An Interpretative Phenomenological Analysis exploring experiences of post-traumatic growth in relationship to self-using arts-based research
Karen Nolan
Professional role: Student
Institution/affiliation: University of Salford
Email: k.nolan4@edu.salford.ac.uk
Aim/purpose: Posttraumatic growth is a term used to capture positive psychological change (Tedeschi and Calhoun, 1996) and occurs when the individual constructs a new psychological and emotional outlook to life from the aftermath of trauma (Calhoun and Tedeschi, 2004). The posttraumatic growth inventory (Tedeschi & Calhoun, 1996) looks at external relationships but not the relationship with self. The research sought to discover how individuals understood posttraumatic growth and their relationship with self.
Design/methodology: The multimodal approach (Boden and Eatough, 2014) was selected to allow visual and verbal data collection and analysis. Six participants were asked to create artwork within a two-week period describing the relationship with themselves since experiencing posttraumatic growth. The artwork was emailed to the researcher and analysed using the Boden and Eatough framework (2014) was used to inform questions for subsequent semi-structured online interviews, where the researcher and participant explored the artwork. Interviews were analysed using interpretative phenomenological analysis. Yardley’s (2000, 2017) criteria for good qualitative research was employed to enhance research quality.
Ethical approval: Ethical approval was granted by the University of Salford.
Results/findings: Three master themes and eight subthemes were developed from the analysis. The master themes were:
- ‘Acceptance’ within the self, of the present moment, and of their progress.
- Separation of self into ‘the parts’, firstly acknowledged, then embraced, then integrated into self, and
- ‘Knowing oneself’ included connection, discovery, reclamation of self, and seeing oneself.
Research limitations: Self-selection bias is present in the study (Sutton and Edlund, 2019). While individuals were required to satisfy the inclusion criteria to participate, half the participants were known to the researcher. Growth was self-reported by participants in the study, rather than using an objective measure of posttraumatic growth.
Conclusions/implications: The findings provide therapists with both a verbal and visual understanding of the relationship with self after trauma. Recommendations for practice include supporting the client to integrate and make meaning of their experience through a creative and narrative approach.
Considerations given to issues of equality, diversity and inclusion: Arts-based research is “particularly suited to working with participants who may not respond to the more verbal research methods such as survey forms, interviews and focus groups” Liamputtong and Rumbold (2008. p. 3). Creating artwork allowed participants to understand, make meaning, and take ownership of their experience both visually and verbally.
Being on the Road or Arriving the Destination: Therapeutic Change Process From the Perspectives of Turkish Emerging Adult Clients and Counsellors
Other author: Professor Seher Sevim
Professional role: Lecturer
Institution/affiliation: TED University, Department of Psychological Counselling and Guidance
Email: asli.ascioglu@gmail.com
Aim/purpose: The purpose of this study was to examine the experiences of the clients and counsellors during the individual integrative counselling process that resulted in positive change. The meaning of the therapeutic change, the progress of the positive change process, the processes that lead the clients to positive change, and helpful factors of the change process were investigated.
Design/methodology: The participants of the study consisted of 23 emerging adult clients and 21 counsellors. The qualitative approach based on interpretative-constructivist grounded theory methodology was employed. Data were collected through semi-structured face-to-face in-depth interviews.
Ethical approval: This study was approved by Ankara University Ethics Committee.
Results/findings: According to the analysis of the positive change stories of the clients, there were six higher-order categories; first orientation to change, what I carry in my pocket, the beginning of the road: in the shadow of ambivalent feelings, moving from change to transformation, roles on the scene and what I take with me when I leave. The observations and experiences of the counsellors were presented in five higher-order categories; first encounters from the other side of the mirror, the beginning of the road, moving towards change, roles on the scene, and my client when leaving.
Research limitations: This study is suitable for in-depth explorations than broad generalisations because of the qualitative nature.
Conclusions or implications: The path that started with the desire to "reach" the point called change seems to have ended with the acceptance that there will be no complete ending. Clients left the process by holding on not only to their new sense of self, but also to the belief and hope they had grown inside. It has been determined that there are overlapping and differentiating dimensions in the narratives of counsellors and clients.
Considerations given to issues of equality, diversity and inclusion: In the literature in Turkey, there is no study that examine the experiences of clients in emerging adulthood who leave individual counselling with positive change. The meaning of the therapeutic change and the factors contributing to it are limited to the literature obtained from Western cultures and the services provided are structured according to these implications. This study aimed to examine the change process through the eyes of Turkish emerging adult clients and to understand the perspectives of two important subjects of the change process in a comparative way.
Bridging gaps between HE and NHS mental health services: A call to action
Emma Broglia
Other authors: Louise Knowles
Professional role: Research and Policy Lead
Institution/affiliation: University of Sheffield
Email: e.l.broglia@sheffield.ac.uk
Aim/purpose: Discrepancies between service provision across sectors create barriers for students accessing and transitioning between mental health services in Higher Education (HE) and the National Health Service (NHS). These barriers lead to students falling through service gaps and experiencing delayed access to mental health support (Taylor, 2019; Universities UK, 2020). Effective response requires unity between sectors and a commitment to develop service partnerships. This research is part of the Mentally Healthy Universities movement and includes partnerships with Universities UK, Student Minds and NHS England.
Design/methodology: Focus groups and interviews with professional staff working in HE services (counselling, mental health, wellbeing and disability) were conducted across 8 universities in 5 regions. A student coproduction project was also conducted to capture the views and experiences students who have accessed HE or NHS mental health services. Separate thematic analyses were used on student and staff data to identify factors that contribute to service partnerships.
Ethical approval: Ethical approval was provided by the University of Sheffield Department of Psychology.
Results/findings: Combined findings underpin a practical toolkit for HE providers striving to develop local partnerships and it will available in January 2022. Sections of the toolkit include: student coproduction, data sharing, managing risk, measuring psychological health, and evaluation. Results, good practice examples and recommendations from the toolkit will be presented.
