof. Sue Wheeler (sw103@leicester.ac.uk), and for more information about SuPReNet, see (www.bacp.co.uk/research/SuPReNet/).

 

For the full paper see the June 2011 issue (11, 2) of Counselling and Psychotherapy Research or click here to view the abstract.

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The Power of New Research

Since it was launched 10 years ago CPR had always aimed to disseminate high quality research in counselling and psychotherapy, while at the same time promoting the work of new researchers. At the journal we are aware that many counsellors and psychotherapists embark on their research journey, perhaps as part of a course of study, and never publish their findings. In all likelihood there is a plethora of undiscovered research that, if published, could contribute greatly to our understanding of the counselling and psychotherapy process.

In collaboration with BACP and sponsored by Routledge, CPR has given its name to a New Researcher Prize for several years. Current or recently graduated students in counselling and psychotherapy are encouraged to submit their research, in the form of a paper, so help identify emerging researchers or key research. The 2009 New Researcher prize was awarded to Mhairi Thurston, a lecturer at the Tayside Institute for Health Studies at the University of Dundee Abertay UK, for her study titled “An inquiry into the emotional impact of sight loss and the counselling experiences and needs of blind and partially sighted people”. This article in featured in the March issue of CPR 10(1).

Mhairi's research typifies what the CPR New Researcher prize is about: innovative research in an under-researched area with potential impact for visually impaired clients, counsellors and psychotherapists, other health care professionals working with the visually impaired, as well as at a policy level.

Mhairi, with her own experience of having lived through the impact of a diagnosis of visual impairment, asked a number of people about their experiences of being diagnosed as visually impaired and their views about counselling provision. Using qualitative approaches in analysing the data, Mhairi touched on the profound effects such as diagnosis can have. As one participant in her study stated, “I was told 'You've got…a genetic progressive eye disease and I'm sorry there is no cure. Away you go home'”, while another talked of her own trauma, “I went out at nine o'clock in the morning quite hale and hearty and I came back at night unable to drive and registered disabled at my work. Nobody said here's a leaflet or information on anything else. I came back and I didn't know if I was going to be blind in six months and it was really traumatic...”.

In exploring how the participants felt about counselling provision, Mhairi received mixed comments, including one participants who felt that “... counselling is not going to help me… the only thing that is going to make you feel better is getting your eyesight back”. While another stated that “Counselling absolutely helped me. I came out of counselling and I felt happy. I had a different perspective”.

In drawing together her conclusions Mhairi proposes a model from sight to blindness, and makes a number of interesting recommendations for counselling practice. Already her research has provoked interest in policy makers in Scotland, UK with the hope that the implications of her study will gather more of a national momentum. Mhairi herself hopes to continue her research in this area.

Read the full paper

Dr Andrew Reeves
Editor, Counselling and Psychotherapy Research

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