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Background: The use of artificial intelligence (AI) is increasing in many areas of healthcare, including mental healthcare. The automated nature of such technologies has the potential to be developed to work with large numbers of people. This paper examines the way that student therapists experience using an interactive text‐based machine client as a training tool. Methodology: Chatbot technology has been used to develop an emotionally responsive interactive client (ERIC). This introduces individuals to concepts of person‐centred therapy (empathy, congruence and unconditional positive regard) by using a series of pre‐programmed scenarios. Twenty‐eight student therapists evaluated ERIC's potential as a learning tool. Individuals were recruited from one university from a postgraduate and an undergraduate counselling programme. Findings: Feedback was generally positive, with all reporting that they enjoyed engaging with ERIC as a learning method. ERIC helped individuals consider their understanding of counselling skills in a non‐judgemental environment. Participants felt the scenarios were realistic and engaging, with many reporting that they felt they were engaging with a real client/person due to ERIC's ability to express emotions. Discussion: ERIC is at the proof‐of‐concept phase. From the feedback presented here, it is evident that it can be a useful learning tool. Further development of ERIC with feedback from a larger sample is, however, required. ERIC is currently a text‐based client, and further development would like to see the intervention be voice‐activated to enhance the experience. ERIC can be further enhanced and adapted to be a useful learning platform for student therapists, as well as for students in other (healthcare‐related) disciplines, whereby a client or patient is required. [ABSTRACT FROM AUTHOR]

Positive body image is a contemporary construct, having only received research attention within the past two decades in an effort to elicit a more holistic, comprehensive account of the concept of body image. Nevertheless, emerging literature has suggested its direct and indirect association with improved outcomes, including indicators of well‐being (e.g. self‐compassion) and feelings towards the self (e.g. self‐esteem). Positive body image has therefore been suggested as both a potential technique and a target of actionable therapeutic work for cultivating both physical and psychological well‐being. First, through insights from quantitative and qualitative seminal works, this paper demonstrates that positive body image is: (i) a multidimensional construct, distinct from negative body image; (ii) a confluence of theoretical disciplines and influences; (iii) protective, with therapeutic capacities; (iv) a positive outcome; (v) young, yet flourishing; and (vi) socially and politically relevant. Thus, complementing what positive body image is, this paper further situates therapeutic practice within the field of positive body image by delineating and contextualising their reciprocal capacities and relevant techniques. [ABSTRACT FROM AUTHOR]

There is a strong evidence base that demonstrates the beneficial impact of engaging in therapeutic writing tasks, often with reference to the successful emotional processing of traumatic life events. This paper looks to explore the experiences and impact of a community‐based therapeutic expressive writing group, which embraced a direct psychoeducational model to enhance emotional well‐being in a group of women. From an experiential qualitative position that embraces a "hermeneutics of empathy", this study uses a thematic analysis (TA) methodology (informed by the work of Braun & Clarke (2013) to explore the group members' narratives obtained through semistructured interviews. The study reveals the significance of a number of key factors, including the importance of the group setting, the identification of core therapeutic writing activities, the beneficial impact of skilled and supportive therapist facilitation, and the emotional value in "letting go" of unhelpful thoughts and feelings in order to strengthen psychological well‐being and resilience. The findings have important implications for service commissioning and the proactive delivery of effective time‐limited, low‐cost mental health interventions within primary settings across society. [ABSTRACT FROM AUTHOR]

Personal development (PD) groups are routinely used in the training of counsellors and psychotherapists. Experiences during such group processes are thought to contribute to the development of self‐awareness, a quality seen as crucial for good practice in many therapeutic approaches. However, evidence from trainees suggests that the PD group experience may not be a positive or facilitative one for many. We also do not know how trainees, once qualified, process their PD group experiences over time. This paper reports findings from a qualitative study in which 12 experienced therapists were invited to reflect back upon their PD group experiences during their training. Their experiences of PD groups were invited through semi‐structured interviews and the data analysed using interpretative phenomenological analysis (IPA). The findings show that most participants found their PD group experiences to be challenging, and that for some participants this was a welcome and facilitative experience. However, a significant number of participants had negative experiences in their PD groups, which at the time they felt to be damaging and which remained so in their view at the time of interview. Such experiences included feeling re‐traumatised by recalling and sharing old traumas, feeling afraid of the volatility and punitiveness in their group and feeling overlooked or abandoned by the group facilitator. Nevertheless, all participants had made persistent efforts to process these experiences and had drawn from them what they regarded as valuable learning. Recommendations for counselling and psychotherapy training are put forward in the light of these findings. [ABSTRACT FROM AUTHOR]