Research limitations: Services and partnerships varied by location and created challenges for collating findings.
Conclusions/implications: Challenges remain for developing partnerships between HE and NHS mental health services. The present study demonstrates that it is possible and beneficial to develop closer alignment between these sectors and the results underpin a practical toolkit and call to action for universities to develop partnerships to enhance student mental health care.
Considerations given to issues of equality, diversity and inclusion: Students experience differential access to university counselling and mental health services. Marginalised and underrepresented student groups experience greater barriers to accessing mental health support from their university. Restrictions to data collection within the NHS mean that important student characteristics are not captured from student clients. These data are necessary for evaluating clinical outcomes for students from different backgrounds and can be used to develop more diverse services and training for therapists working with marginalised groups. The present study and subsequent toolkit intend to address these issues.
Comics in Clinical Practice: A grounded theory exploration of how sequential art is applied to talking therapy
John Pollard
Institution/affiliation: Metanoia institute
Email: john@johnpollardtherapy.com
Aim/purpose: Therapists are required to engage in a continuous process of development regarding the range of their knowledge of theory, skills, and clinical tools. This is of particular importance when working with clients that struggle with traditional methods of working. This research project explores the application of sequential art (comic books, graphic novels, manga, comic strips etc) as a clinical tool for engaging with clients in talking therapy.
Design/methodology: Social-constructivist grounded theory was used to explore how sequential art was applied to practice, with whom, for what purpose, and to what end. Ten therapists with experience of applying sequential art to their clinical practice were interviewed.
Ethical approval: This study was granted ethical approval by the Metanoia Institute’s research ethics committee.
Findings: This research indicates that therapists consider the application of sequential art to be a useful tool for working with a range of clients’ presenting issues. The findings also indicate that therapists consider that the application of sequential art can support communication and collaborative working between them and their client, their client’s development of empathy, self-compassion and insight, and their client’s engagement in therapy overall. The clinical application of sequential art takes three broad forms; interventions based on the creation of sequential art, interventions based on the consumption of sequential art, and some combination of these two forms.
Research limitations: A therapist's account of their practice and their practice in action may differ. While the methodology applied here provided strong internal consistency across participant reports, a limitation of this study is that interventions used by participants were not independently observed.
Conclusions: This research has indicated that sequential art can be a useful tool for working with a number of presenting issues including historical trauma and chronic shame. While not all clients will connect with interventions that use sequential art, for those that do, it can help to make therapy feel more accessible and engaging. This study also provides an important insight into how protocols for new ways of working in clinical practice can be developed in the absence of specialist supervision or pre-existing frameworks to refer to.
Considerations given to issues of equality, diversity and inclusion: This study shows that the use of media like sequential art in talking therapy can open up an important route of engagement for clients that may experience difficulty with more mainstream tools for a variety of reasons.
Exploring the management of symptoms in persons diagnosed with Irritable Bowel Syndrome and its impact on their lives
Ellie Brandrick
Professional role: Counselling and Psychotherapy Student
Institution/affiliation: Keele University
Email: elliebrandrick1992@gmail.com
Aims/purpose:
- To explore how people with Irritable Bowel Syndrome (IBS) manage their symptoms
- To look deeper into the impact of IBS on people’s lives
Background: IBS is a chronic condition affecting people all over the world, it has a range of symptoms and currently requires a medical diagnosis. While there are many treatment options available, none have been shown to be wholly effective for IBS due to the lack of an agreed aetiology. More research is needed into the day-to-day management of the condition as well as how IBS impacts on the lives of those with the condition.
Design/methodology: Semi-structured interviews were carried out with five participants aged between 25 and 68, who had self-reported a medical diagnosis of IBS. Transcripts from these interviews was analysed using reflexive thematic analysis.
Results/findings: Reflexive thematic analysis of the data from this study found four broad themes across the interviews: managing IBS; emotions around IBS; living with IBS; effect of IBS on the sense of self.
Discussion: Findings around participants’ management of IBS were largely in-line with previous research in terms of reported symptoms and triggers. Overall, participants used a variety of methods to manage their condition, with most finding ‘alternative’, non-medical treatments the most helpful. Participants also described a strong emotional reaction towards their IBS. While there has been some emotional impact reported in previous studies, none have focussed particularly on the emotional reaction to IBS. Within the theme of ‘living with IBS’, participants commonly reported having to fit their lives around their IBS, similar to some previous research. Throughout this theme, there are implications for an impact on participants’ quality of life. Finally, the effect of IBS on participants’ sense of self is a more personal impact than seen in previous research, though again there are further inferences within this for IBS impacting on the quality of life and psychological wellbeing of participants.
Conclusions/implications: The impact on quality of life and psychological wellbeing suggests implications for counselling as a treatment for the impacts of IBS on the lives of those living with the condition. Further research could look into the emotional impact of IBS, or potentially a study replicating this research on a larger scale.
Helpful factors, unhelpful factors and processes of change in person-centred counselling for young people: An interview study
Mick Cooper
Other authors:Stephanie Smith, Amy Louise Edwards, Jon Eilenberg, Jasmine Childs-Fegredo, Joanna Holmes, Praveen Subramanian, Siobhan Kelly, Michael Barkham, Jennifer Beecham, Peter Bower, Karen Cromarty, Charlie Duncan, Peter Pearce, Tiffany Rameswari, Gemma Ryan, David Saxon, Megan Rose Stafford
Professional role: Professor of Counselling Psychology
Institution/affiliation: University of Roehampton
Email: mick.cooper@roehampton.ac.uk
Keywords: Young people, school counselling, humanistic therapy, helpful factors, unhelpful factors,
Aim/purpose: The aim of this qualitative study was to identify what young people found helpful and unhelpful in school-based humanistic/person-centred counselling, and to identify specific processes of change.
