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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]

Counselling and psychotherapy are not common professions that are considered alongside the work of sporting institutions, such as football academies. This paper therefore provides a brief reflection upon the existing research considering the way that such institutions currently engage with the mental health and well‐being of those that they support. In doing so, the world of elite sport engagement is considered before focusing more specifically upon research that has explored how football academies make use of psychological theory and therapy. This paper concludes that counselling and psychotherapy have an important role to play in supporting those at all stages of their football careers. However, delineation with clear roles and boundaries from other professions, such as sport psychology, proves vitally important, and further systematic exploration of this growing area of work is needed. [ABSTRACT FROM AUTHOR]

This paper explores the components of Chinese college counsellors' mental models in their daily work based on a rich content analysis of the story accounts of 152 exemplary college counsellors over the past 8 years. On the basis of a rigid three‐step coding procedure, this study reveals that Chinese college counsellors' mental models generally comprise four common constituents, namely a love‐filled faith system, a rule‐based thinking system, a professionalism‐based knowledge system and action‐based performance. These components jointly illustrate the general landscape of Chinese college counsellors' internal well‐being and fill a research gap regarding the sparse attention given to counsellors in the global literature on faculty professionalism. [ABSTRACT FROM AUTHOR]

The cognitive–developmental theory of 'levels of emotional awareness' (LEA) addresses an individual's capacity to experience and express emotion, a capacity highly relevant to psychotherapy. Previous papers on LEA and psychotherapy addressed the aspect of LEA theory pertaining to the 'trait' (i.e. enduring) aspects of an individual's emotional functioning over time. LEA theory also applies to the construction of emotional experience at any given moment, in which levels emerge or disappear in a process of microgenetic construction as a function of arousal and other variables. This state‐related perspective is supported by recent research showing that people vary in their LEA from moment to moment. Momentary changes in LEA correspond to the variations in lived experience that occur in relationships, including the therapy relationship, and provide the context for corrective emotional experiences that promote change. In this paper, the construction of emotional experience at different levels of organisation is discussed separately in relation to clients and therapists. Key phenomena relevant to psychotherapy include the transition from bodily sensations to specific differentiated emotional feelings, the ability to be aware of multiple feelings that may be contradictory or counter‐intuitive, and the appreciation of how complex combinations of feelings may differ in self and other. This perspective adds to the literature on how the integration of emotion and cognition contributes to change in psychotherapy. The clinical and research implications of this perspective are discussed. [ABSTRACT FROM AUTHOR]

Background: Method of levels (MOL) is a cognitive therapy with an emerging evidence base. It is grounded in perceptual control theory, and its transdiagnostic nature means techniques are widely applicable and not diagnosis‐specific. This paper contributes to psychotherapy process research by investigating a key technique of MOL, asking about disruptions, and in doing so aims to explore how the technique works and aid the understanding of related techniques in other psychotherapies. Method: Conversation analysis (CA) is applied to asking about disruptions in 12 real‐life therapeutic interactions. Findings: Analyses explore how and when therapists ask about disruptions, with examples presented according to their degree of adherence to the MOL approach. The majority of identified instances project responses consistent with MOL aims, encouraging further talk, focused on the client's problem, and with a shift to metalevel commentary. Also presented are examples of therapist and client influence on disruptions. Conclusion: The paper provides support for a number of MOL practices, with clinical implications and links to other psychotherapies highlighted. [ABSTRACT FROM AUTHOR]

Anxieties about sex and sexual problems are widespread and are often brought to counselling and psychotherapy. Research has found that even practitioners without specialist training often work with sexual difficulties because of the prevalence of such problems. Some of the most common concerns brought to therapy centre on desire discrepancies between male and female partners and a lack of sexual desire. In this paper, we ask the question what understandings of "heterosex" might await women and men bringing concerns about desire discrepancies and a lack of desire to the therapy room? We report the findings of a qualitative study exploring the discourses underpinning therapists' and psychology undergraduates' constructions of women and men repeatedly refusing sex in the context of an ongoing heterosexual relationship. Data were collected from 71 participants (33 therapists and 38 students) using the innovative story completion method, in which participants are presented with the opening sentences of a story centred on a hypothetical scenario and asked to complete it. The resulting stories were analysed with thematic analysis. Participants drew on heteronormative discourses of masculinity, femininity and heterosex to make sense of sexual refusal and its consequences. However, the stories written by male and, especially, female therapists included less problematisation of the absence of sex and more possibilities for overcoming sexual and relational problems. The data potentially raise questions about whether professional training allows therapists to access discourses that subvert dominant understandings of heterosex, as we argue it ideally should. [ABSTRACT FROM AUTHOR]