Psychotherapy can be an emotionally laden conversation, where both verbal and nonverbal interventions may impact the therapeutic process. Prior research has postulated mixed results regarding how clients emotionally react following a silence after the therapist is finished talking, potentially due to studying a limited range of silences with primarily qualitative and self‐report methodologies. A quantitative exploration may illuminate new findings. Utilising research and automatic data processing from the field of linguistics, we analysed the full range of silence lengths (0.2–24.01 s), and measures of emotional expression—vocally encoded arousal and emotional valence from the works spoken—of 84 audio recordings of Motivational Interviewing sessions. We hypothesised that both the level and the variance of client emotional expression would change as a function of silence length; however, due to the mixed results in the literature, the direction of emotional change was unclear. We conducted a multilevel linear regression to examine how the level of client emotional expression changed across silence length, and an ANOVA to examine the variability of client emotional expression across silence lengths. Results of both analyses indicated that as silence length increased, emotional expression largely remained the same. Broadly, we demonstrated a weak connection between silence length and emotional expression, indicating no persuasive evidence that silence leads to client emotional processing and expression. [ABSTRACT FROM AUTHOR]

Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g. talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic 'work' or ending the session. In this study, we modelled three vocal features—pitch, energy and rate—with linear and quadratic multilevel models to understand how therapists' vocal features change throughout a therapy session. We hypothesised that all three vocal features would be best fit with a quadratic function—starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session. [ABSTRACT FROM AUTHOR]

The Emotionally Focused Individual Therapy Adherence Measure (EFIT‐AM) is presented as a scale to measure a therapist's adherence to the EFIT model. The theoretical rationale for EFIT as a promising model of individual therapy and conceptual development of EFIT‐AM are introduced. The EFIT‐AM was developed to measure therapist adherence to treatment tasks when working specifically with clients presenting with negative emotional disorder and can be used to promote therapist education and development in training and supervision. The measure includes assessment of essential skills, meta‐themes, and stages of EFIT. The measure was piloted using participants (n = 20) with advanced training in EFT. Participants used the measure to rate therapist adherence to EFIT model by observing a recorded therapy session of an expert EFIT therapist. Participant ratings were used to examine consistency among ratings of therapist behaviour and to receive feedback regarding the user experience of the EFIT‐AM. Mean item ratings of three and five within the same talk turn were considered to signify reliable identification of an EFIT skill. Of the 18 adherence items on the EFIT‐AM, 12 items met our criteria for 50% of participants identifying the item at the same time with a rating of three or five. Six items did not meet these criteria and were considered to either occur at a session, as opposed to talk turn, level or in need of consolidation. The high level of inter‐rater reliability and internal consistency of the EFIT‐AM indicates the EFIT‐AM is a promising tool to evaluate therapist adherence. [ABSTRACT FROM AUTHOR]

Background and aims: Self‐mutilation (self‐harm) is a phenomenon that is increasingly being seen in patients presenting in mental health services in the United Kingdom. This present study aimed to explore the lived experience of South Asian women raised in the United Kingdom and their perspective of 'Izzat', which refers to honour. Method: Semi‐structured interviews were conducted with 12 women of 'South Asian' heritage. Their accounts were analysed using interpretative phenomenological analysis (IPA). Findings and discussion: The findings suggest that the concept of Izzat and Asian cultural identity permeated the narratives of all the participants. The results position Izzat as central to cultural discord felt by the women and as a base for some of the discontent that led to self‐mutilating. The analysis revealed five over‐arching themes as the most common factors to self‐harm among South Asian women, which include: (1) The struggle to maintain cultural identity, (2) Experience of loss of control and trauma, (3) Focus on self‐mutilation as a distraction process, (4) Psychological angst as metacommunication of pain, and (5) Enactment of perceived deserved punishment. Our conclusions argue for the importance of understanding the complexity of cultural diversity, introjected cultural expectations, and its impact on the development of trauma and implications for clinical practice. Future research and practice should focus on exploring trauma‐informed methodologies and culturally sensitive approaches in working with those impacted by Izzat and the cultural responsibility of maintaining family honour. [ABSTRACT FROM AUTHOR]