Design/methodology: This study draws on endpoint interview data from 50 young people (aged 13-16 years old) who had school-based counselling (up to 10 sessions) as part of the ETHOS trial. The interview consisted of both open- and closed-ended questions. The first part of the analysis was a thematic analysis, focusing on helpful and unhelpful elements of the counselling process. The second part was a ‘process analysis’, focusing on the concrete, explicitly identifiable processes by which change was reported as coming about, or inhibited. Inter-coder reliability for each part was established.
Ethical approval: Ethical approval for the trial was obtained under procedures agreed by the University Ethics Committee of the University of Roehampton, Reference PSYC 16/227, 31st August 2016.
Results/findings: In terms of what was helpful, the most frequently cited counsellor qualities were being non-judgmental, caring, and friendly; with listening, advice, and understanding were the most frequently cited counsellor activities. The young people said that these qualities helped them open up and feel comfortable and supported; and this led to expressing their feelings and getting things off their chest. Immediate outcomes were feeling calmer and less burdened; with longer-term outcomes being improvements in relationships and at school, and reduced distress. The most frequently cited unhelpful factors were the counsellors’ silences and feeling awkward in the counselling. Process analysis indicated that getting things off one’s chests and acting on advice were the most frequently cited change processes, with a lack of input and counsellor silences being the most frequent inhibitors.
Research limitations: Participants were primarily White, and self-report data may not accurately reflect their experiences.
Conclusions/implications: The results from this large sample triangulate well with previous findings and give a robust picture of the factors and processes through which person-centred counselling can be helpful to young people, as well as areas for improvement.
Investigating the cross-cultural relevance of the Strathclyde Inventory: A pilot study
Susan Stephen
Other authors: Dr Afnan Alhimaidi, Dr Emmanuelle Zech
Professional role: Lecturer
Institution/affiliation: University of Strathclyde
Email: susan.stephen@strath.ac.uk
Aim/purpose: The Strathclyde Inventory (SI) is a brief instrument designed to measure Rogers’ concept of the fully functioning person. Originally developed in English by a Brazilian woman living in Scotland, drawing on the mid-20th century work of a white American man, the SI has been translated into French and Arabic, with other translated versions in the pipeline.
In this pilot study we begin to explore the cross-cultural relevance of the SI, by comparing existing datasets collected using the three different language versions of the SI in Scotland (n = 216), Belgium (n = 205) and Saudi Arabia (n = 38). We aimed to identify differences in the functioning of individual SI items when we compared the data collected from each respondent group. We anticipated that we would find some differences and were interested in exploring the potential implications of these differences from our own cultural perspectives.
Design/methodology: We used Rasch modelling to compare our datasets. Rasch is a form of item response theory that transforms raw scores into standardised units of measurement (“logits”) and calculates “item difficulty” in relation to “person ability” on a unidimensional linear model. Specifically, we used Differential Item Functioning (DIF) pairwise to calculate the size and statistical significance of the DIF contrast for each SI item in each paired dataset: Saudi-Scottish; Saudi-Belgian; Scottish-Belgian.
Ethical approval: Ethical approval for this study was provided by the first author’s institution.
Results/findings: Our preliminary results identified ten items with statistically significant DIF contrasts of 0.5 logit or more: three items (e.g., I have hidden some elements of myself behind a “mask”) indicated differences between the Belgian and Saudi Arabian datasets; five items (e.g., I have been able to be spontaneous) revealed differences between the Scottish dataset and the other two datasets; and two items (e.g., I have felt myself doing things that are out of character for me) identified differences between the Belgian dataset and the other two datasets.
Research limitations: The datasets were not collected for the purpose of this pilot study. Therefore, we made inclusion/exclusion decisions to maximise sample size (Saudi Arabian dataset) and reliability (Belgian dataset). Further studies are required to test our findings.
Conclusions or implications / Considerations given to issues of equality, diversity and inclusion: By assuming that quantitative instruments have the same meaning in different cultures, we undermine equality, diversity and inclusion in counselling research, policy and practice. Instead, by embracing and exploring differences in meaning, we can develop our understanding of the cross-cultural relevance of the instruments that we use.
M(other) Tongue: An exploration of the impact on power dynamics for the therapist working in English as a second language
Charlotte Medlicott and Szabina Tomicsne Wagner
Other author: Federica Griffo
Professional role: Psychodynamic Counsellor
Institution/Affiliation: Basingstoke Counselling Service
Email: charlotte@basingstokecounselling.org.uk
Keywords: power, language, bilingual, therapists’ experience, difference, inherent self-disclosure.
Aims/purpose: Our research explores the experience of bilingual therapists who work in their second language with clients speaking their mother tongue. Existing literature suggests that the therapeutic relationship is inherently unbalanced with the therapist constructed as the more powerful. However, the power balance can shift in the client’s favour, particularly if they hold knowledge about their therapists. Our research focuses on how bilingualism as an inherent self-disclosure might result in shifting the power in the therapeutic dyad when the client is perceived as the more competent native speaker. This research aims to contribute an alternative to the prevailing view that linguistic difference is merely challenging.
Design/methodology: Qualitative semi-structured interviews generated narrative transcripts from six participants (practising counsellors or psychotherapists of various modalities, all with a discernable ‘accent’ when speaking English), which were analysed using Thematic Analysis. Three themes emerged, demonstrating how the therapists experienced their difference in terms of power shifts.
Ethical approval: This research was carried out for a Diploma submission. Ethical approval was granted by the counselling service at which the researchers were studying.
Results/findings: Participants’ experiences centred around three themes: my difference is an inherent vulnerability; my difference is a tool; my difference is unspoken. When experienced as a vulnerability, therapists’ bilingualism results in a power struggle. Working with this vulnerability can facilitate the alliance and create a sense of equality. This brings bilingualism as a tool into focus. Almost all participants experienced a lack of recognition of this aspect of their diversity in training and supervision. Most participants acknowledged that it remained unspoken between them and their clients.
