Discussions
Research Conference 2022 abstracts

A narrative portrait of life with HIV through the lens of social justice counselling

Edgar Rodriguez-Dorans

Professional role: Lecturer in Counselling and Psychotherapy
Institution/affiliation: University of Salford
Email: e.rodriguez-dorans@salford.ac.uk

Background and context: Adherence to HIV treatment is crucial for the wellbeing of people living with HIV. Treatment consists of antiretroviral therapy – a combination of medicines that needs to be taken everyday. This intake is not consistent across individuals; some people take their medications with conscientious regularity whilst others, for a variety of reasons, are inconstant. Achieving and maintaining healthy lives demands from people living with HIV a series of everyday commitments to keep their treatment adherence. At the same time, they face several everyday challenges and personal barriers related to stigma, prejudice, discrimination, and other psychosocial factors impacting their mental health. The treatment-adherence approach – take your meds and you’ll be fine – frames intake efficacy as the individual’s task but fails to acknowledge the broader social challenges that impact on this everyday commitment.

Questions and issues to consider in the session: This session invites a conversation about the limits of the treatment-adherence approach to wellbeing management of people living with HIV and the potentiality of community-based, social justice approaches to complement medical treatments.

Bringing together social justice counselling and narrative portraiture illustrated through long-term counselling work with a young gay man living with HIV, this presentation addresses ordinary aspects of life with HIV at the intersection of migration, minority status, stigma, prejudice, violence, and the inequalities that are at play with these characteristics.

Audience: This session will be of interest for practitioners and trainees working with people living with HIV and, more broadly, to those interested in community care and social justice counselling.

Considerations given to issues of equality, diversity and inclusion: Studies related to the ordinary aspects of life of people living with HIV are scarce and medical advancements are not sufficient in themselves to guarantee treatment adherence. By considering a broad range of everyday aspects of life such as intrapersonal processes (anxieties, fears, beliefs, ideas about the future) and interpersonal dynamics (with partners, lovers, friends, family, public discourses); and the relationships of the individual with the material world (hospitals, labs, medicines, medical documents) and with the digital world (biometric data, online contents), this discussion will bring the conversation from an individualised, medicalised perspective towards a socio-cultural understanding of the everyday aspects of life with HIV.

Advancing Lesbian, Gay, Bisexual, Transgender, and Queer+ (LGBTQ+) human rights in counselling, psychotherapy and coaching

Sharon Horne and Eric Manalastas

Professional role: Professor
Institution/affiliation: University of Massachusetts Boston
Email: sharon.horne@umb.edu

Background/context: In this discussion session, we will draw from our work (e.g., in The Cambridge Handbook of Psychology and Human Rights and the special issue on 50 Years Since Stonewall in The American Psychologist) on LGBTQ+ human rights in practice. Our focus will be to highlight current global stances available to advance equality, diversity, and inclusion (EDI) in professional psychotherapy practice. We will cover both UN Sexual Orientation and Gender Identity positions and the Commitment Statement of the International Psychology Network for LGBTQ Issues (IPsyNet), which has been endorsed by 43 national psychology organisations and translated into 13 languages. Discussion items will include challenges and barriers for counsellors and psychotherapists in working with clients who are diverse in sexual orientation, gender identity and expression, and gender reassignment status, and how transnational LGBTQ+ policies and standards may assist with establishing spaces that are inclusive and welcoming of diverse clients. We will offer examples of how these resources can be integrated in practice to support LGBTQ+ clients, how they can signal to clients therapist’s commitment to EDI, and how familiarity with these positions can foster greater organisational dedication to inclusive policies to better serve LGBTQ+ clients.

Questions/issues to consider in the session: Following examples of the integration of policies with counselling/psychotherapy practice, we will invite audience members to share their experiences of including human rights and position statements in working with LGBTQ+ clients. We hope to provide a space for clinicians who are working with LGBTQ+ clients to share information and experiences; to foster networking among participants; to increase engagement and share examples of successful efforts to embed policy and supports for LGBTQ+ clients.

Audience: Counsellors and psychotherapists who work, or expect to work, with LGBTQ+ individuals, couples, and groups are expected to benefit from this session.

Considerations given to issues of equality, diversity and inclusion: The discussion session will address the theme of equality, diversity and inclusion (EDI) directly by focusing on counselling/psychotherapy and coaching issues related to the protected characteristics of sexual orientation and gender-reassignment, two of the most historically contested topics in professional mental health practice. 