Background:While counsellor education becomes increasingly culturally diverse, little is known about international trainees' experiences of training.Objective:The present study explores one aspect of training, namely clinical practice from the perspective of international, non-native speaking trainees. In particular, this paper focuses on the challenges this group encounters when practicing in a second language.Methodology:Semi-structured interviews with four non-native English-speaking trainees were conducted and analysed following the principles of interpretative phenomenological analysis (IPA).Results:Findings suggest that participants encounter practical difficulties related to their non-native/foreign identity in practice, such as problems with articulate self-expression and understanding the client's speech. These difficulties generate anxiety and impact on the trainees' confidence.Conclusions and implications for counsellor training:This study elucidates language as a fundamental aspect of culture, and identifies second language use as a significant source of difference in counselling practice. This paper highlights the need for attention to linguistic diversity and for appropriate support during counsellor education. This will improve international trainees' experiences of training, but also enhance all trainees' understanding of difference, resulting in better service provision for the community. [ABSTRACT FROM AUTHOR]

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format. [ABSTRACT FROM AUTHOR]

Idiographic network models based on time‐series data have received recent attention for their ability to model relationships among symptoms and behaviours as they unfold in time within a single individual (cf. Epskamp, Borsboom, & Fried, 2018; Fisher, Medaglia, & Jeronimus, 2018). Rather than examine the correlational relationships between variables in a sample of individuals, an idiographic network examines correlations within a single person, averaged over many time points. Because the approach averages over time, the data must be stationary (i.e. relatively consistent over time). If individuals experience varying states over time—different mixtures of symptoms and behaviours in one moment or another—then averaging over categorically different moments may undermine model accuracy. Fisher and Bosley (2019) address these concerns via the application of Gaussian finite mixture modelling to identify latent classes of time points in intraindividual time‐series data from a sample of adults with major depressive disorder and/or generalised anxiety disorder (n = 45). The present paper outlines an extension of this work, wherein network analysis is used to model within‐class covariation of symptoms. To illustrate this approach, network models were constructed for each intraindividual class identified by Fisher and Bosley (137 networks across the 45 participants, mean classes/person = ~3, range = 2–4 classes/person). We examine the relative consistency in symptom organisation between each individual's multiple mood state networks and assess emergent group‐level patterns. We highlight opportunities for enhanced treatment personalisation and review nomothetic patterns relevant to transdiagnostic conceptualisations of psychopathology. We address opportunities for integrating this approach into clinical practice and outline potential shortcomings. [ABSTRACT FROM AUTHOR]

This paper presents an introduction to theoretically informed qualitative psychotherapy research (QPR). Although QPR researchers have traditionally remained silent on theory, we suggest this has resulted in an implicit and unacknowledged use of theory. We argue instead for a clear articulation of qualitative researchers' theory and outline how theory can be incorporated to inform the entire qualitative research process. This approach assumes the research problem is embedded in a clearly defined and articulated theoretical framework, which also informs data collection and data analysis. We outline how researchers can use explicit theoretical frameworks to inform research question formulation, data collection and data analysis and illustrate this with specific applications of the method in practice. We believe that starting from a declared theoretical framework sets up a dialogue between the research problem, the type of data required and their meaningful analysis and interpretation. This aims not only to achieve greater depth in the final product of research, but also to enhance its utility in terms of practice; it contributes to building, altering and differentiating theory; and it allows for greater transparency by openly articulating the theoretical framework that scaffolds the entirety of the research process. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue. Published within the issue are papers about counseling older people. Andrew Hill and Alison Brettle from the University of Salford present the findings of their study on counseling with older people. Melanie Shepherd and her colleagues present a study on the use of CORE to explore clinical outcomes and inform practice.