Background: This study explores perceptions regarding counsellors who are also public entertainers, an issue on which there is a dearth in literature and in codes of ethics. For this study, we reviewed three codes of ethics: the 2014 American Counselling Association's (ACA), the 2017 British Association for Counselling and Psychotherapy's (BACP) and the 2011 Malta Association for the Counselling Profession's (MACP). Method: The research question begged a qualitative approach using individual, audio‐recorded, semi‐structured interviews with twelve participants: six counsellors and six non‐counsellors. Thematic analysis was selected as the most appropriate methods for analysis. Findings: Participants think that counsellors can be entertainers during their free time, but need strict boundaries and ethical responsibility whilst following Rogers' (1957, 1980) person‐centred skills of being non‐judgemental, empathic and congruent. Boundaries, the context of a small‐island community, public life, self‐disclosure, wellbeing and challenges were all major themes elicited. Counsellor participants (CPs) highlighted that there is no guide Maltese counsellors can follow regarding what they can and cannot do in public as public entertainers. Participants noted that in the local context, counsellors need to be careful about disclosing their opinions regarding Politics and political affiliations. Politics seemed to be of particular concern and reflects the local biparty culture often loaded with emotions and very strong opinion and allegiances. Participants also reflected that the status of an entertainer/counsellor can also help publicise the profession in the best interest of wellbeing and the profession. Implications for Practice: Implications for practice include training courses with opportunities for reflection on what counsellors can/not do in public in order to continuously address boundaries; training on social media behaviour; training on specialised ethical issues around being a counsellor/entertainer through continuing professional development sessions; specialised training for supervisors; issues to be address in contacts with clients; and updated codes of ethics/ethical framworks. Conclusion: Recommendations include personal reflection and supervision, training at master's level, continued professional development, revised codes of ethics and ethical guidance by qualified supervisors. This study was a master's dissertation submission, where Karen was the supervisee and Ruth the supervisor. [ABSTRACT FROM AUTHOR]

Background: The main purpose of our study was to theoretically substantiate and practically verify the effectiveness of the developed method of reducing anxiety in breast cancer patients. Method: We suggest that involuntary narratives, such as spontaneous, unprepared and non‐structural writing without rumination, help to express fears and concerns, thoughts and emotions and, as a result, decrease the level of anxiety. The respondents (49 female patients diagnosed with breast cancer at the Oncology Center of Ternopil, Ukraine, mean age 55.43 ± 11.31 years) were asked to write down (for 10 days) all their emotions and thoughts, which appeared in the morning immediately after awakening. They were asked to provide spontaneous thoughts without proper grammar, not observing lexical or spelling rules. Results: Comparison of the level of state anxiety and differential emotions in the experimental and control groups before and after the experiment showed a statistically significant decrease in the level of anxiety and negative emotions in breast cancer patients. Conclusions: The primary practical application of the study is the prospect of using involuntary narratives to decrease anxiety in breast cancer patients. [ABSTRACT FROM AUTHOR]

Introduction: Depression affects many adults in the UK, often resulting in referral to primary care mental health services (e.g. improving access to psychological therapies, IAPT). CBT is the main modality for depression within IAPT, with other approaches offered in a limited capacity. Arts psychotherapies are rarely provided despite their attractiveness to clients. However, the recent dropout rate of 64% within IAPT suggests that clients' needs are not being fully met. Therefore, in order to expand clients' choice we developed a new creative psychological therapy integrating evidence‐based approaches with arts psychotherapies. Method: A three‐level approach was used: (a) thematic synthesis of client‐identified helpful factors in evidence‐based approaches for depression and in arts psychotherapies; (b) studio practice exploring Cochrane Review findings on arts psychotherapies for depression; (c) pilot workshops for clients with depression and therapists. Findings and Discussion: Eight key ingredients for positive therapy outcomes were identified: encouraging active engagement, learning skills, developing relationships, expressing emotions, processing at a deeper level, gaining understanding, experimenting with different ways of being and integrating useful material. These ingredients were brought together as Arts for the Blues for clients with depression: a 12‐session evidence‐based pluralistic group psychotherapy integrating creative methods as well as talking therapy. Conclusion: The evidence‐based foundation, creative content and pluralistic nature of this new approach aligned with eight client‐identified key ingredients for positive therapy outcomes make it a promising therapy option that can be adapted to individual therapy. Implications include consideration for NICE approval as an additional therapy for depression. [ABSTRACT FROM AUTHOR]