Implications for counselling and psychotherapy policy, research and practice of knowledge based on averages

John McLeod

Professional role: Professor of Counselling
Institution/affiliation: Visiting Professor, IICP College, Dublin
Email: johnmcleod2016@gmail.com

Background and context : This discussion aims to provide an opportunity to explore issues around how research is carried out, and how different methodological choices shape the type of knowledge that is produced. These questions are particularly relevant for researchers in the field of counselling and psychotherapy, where research-based knowledge is used for different – and sometimes contradictory – purposes in relation to policy and practice. The specific methodological choice that will be the focus of this discussion is the widely-adopted practice of collecting and analysing data, and drawing conclusions, on the basis of averages (i.e., mean, mode, median, qualitative themes and categories, etc.). An initial brief presentation will summarise recent methodological and philosophy of science perspectives that have argued that an over-reliance of average-based knowledge limits the possibilities for using research findings to inform practice. Examples of therapy research studies that illustrate the implications of averages-based analysis and contrasting forms of more individual or sub-group analysis, in the area of counselling for adolescents.

Questions and issues to consider in the session:

The second half of the session will involve discussion and dialogue around such questions as:

• how therapy research is used to guide policy and practice;
• what it means for me as a researcher, to analyse data in terms of average scores/themes, or to deploy an approach that is grounded in individual cases?
• the pros and cons for me as a practitioner who reads research, of these contrasting stances?
• strategies for combining average-based and sub-group approaches to data analysis;
• what are the underlying philosophical, political and social dimensions associated with this type of methodological choice?

Audience: The session is intended to be of value both to experienced researchers who wish to reflect on the methodological assumptions that support their work, and practitioners who seek to gain a fuller appreciation of how different forms of inquiry might influence the value of studies that they come across. Participation in the discussion does not require any prior training in research methodology.

Considerations given to issues of equality, diversity and inclusion: Practical knowledge that addresses issues of social justice and the crisis of the relationship between human beings and the natural world, requires a capacity to engage in dialogue across different epistemological stances and contrasting social identities and life experience. The workshop seeks to enhance awareness of some of the ways in which methodological choices can serve both to challenge and reinforce existing structures of inequality.

‘Invisible fire’: Unanswered questions about queer female erotic transference in the psychodynamic and psychoanalytic literature

Harriet Mossop

Professional role: Postgraduate Researcher
Institution/affiliation: University of Essex, Department of Psychosocial and Psychoanalytic Studies
Email: hm21886@essex.ac.uk

Background/context: The long history of the pathologisation of non-heterosexual sexualities in psychotherapy (Dean & Lane, 2001) means that homoerotic desire in psychotherapy can still be difficult to for psychotherapists to talk about and work with (Mann, 2003). This seems to be especially true of female-female erotic transference, which has been found to be especially intense (Lester, 1985), ‘dramatically sexual’ (Person, 1985), or ignored entirely. This may be one reason why female psychotherapists most often commit sexual boundary violations with female patients (Celenza, 2014), and lesbians and bisexual women in the UK experience worse outcomes in psychotherapy than heterosexual women (Rimes et al., 2019).

Questions to consider in the session: This session will review the psychodynamic and psychoanalytic literature on queer female erotic transference and countertransference from Freud to the present. It will explore the adequacy of current theories to explain why erotic feelings between women in the psychotherapy consulting room can be difficult to discuss and work with, experienced as a dangerous “invisible fire” in the consulting room. Is it because they arise from powerful pre-verbal maternal-infantile erotic interactions brought alive in the transferential field (Elise, 2002)? Because female psychotherapists’ training and personal therapy have not adequately explored their same-sex desires and internalised homophobia (O’Connor and Ryan, 1993)? Or because of broader societal challenges in conceptualising lesbian desire which are reflected in psychotherapy (de Lauretis, 1994; Lorde, 1984; Roof, 1990)? The session will examine potential answers to these questions based on the literature and will highlight where further work is needed from clinicians, psychotherapy training institutions, and researchers.

Audience: The session will be useful for conference delegates of any gender, but especially female delegates who wish to understand and reflect on same sex attraction as it arises in the psychotherapy consulting room and consider implications for their research or clinical practice.

Consideration given to equality, diversity and inclusion: Erotic feelings can arise in female-female therapeutic dyads regardless of the sexual orientation of the therapist and the patient. However, it is especially important to be able to identify and work with these feelings with women who identify as lesbian, gay or bisexual, or who are exploring their sexual orientation, as indicated by the data on boundary violations with female patients and outcomes in psychotherapy in the UK with lesbian and bisexual patients. This session would therefore contribute towards the safer inclusion of LGBT women in psychotherapy practice and research. 

Justice and Juxtaposition: A Facebook group for people bereaved by and during Covid-19

Lynne Gabriel and Dr John Wilson

Professional role: Professor of Counselling & Mental Health, Director of University Mental Health Centre, York St John University
Institution/affiliation: York St John University
Email: l.gabriel2@yorksj.ac.uk

Background and context: Limited literature exists in counselling on how diverse peoples and communities grieve. Anthropological studies indicate cultural identity influences grief processes and rituals (Silverman, 2021). Cultural norms inform grieving and ways that people build new roles, relationships, and identities. When people find themselves in contexts different from their culture of origin and feel unable to express grief in culturally significant ways, complicated or traumatic grief can develop (Smid et al., 2018).