Research limitations: As a small-scale qualitative study the results cannot be generalized. The client’s perspective is absent, limiting how full a picture can be gained on what is a relational construct.
Conclusions/implications: Implications for clinical practice include the need for more direct thinking about the connection between power and bilingualism, and a more conscious approach to how the therapist’s vulnerability can be a tool used for the benefit of the therapeutic relationship.
Considerations given to issues of equality, diversity and inclusion: This research gives voice to the experience of bilingual therapists and highlights the absence of this point of difference in current training provision, with significant implications for future practice. The findings demonstrate how linguistic difference is an untapped resource.
Outcomes for Person-Centred Experiential Counselling for Depression (PCE-CfD), Cognitive Behaviour Therapy (CBT) and other High Intensity Therapies (HIT): Evidence from routine data
Dave Saxon
Other authors: Dr Emma Broglia (University of Sheffield); Charlie Duncan (BACP/University of Roehampton)
Professional role: Research Fellow in Data Management
Institution/affiliation: University of Sheffield
Email: d.saxon@sheffield.ac.uk
Aim/purpose: Research undertaken within the context of randomised controlled trials (RCTs) has consistently shown that outcomes for different types of therapies are broadly equivalent (e.g., Barkham et al., 2021). However, RCTs can be problematic due to their rigid design, making it difficult to generalise findings and to showcase them as examples of what happens in ‘everyday practice’. England’s Improving Access to Psychological Therapies (IAPT) programme routinely collects session-by-session from client’s accessing services, including demographic information, presenting issues and routine outcome measures, such as PHQ-9 (depression), GAD-7 (generalised anxiety) and WSAS (work and social adjustment). This naturalistic data source presents an opportunity to look at outcomes across different types of therapies in routine settings, rather than experimentally controlled environments.
Design/methodology: The present study utilises a year of national IAPT data collected between 2016 and 2017 to compare outcomes for PCE-CfD, CBT and other HIT, while controlling for other factors (e.g., demographics, referral source, presenting issues). Routine data were available from 50000 clients who received at least two sessions of PCE-CfD, CBT or HIT between March 2016 and March 2017 in IAPT services across 200 Clinical Commissioning Groups (CCGs) in England. Multi-level modelling will be applied to the data to account for the ‘nested’ data structure (e.g., clients nested within GP practices, nested within CCGs) and identify significant predictors for outcomes on PHQ-9, GAD-7 or WSAS.
Ethical approval: Ethical approval for this study was obtained from [blinded for the purposes of peer review] Research Ethics Committee.
Results/findings: Data analysis is currently underway and findings will be available by the time of the conference. A CCG effect and a GP Practice effect will be produced to assess the outcome variability due to the GP Practice/CCG that the client attended and any variables which may explain any of the variability will be identified.
Conclusions/implications: Data collected in routine settings has an important role to play in terms of contributing to the evidence-base for counselling and psychotherapy. Currently, only data collected through rigorously controlled trials is accepted as evidence by the National Institute for Health and Care Excellence (NICE) in the development of their clinical guidelines and we argue that routine data should also be considered.
Considerations given to issues of equality, diversity and inclusion: Whilst this study does not directly address issues relating to equality, diversity and inclusion, it will utilise the demographic and other information available within the dataset to understand more about what factors predict better or worse outcomes.
Psychodynamic Psychotherapy and Same-sex Sexual Orientation: An empirical investigation
Dr Wayne Full
Professional role: Senior Research Fellow BACP
Institution/affiliation: University College London (UCL)
Email: wayne.full@bacp.co.uk
Aim/purpose: A mixed-method study aimed to clarify:
- how UK psychodynamic therapists understood same-sex sexual orientation both theoretically and clinically; and
- how psychodynamic training shaped the views and practice of UK psychodynamic practitioners working with LGB clients.
Design/methodology: A self-completion questionnaire was distributed to 1403 registrants of the British Psychoanalytic Council (BPC). 287 registrants returned valid responses — a 20% response rate. Descriptive statistics and chi-squared (2) tests were used to examine the quantitative data. Using a purposive sampling technique, 36 semi-structured interviews were conducted with psychodynamic practitioners. A Framework Analysis identified ten overarching themes.
Ethical approval: Ethical approval was granted from the UCL Research Ethics Committee (REC).
Results/findings: Research participants were well informed about the ways in which societal stigma, family rejection, internalised homophobia, anti-LGB discrimination and the ‘coming out’ process contributed to the anxiety, depression and relationship conflicts reported by LGB clients in therapy. However, research participants were less informed about specific aspects of LGB sex lives and norms, and held predominantly heteronormative and monosexual views on love, relationships and sex. Research participants overvalued Oedipal/developmental explanations for understanding same-sex sexual orientation, despite empirical evidence showing that these explanations held little scientific weight. Psychodynamic therapists’ clinical work with LGB clients oscillated between good practice in line with existing psychotherapy guidelines for this client group and practice that was biased, out-dated and potentially harmful. Therapists’ accounts indicated that many psychodynamic trainings do not adequately address LGB-specific issues and that anti-LGB discrimination persists at some training institutions.
Research limitations: The research only presents one side of the story: data was not collected from LGB clients who are or have been in psychodynamic psychotherapy. Methodological limitations include:
- the low questionnaire response rate;
- the self-selecting nature of the questionnaire sample;
- the impact of social interaction effects in the face-to-face interviews;
- social desirability factors in the shaping of respondents’ answers; and
- the use of retrospective self-report questions.
The main problems with the statistical analysis were:
- lack of power; and
- the risk of spurious results from multiple testing.
Conclusions/implications: The psychodynamic curriculum on sexual orientation must be broadened to more fully account for LGB lives. UK psychodynamic training organisations must continue their efforts to create a learning and professional environment that is non-discriminatory to LGB individuals.