Covid-19 brought into sharp contrast the trauma of conflicted and complicated grieving, including denial of social, familial or community- based death rituals. Early in the pandemic we secured ethical consent to set up and undertake research through a closed Facebook group for people bereaved by or during Covid-19. The group has grown to over 600, with counsellors and therapists amongst its membership. It operates on a mutually respectful, collaborative basis. Drawing people from different cultures across the UK and abroad, members represent diverse ages, genders, sexual identities, religions, cultural heritages, and ethnic backgrounds. Members join on the basis that we are hosting a research-based group, with people participating in bereavement support groups and co-producing ethnographic content. Membership requests are vetted and, occasionally, members have been excluded when unethical agendas or behaviour become evident.

Exclusions aside, inclusivity is a central feature of the group. Decolonisation of bereavement work, through challenging the ‘perceived wisdom’ of extant knowledge, is important to the researchers and is a key feature in the discussion.

Questions and issues to consider:

• How can we diversify bereavement concepts, theories, and practices, in support of approaches that epitomise justice, accessibility and inclusivity?
• What does decolonisation mean in the context of bereavement support?
• How can we host a group space in which multiple and diverse beliefs are welcomed and valued?

Audience - who will benefit from attending the session? How will the session be of use to conference delegates? Those benefitting include people working with bereaved clients or engaging with bereavement in a range of settings including training, education, supervision, and therapeutic group settings. The discussion will invite critique and challenge perceptions of dominant westernised concepts of grief, loss, and bereavement.

Considerations given to issues of equality, diversity, and inclusion: The group was initiated with sensitivity to protected characteristics. Core criteria for membership were made clear, along with standards of behaviour in relation to being a member and to any content posted in the group (Rosenblatt, 2001; 2017). 

Missing voices: Thickening research narratives

Dr Mhairi Thurston and Nicola Blunden

Other presenter: Nicola Blunden, Metanoia Institute
Professional role: Senior Lecturer in Counselling
Institution/affiliation: Abertay University, Dundee
Email: m.thurston@abertay.ac.uk

Background/context: What does the literature say about the mental health of people with a vision impairment and the impact of counselling? Five electronic databases were searched in October 2021. The databases included CINAHL, Scopus, PsycArticles, PubMed and ProQuest Dissertations and Theses, Studies that fitted the inclusion criteria were screened. A narrative synthesis of studies and the associations between vision impairment, mental health and counselling was completed. The authors observed methodological hierarchies. The voices of blind people were missing in most studies.

Questions/issues to consider in the session: The findings prompted the following observations:

• A thin narrative – publications in Ophthalmology journals cited other publications in Ophthalmology journals.
• Did the thin narrative lead to a medicalised interpretation of sight loss and mental health?
• What evidence was being missed out? Pluralistic research perspective could be useful (Smith, K, McLeod, J, Blunden, N, Cooper, M, Gabriel, L, Kupfer, C, McLeod, J, Murphie, M-C, Oddli, H W, Thurston, M, & Winter, L A (2021). A pluralistic perspective on research in psychotherapy: harnessing passion, difference and dialogue to promote justice and relevance. Frontiers in Psychology, 12, [742676]. 

Discussion will be welcomed about how thin narratives are perpetuated in research and how interventions are “done to” rather than “done with” marginalised groups.

Audience: The following delegates may find this session of interest:

• Anyone who is interested in research evidence and social justice
• Counsellors who are interested in better understanding the association between sight loss and mental health
• Researchers who are interested in co construction with marginalised client groups.

Moving a counselling organisation to an online data management system: are online database systems the way forward for counselling organisations?

Jeannette Roddy

Professional role: Senior Lecturer
Institution/affiliation: University of Salford
Email: j.k.rodddy@salford.ac.uk

Background/context: Counselling in the UK is often delivered through small private practices or third sector organisations. Online systems can consist of spreadsheets and databases constructed to meet the specific needs of the organisation which, over time, can become cumbersome and time consuming to keep up to date.

At the University of Salford, after rapid expansion of our Counselling Centre, we needed a more efficient way to manage our clients and student counsellors and invested in an online client management system. This is working well for us but moving from one system to another was not without its challenges.

This session offers the opportunity to reflect on both the benefits and challenges of not only the technology, but also the way that we work.

Questions/issues to consider in the session:

• What database features would be most helpful to you and your service?
• How do you ensure that your staff team are fully up to speed when they work part-time, and cannot all attend the training sessions?
• Who needs access to data and who wants access to data?
• What permissions do you need to use the measures or the data you are collecting electronically?
• How do you know whether the system is working for you?
• How could you use the data provided to help in client work (not just in terms of session scores)?
• Are there any effects on your clients?

Audience: The session will be of use to anyone who is currently using an online client management system or thinking about moving to one. It will look at system use and provide some thoughts and ideas about how to make the most of these systems.

Considerations given to issues of equality, diversity and inclusion: The use of online systems for referral, for example, come with some disadvantages, for example those without access to a computer or smart phone, those with difficulties using a computer and therefore are not suitable for all. However, we are seeing increasing numbers of clients from minority groups self-referring to our service, suggesting that it is providing increased access to other groups. This is an issue which also deserves further discussion and research.

Queer Existentialism: Beyond the closet and toward actualization

Dr Jake Wheatley, PhD, LPC, NCC, CCLS

Professional role: Assistant Professor
Institution/affiliation: California University of PA
Email: wheatley@calu.edu

Background and context:The topic of queer affirming therapy has circled around the ideas of helping individuals integrate their identity, come-out, and then build accepting relationships. Through the last 5 years as a counselor specializing in LGBTQIA+, I have found that there is a phenomenon that leaves many queer individuals left unsatisfied and anxious. What is beyond acceptance? This discussion will circle around the following identified issues as there is no current research on the topic:

• The importance of an existential understanding of oneself and life.
• How queer identifying individuals have a specific developmental process that focuses on acceptance but not much beyond that concept.
• The consequences as they are observed in queer life when not provided the proper mental framework for existential examination.
• A discussion on the themes of identity, success, relationship, and culture manifest in counseling with queer individuals.
• How current therapeutic processes are being used by the presenter to address this large gap.

Questions and issues to consider in session:

• As counseling professionals, what are the differences you see in queer identity acceptance vs. tolerance vs affirming?
• How do the existential themes of freedom, choice, and responsibility intersect with queer identity in cultures and lived experiences that are not the most accepting?
• How can we promote queer individual search for meaning beyond the coming out process and desiring just acceptance?

Audience: This session is a benefit to practicing counselors, professionals, and researchers. Conference delegates will have the opportunity to learn and process this important aspect of queer identity development.

Considerations to equality, diversity and inclusion (EDI): This discussion directly ties to EDI as it allows delegates to examine the main themes and needs of LGBTQIA+ mental wellness beyond acceptance. This is particularly pertinent as we examine the rights of queer individuals being infringed upon amongst the dissonance of legislation that promotes surface identity acceptance.

Relational interventions for gang-associated young people's mental health

Lakhita Uppal

Professional role: Trainee Counselling Psychologist
Institution/affiliation: London Metropolitan University
Email: lakhita.uppal@gmail.com

Background/context: The latest research suggests an estimated 29,000 children are in gangs, with approximately 22 becoming victims of serious youth violence each day. The public health problem is growing, with predictions the Covid-19 pandemic will increase the one in 25 adolescents already falling through gaps in education and social care. Poor mental health is at the forefront of this, not only as a risk factor for exploitation by gangs, but also the higher rates of PTSD, depression and anxiety as a result. In response, there is a drive for significant expansion of early intervention services and increased investment in mental health services for young gang-associated people. However, research suggests engagement with such services may be low, with macro-, meso- and micro-level factors in their accessibility and appropriateness. For example, stigma, distrust of professionals, and hypermasculinity are all barriers to mental health support for young people involved with serious youth violence, not least that many of them are criminalised before they are helped.

We know that mentoring relationships are popular amongst this population, but we are yet to understand the extent to which these explicitly support their mental health. Knowing that vulnerable young people actively dislike therapy, could understanding how the values of a therapeutic relationship exist within mentoring help inform best practice mental health interventions for these young people?

Questions/issues to consider in the session

• The challenge of accessibility and appropriateness of therapy for marginalised / ‘hard-to-reach’ young people
• Professional duty to challenge the stigma of mental health and therapy across issues of equality, diversity and inclusion
• The need for accessibility and appropriateness of therapy when other relational interventions exist (eg. mentoring)

Audience: School-based counsellors, therapists, mentors, coaches, researchers, and any services working with young people generally (due to poor mental health as a risk factor) and those involved with serious youth violence.

The session could take a critical perspective on our duty to improve the appropriateness and accessibility of mental health interventions for this population

Considerations given to issues of equality, diversity and inclusion: This directly considers issues of equality, diversity and inclusion for practices of counselling, psychotherapy and coaching in improving access and appropriateness for young people involved in serious youth violence. There is literature that draws upon how constructs of race , class, gender , social mobility and power are woven throughout the lack of engagement with, and inappropriateness of, mental health interventions for this population.