EDI considerations: The research provides a strong evidence base on which the UK psychodynamic psychotherapy profession can reappriase its approach to theory, technique and training in relation to same-sex sexual orientation.
Reducing Students to Tiers: An exploratory investigation of Tier 1 counselling provision in English education
Danielle Evans
Professional role: Assistant Head of Sixth Form/Academy Counsellor
Institution/affiliation: Staffordshire University
Email: danni8844@hotmail.com
The current structure of mental health (MH) support for children and young people is offered via a tiered system. Schools are increasingly finding themselves acting as assessors, referrers and even providers of support for pupils. However, little is known about students understanding of the tier services that school-based counselling (SBC) finds itself embedded in. Secondly, Post-16 school students are a cohort uniquely divided in their experience of accessing SBC; with many branded ‘too old’ for Child and Adolescent Mental Health Services (CAMHS). This research aimed to explore an under-researched area of Equality, Diversion and Inclusion in investigating both i)this unique age group and ii)economically-disadvantaged students; hypothesising both groups experience a disadvantage in access to Tier 1/SBC services.
Staffordshire University’s Ethical Review Committee granted ethical approval and a single school case study was designed, using both quantitative and qualitative methodology. Two preliminary focus groups (each N=4) were explored using thematic analysis, and revealed four main themes: School, SBC, Experiences, and Accessing Support: Tiers. Secondly, an online survey of service-users in the school, including Sixth Formers (16-19-year-olds; N=86) and all staff (N=26), explored: i)knowledge of CAMHS/tiers and accessing support, ii)perception of SBC and support, iii)negative expectations of accessing support, and iv)student experience of MH support in school or v)staff confidence of dealing with MH in school. Statistical analyses showed a significant difference in knowledge and understanding between staff and students on all measures and no difference across economic status for students.
Overall, students felt extremely well-supported by staff, and positive about the prospect of SBC. However, students evidenced confusion around the tiered process, and staff were significantly more positive about knowledge/experience of MH provision than students. There was a high variability across students regarding ‘feeling supported’ and some indication that staff pressures may be impacting provision. The limitations of the generalisability of the single-school design are noted, as is the potential impact of the study’s surrounding context (i.e. during a national lockdown).
The researcher concludes that the positioning of SBC within the tiered structure of support is inextricably connected to the use of significant others (particularly education staff) and proposes further research is needed to: i)meet the “growing expectation…for teachers to have an understanding of common mental health problems in young people” (Shelemy et al., 2019, p.100), ii)enable student expectations to consistently be heard, and iii)ensure that the value in MH support and SBC is not simply reduced to a tiered model.
Referrals to high intensity interventions in IAPT: level playing field or rigged game?
Charlie Duncan
Other authors: Dr Emma Broglia (University of Sheffield), Dr David Saxon (University of Sheffield)
Professional role: Senior Research Fellow/PhD Candidate
Institution/affiliation: BACP
Email: charlie.duncan@bacp.co.uk
Aim/purpose: Research indicates that particular demographic groups receiving psychological interventions are at risk of poorer outcomes, such as clients from ethnic minority groups and those experiencing higher levels of social deprivation (e.g., Amati, 2020; Assari, 2017). Despite research suggesting that different psychological therapies are broadly equivalent in terms of outcomes (e.g., Barkham et al., 2021; Pybis et al., 2017), this does not consider how demographic factors and referral sources – and the intersectionality of these factors – may impact on which type of therapy a client is allocated to, and hence whether certain modalities of therapy are disadvantaged in terms of prospective outcomes from the outset. The present study considers these questions in the context of data collected through England’s Improving Access to Psychological Therapies (IAPT) programme.
Design/methodology: Routine data were available from approximately 50,000 clients who participated in at least two sessions of Person-Centred Experiential-Counselling for Depression (PCE-CfD), Cognitive Behaviour Therapy (CBT) or another High Intensity Therapy (HIT) between 2015 and 2018 in IAPT services in England. Data analysis is currently underway, but it is assumed that appropriate parametric and non-parametric testing will be utilised to analyse the data.
Ethical approval: Ethical approval for this study was obtained from [blinded for the purposes of peer review] Research Ethics Committee.
Results/findings: Data analysis is currently underway, and findings will be available by the time of the conference.
Conclusions/implications: It is important to understand more about how allocations to different therapeutic modalities in IAPT settings may be unequal in terms of demographic factors, presenting issues and referral sources. Identifying inequalities may help us to understand more about ‘what works for who’, as well as the extent to which outcomes can be fairly compared across different therapeutic modalities.
Considerations given to issues of equality, diversity and inclusion: Issues of equality, diversity and inclusion are at the centre of this project and will help us to identify inequalities in referrals to particular therapeutic modalities in terms of ethnicity, gender, age, referral source, and presenting issue(s).
The mothers’ perspective on being blamed for children’s non-attendance at school
Emma Mallace
Professional role: Counselling Psychologist in Training
Institution/affiliation: University of Manchester
Email: emma.mallace@postgrad.manchester.ac.uk
Aim/purpose:
- To highlight the inequality experienced by mothers whose children find regular attendance at school difficult
- To investigate how the helping professions can work to best support families in this position
- To explore the suitability of schools/current legislation to meet the needs of children who have a protected characteristic
Design/methodology: I used semi-structured interviews to collect data from mothers who have received a fine for their child’s non-attendance. The data was analysed using Thematic Analysis.
Ethical approval: Ethical approval was granted by the Environment, Education and Development School Panel at The University of Manchester.
Results/findings: The identified themes included mothers feeling they have no power in the situation; legitimate reasons for absence were ignored such as anxiety, disability and grief; school does not feel safe; mothers are not considered to have the authority to decide if their child is well enough to attend school; it is always blamed on the mother, and absence related sanctions cause harm and do not improve attendance.
Research limitations: I have been reflexive throughout the process to maintain high standards of reliability and validity.
Limitations of the project include a lack of ethnic diversity in participants. This is explored and suggestions for future research is suggested.
Conclusions/implications: Schools are not meeting the needs of some pupils and are placing the responsibility onto mothers. The participants do not feel listened to and often are expected to act against their parenting instincts, by forcing children into an environment that seems damaging. The sanctions do not help families but add to the felt stress for all involved. Attendance levels were not increased because of sanctions in any of the cases in the study. This provokes the question as to what function the fines serve for children and wider society. Feeling they are being listened to by professionals is an important protective factor for mothers, and children. Mental health professionals understanding the inequalities present can help to provide non-blaming support.
Considerations given to issues of equality, diversity and inclusion: All of the families involved in the study had at least one societal disadvantage, such as a disability, mental health difficulties, illness, low socio-economic status and/or minority ethnic status, arguably contributing to the low attendance levels.
This study focuses on mothers, as according to research they are disproportionately prosecuted even the father has equal parental responsibility. Within the study mothers receiving blame as standard is explored, in relation to feminist literature.
‘They Need Somebody to Talk to’: Parents’ and carers’ perceptions of school-based humanistic counselling
Phaedra Longhurst
Professional role: Research Assistant
Institution/affiliation: British Association for Counselling and Psychotherapy
Aim/purpose: This study sought to identify parents’ and carers’ perceptions of school-based counselling (SBC) prior to, during, and after receiving this intervention. Parents and carers had the opportunity to reflect upon the therapeutic process and their perception of their child’s experiences. In doing so, the paper contributes to a more comprehensive understanding of the outcomes and process of SBC.
Design/methodology: A qualitative research design was utilised and as part of a wider effectiveness and cost-effectiveness trial of school-based humanistic counselling (ETHOS). Semi-structured interviews with 17 parents and carers were analysed using an inductive form of thematic analysis to identify and report pattens (or themes) of meaning within data. Ethical approval for the study was obtained under procedures agreed by the University Ethics Committee of the [masked for anonymity].
Results/findings: Two superordinate themes were identified: (i) the context of counselling, and (ii) the content of counselling, the latter referring to stages of the therapeutic process and its outcomes. The context of the counselling was the backdrop to the child’s involvement in the school-based counselling, which included home environment and school environment. The content of the counselling related to the different stages of the process, which included before, during, and after the counselling, as well as the outcomes.
Research limitations: Our method may not depict an accurate perception of SBC, as parents and carers may have been more compliant than the average parent or carer. Their reports of the impact of counselling are also ‘second hand’, in that they are based on perceived effects rather than felt effects and may also be subjective or reflect demand biases. Future studies should explore perceptions of parents and carers by collecting data from a more naturalistic setting.
Conclusion/implications: Our study has found that parents and carers perceive SBC generally positively. Overall, the intervention was perceived as beneficial for young people, with positive changes in social and emotional wellbeing. It further supports schools as a promising setting for the provision of mental health support.
Considerations given to issues of equality, diversity, and inclusion: Whilst this study did not explicitly consider issues relating to equality, diversity and inclusion, the wider ETHOS trial operated in a context of high social deprivation, and high proportions of young people from racialised communities, suggesting that the findings could be more widely applied to diverse groups. Future research which utilises the data from the ETHOS study should look to explicitly address issues relating to equality, diversity, and inclusion.
Towards a standard minimum dataset for counselling services embedded in higher and further education: Part of the SCORE project
Jenny O’Donnell
Professional role: Research Fellow
Institution/affiliation: BACP
Email: jennifer.odonnell@bacp.co.uk
Aim/purpose: An exploration of the views of counsellors in the university and college sector about which data is important to collect to develop a national standard minimum dataset to provide evidence for the usefulness of counselling in the sector. This is part of the wider Student Counselling Outcomes Research and Evaluation (SCORE) initiative that is pooling clinical outcome data with the longer term aim of improving datasets and evidence for counselling in this sector.
Design/methodology: Semi-structured focus groups were held with university and college counselling staff including counsellors, service leaders and mental health advisors. They explored the elements of data for inclusion in a minimum dataset, current data collection practices, service and sector level barriers to collecting data. Two researchers performed content analysis involving identifying fields for inclusion in the minimum dataset. Thematic analysis was used to identify contextual issues surrounding collecting data.
Ethical approval: The University of Sheffield’s Ethics Review Procedure, as administered by the Psychology Department has reviewed and ethically approved this study (Ref. 036289).
Results/findings: Ten focus groups (between three and seven participants) were conducted with 41 participants across 26 universities and colleges with counsellors, service leaders and mental health advisors. Initial content analysis identified categories of information to collect for the minimum dataset based on student characteristics, demographics, clinical assessment and service evaluation markers. Thematic analysis explored context for collecting data, barriers and facilitators, institutional influence, culture for using outcome measures and current and ideal data collection practices. The analysis is still in progress and final results will be reported at the conference.
Research limitations: We interviewed staff at 26 institutions, however different data management practices may be in place at other institutions which may impact on data collection.
Conclusions/implications: This research will inform the development of a standard minimum dataset as part of the SCORE study. The wider aim of SCORE is to create a uniform dataset across university and college counselling services, enabling the growth of evidence for the sector which may allow increased funding and service provision.
Consideration given to equality, diversity and inclusion: We interviewed staff at different types of institutions including those in the Russell Group, red brick and plate glass universities, metropolitan universities and colleges. The institutions were of different sizes, geographical locations and included diverse student populations. The goal of discussing data collection priorities was to respond to known gaps surrounding demographic data collection in university and college counselling services with the aim of ensuring that diverse demographic data is collected routinely in services.
Uncovering veiled data: Using duoethnography to explore power in the therapeutic space
Dr John Hills, Dr Fevronia Christodoulidi and Professor Divine Charura
Professional role: Senior Lecturer and Private Practitioner
Institution/affiliation: Leeds Beckett University
Email: j.hills@leedsbeckett.ac.uk
Aim/purpose: Three practitioner-academics came together to explore the application of duoethnography as a research method in the context of Counselling and Psychotherapy with the purpose to produce an exemplar study of its application in our profession. The focus of our dialogues was on privilege and power as experienced by our clients in the social worlds they inhabit, and within the therapeutic relationship.
Design/methodology: In duoethnographic research, the researchers generate their own data through reflexivity and reflection upon their socially and culturally embedded experience. Data are generated through dialogue. Over four months in 2021, we met through Microsoft Teams to record our dialogues and furthered our exchange via email communications. Topics were agreed upon prior to each session to maximise the potential of yielding useful data. After each dialogue the first author – as ‘caretaker’ of the data offered a first analysis of emergent themes to share with others in advance. We came together explicitly mindful of and valuing our differences – one woman and two men; our ethnocultural heritages being Greek, African, and English; with different trajectories towards our professional positions.
Ethical approval: Ethical approval was formally granted through Leeds Beckett University as well as being an ongoing reflexive process between us.
Results/findings: Data are presented as an idealised dialogue which could be thought of as the speaking turns of a play. Emergent themes include: the visible – invisible spectrum of privilege, power differentials manifesting across different polarities, and as different identities are invoked, therapist humility, and the client taking power back. We highlight the varying meanings of silence, ambivalence and unknowing in therapeutic process. We also consider our private motivations for wanting to promote change.
Research limitations: Whilst our dialogues benefited from open acknowledgement and working with the differences between us, we also recognised the ways in which we were similar: each heterosexual, married with children; each in senior positions in higher education. Recognising that each dialogue brings unique configurations of similarity and difference, we thus make the case for greater uptake of duoethnography in counselling and psychotherapy research.
Conclusions/implications: As an ongoing, highly relational form of encounter, this research project highlighted the benefits this approach can bring in the ongoing development of therapists. We experienced the way participation facilitated the revelation of more unconscious or unarticulated material. We ultimately found the duoethnography depended upon our mutual negotiation of trust and preparedness to be vulnerable in the encounter.
Understanding the perceptions and experiences of UK-based clients transferring from face-to-face to video counselling during the Covid-19 pandemic
Robert Sheehy
Professional role: Counsellor
Institution/affiliation: University of Salford
Email: sheehy.rob@gmail.com
Aim/purpose: Video counselling has become increasingly prevalent in recent years, with research indicating efficacy and acceptance across diverse client populations. Lockdown measures necessitated by the Covid-19 pandemic led to an unparalleled acceleration in the utilisation of online video platforms, as clients and counsellors unable to meet in-person transferred their counselling sessions online. While qualitative studies have focussed primarily on the responses of counsellors towards this switch, parallel research aimed at clients remains limited. The purpose of this study was therefore to explore the perceptions and experiences of clients transferring from face-to-face to video counselling as a result of Covid-19 restrictions.
Design/methodology: Data was collected through semi-structured interviews with seven clients in private practice, who had undertaken counselling in-person before transferring to video sessions delivered remotely. Thematic analysis was used to identify five themes and thirteen subthemes.
Ethical approval: Ethical approval was granted by the University of Salford prior to the commencement of recruitment and its academic ethics policy (2021), alongside the BACP ethical guidelines for research (2019), were adhered to throughout the study.
Results/findings: Findings focussed on client responses to enforced change, the practical and emotional impacts of technology, environmental changes to the therapeutic space, impacts on established therapeutic relationships, and the effects of video counselling on therapeutic progress. Findings suggest that a better awareness of the complex responses felt by clients switching from face-to-face therapy and being introduced to remote technologies, may help in managing transitions more effectively. Ways in which video platforms can replicate the therapeutically beneficial time afforded to clients travelling to and from in-person sessions, should also be considered.
Conclusions/implications: The effect of Covid-19 on mental health providers can be seen as a catalyst both for immediate operational change, and a broader consideration of how counselling is made accessible to clients going forward. The findings could help in the training and skills development of organisations and counsellors transferring existing clients from face-to-face to video environments.
Considerations given to issues of equality, diversity and inclusion: It is recognised that the sample may not be representative of individuals from other groups. Within this study, all participants identified as white British and the majority identified as female. At present, there remains a paucity of existing evidence linking gender or ethnicity with responses to video counselling. All participants also had access to the digital equipment required for video counselling and a private space within their home environments to conduct sessions. Greater consideration is needed towards socio-economic and educational barriers which prevent access to remote therapies.
“We listen and we give them a safe space…”: Women’s experiences of volunteering within a Women’s Centre
Nina Martin
Professional role: Senior Lecturer and Psychotherapist
Institution/affiliation: Leeds Beckett University
Email: n.martin@leedsbeckett.ac.uk
Aim/purpose: Women’s experiences of volunteering in community settings, such as Women’s Centres, is an under-researched area. The study therefore aimed to explore how women – including volunteer counsellors – understand, and make sense of, their experiences of volunteering within a Women’s Centre.
Design/methodology: This was a qualitative study conducted within a phenomenological framework. Women were selected via a purposive sample on the basis that they were actively involved in the provision of services within the Women’s Centre. Of the 43 women identified as eligible for the study, nine agreed to take part in a semi-structured interview, including three volunteer counsellors. Interviews lasted between 40-70 minutes. The interview schedule was designed collaboratively with the Women’s Centre and explored participants’ experiences of volunteering. Interviews were audio-recorded and transcribed verbatim with participants permission. Data were analysed using reflexive thematic analysis. Transcripts were read and re-read, and initial codes generated. Data across the entire data set were then collated into potential themes and sub-themes, which were reviewed and refined in relation to the coded extracts. NVivo 12 Pro was used to manage the data.
Ethical approval: The study was approved by the University Research Ethics Committee. To protect participant identities, pseudonyms have been used throughout.
Results/findings: Five themes were generated from the data:
- “For women, by women”: understanding and connecting with women-centred values;
- Learning from ‘other’ women; support and opportunities enabling women’s professional development
- Awareness of self: empowering women’s personal development;
- Quality personal relationships; developing women’s self-in-relation and,
- Wider community impacts: change “for women, by women” leading to social change.
Research limitations: The findings of this study are limited to the experiences of a small sample of nine participants who all identified as heterosexual and white British, therefore it is not known whether or how the findings may be different with a sample that included those of other sexualities and ethnicities.
Conclusions/implications: Women’s connection with the values of the Women’s Centre has implications for the training and retention of volunteers, including volunteer counsellors; volunteering in an all-women environment has clear benefits for some women, in terms of self and relationships; opportunities for learning from women are provided and positively impact women’s career development.
Considerations given to issues of equality, diversity and inclusion: The focus of this paper is on gendered volunteering in a women-only space. Whilst bringing women together, Women’s Centres can provide opportunities for learning and development afforded by valuing ‘other’ women - women of difference - in respect of, culture, ethnicity, age, class, and religious beliefs.
What has Whiteness got to do with it? - Exploring meanings of Whiteness in the context of anti-racist psychotherapy practice
Frances Basset
Professional role: Psychotherapist and Supervisor
Institution/affiliation: Basset Consultancy
Email: frances@bassetconsultancy.co.uk
Aim/purpose: To explore therapists’ understandings of the terms ‘whiteness’ and ‘white cultural identity’. In doing this, the research aims to provide a deeper exploration of whiteness vis-à-vis anti-racist psychotherapy practice
Design/methodology: A mixed-methods, anonymous survey containing quantitative and qualitative elements. A purposive sample was utilized, in which respondents demonstrated an interest in anti-racist practice and contacts were made via EDI conferences, affinity groups, workshops and discussion forums. It included UK based qualified counsellors and psychotherapists. Approximately one hundred and fifty surveys were sent out with fifty returned.
Ethical approval: Achieved in September 2021 from Metanoia Institute and Middlesex University. Presentation and discussion also took place at BACP Research Forum September 2021.
Results findings: Results obtained via statistical frequency counts and reflexive thematic analysis (RTA). Respondents believe that the terms ‘whiteness’ and ‘white culture’ reflect a dominant, but oftentimes invisible force in the field of race, and culture. Dialogue inclusive of the meaning and power of ‘whiteness’ needs to be addressed in anti-racism training and education. A core concept, ‘Heart of the Work’ was the connecting principle between four key themes: - The Dominance of Whiteness; Ambivalence, Complexity and Paradox; The Importance of Education, and Understanding the Wider Context.
Research limitations: The findings are not generalizable to the wider profession as this is not the purpose of a Qual-quan leaning project - the survey contained open questions to allow rich data collection and the illumination of themes. The fact that it will not be possible to generalize the findings to the wider profession, in quantitative terms, could be seen as a limitation. A white researcher exploring whiteness will be limited by unconscious bias.
Conclusion/implications: A re-commitment to addressing racism and inequality within the psychotherapy and counselling profession must include those that benefit from racism; namely white therapists. Evidence from this survey indicates that discussions about whiteness, white privilege and whiteness as a racial identity could enhance anti-racist practice. There is a real concern about the re-traumatisation of racially minoritised members of therapy training groups, and the requirement for reflexivity and skilled facilitation is highlighted.
Young women’s recovery stories after domestic abuse in childhood: Implications for counselling and psychotherapy practice
Tanya Beetham, PCCS Books Award 2022 Winner
Professional role: Psychology Lecturer
Institution/affiliation: University of Teeside
Email: tanya.beetham@tees.ac.uk
Aim/purpose: Those who experience domestic abuse in childhood are affected in multiple ways, but existing research uses a narrow lens, relying heavily on psychotherapeutic and neuroscientific understandings of recovery. This article explores women’s recovery stories and focuses on implications for counselling and psychotherapy practitioners who may work with women who have experienced childhood domestic abuse.
Design/methodology: Narrative interviews were conducted with ten young women in England, and a voice-centred feminist narrative analysis was used.
Ethical approval: Ethical approval was given by the University of Stirling’s General University Ethics Committee.
Results/findings: This research found that recovery after domestic abuse in childhood can be considered a dynamic process that is individual, as well as shaped by social, political, and relational contexts that make some stories more speakable than others. It found that storytelling can be a powerful tool for women, in re-writing and re-imagining their stories and selves, though there are several ambiguities and tensions in women’s recovery stories that should be attended to, instead of smoothening over. Thirdly, a gendered lens shines light on issues surrounding how women’s stories are heard, and how they may be read as untrustworthy, not reliable, or ‘unstable’ speakers. This has implications for how women talk about their stories, and what kinds of stories are possible to tell.
Research limitations: This research is based on a small sample of women in England, who were predominantly white and most of whom had at least a university degree. There needs to be much more research with people who are from a more diverse range of identities and backgrounds.
Conclusions/implications: A feminist analysis helped to centralise the gendered power relations that shape how women’s stories are articulated and heard, and this has implications for therapeutic settings, where women may be invited to tell their stories. This paper concludes that therapists should work to attend to the gendered socio-political structures that shape women’s lives and experiences of domestic abuse, and storytelling can be a powerful therapeutic tool for domestic abuse practitioners.
Considerations given to issues of equality, diversity and inclusion: A feminist analysis allowed a nuanced analytical focus on power and gender, although as noted, there does need to be a better commitment by researchers in domestic abuse research to adopt an intersectional lens to explore other intersections of power, and how they operate in women’s storytelling and meaning making after domestic abuse.