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes a qualitative study focusing on counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact this has on the therapist. Method: Semi‐structured interviews were employed and the constant comparative method utilised to analyse the data. Findings: Findings indicate that counsellors experience intense emotions in response to self‐harm including: shock; sadness; anxiety; anger; and frustration. Counsellors also struggled to manage the tension between multiple dualities, corresponding to professional opinions of a seemingly polar opposite nature. Although participants indicated a requirement to work in a client‐led way, they all had either an explicit or implicit agenda for change. These two conflicting states create a tension for a counsellor that is difficult to resolve. In addition there were various views of client progression, yet all participants agreed that progression was not simply about stopping self‐harm. Conclusion: There is a significant impact on the counsellor when working with clients who intentionally self‐harm and the complexity of the phenomenon appears to exacerbate their anxiety. Implications: Further research within the counselling field focusing on the ambiguous nature of the subject may increase understanding, which in turn may contribute to greater therapist efficacy when working with this client group. [ABSTRACT FROM AUTHOR]

Aim: To explore therapeutic activities and psychological interventions used by experienced cognitive behavioural and psychodynamic therapists to treat clients with medically unexplained symptoms (MUS). Method: Twelve in‐depth, semi‐structured, qualitative interviews with psychotherapists, recruited from two British National Health Service (NHS) Departments were conducted. Interview transcripts were analysed using grounded theory. Findings: Therapists from two modalities share the following therapeutic activities and psychological interventions in their work with MUS clients: working together with clients, sensitive, empathic responding and building trust, being flexible with techniques, keeping an open mind and multi‐disciplinary cooperation. They also use modality specific interventions discussed in this paper. Even though participants experienced difficulties in forming alliances with MUS clients early on in their work, they expressed the importance of nurturing hope, empowering and engaging clients in jointly constructing understandings, which helps symptom management. [ABSTRACT FROM AUTHOR]

Aims: This paper presents a model of a group-based intervention for the treatment of clients with Obsessive Compulsive Disorder (OCD) referred to secondary mental health care services, which has been developed by the authors over the last five years. Method: Groups are not a common form of treatment design for this client group, however the available literature is briefly reviewed and the common issues that informed the design are identified. Following this additional technique of neuropsychological theories, Mindfulness, and socialisation are presented and a brief rationale for their inclusion provided. Quantitative and Qualitative outcome measures of the most recent group are discussed with respect to the utility and validity of the model. Conclusion and implications for practice: It is concluded that the group has good ecological as well as outcome validity and provided a method of linking together evidence-based practice (EBP) and practice-based evidence (PBE) movements. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this commentary is to argue that the value of counselling and psychotherapy research lies, not only in what it teaches us as therapists, but also in its ability to challenge us and our assumptions. Method: The paper identifies eight beliefs that may be prevalent in sections of the counselling and psychotherapy community, and presents evidence that challenges them. Findings: While many of our beliefs may hold true for some clients some of the time, the research evidence suggests that they are unlikely to be true for all clients all of the time. Discussion: By questioning and challenging therapists' a priori assumptions, research findings can help counsellors and psychotherapists to be less set in their beliefs; and more open to the unique experiences, characteristics and wants of each individual client. [ABSTRACT FROM AUTHOR]

Counseling outcomes are often measured in terms of standardized questionnaires. Though efficient for large numbers of participants, this method cannot capture the unique and subtle 'shifts' that clients often report when qualitative methods are utilized. Further, such questionnaires usually focus on the individual, missing the wider social implications of therapy. This paper presents the preliminary findings from a study that utilizes the client's own perceptions of changes in their "Life Space" to establish the significance of their change process. These results are compared and contrasted with a standard outcome questionnaire and the participant's experiences of using the two methods are explored. [ABSTRACT FROM AUTHOR]

An important problem for our counselling service is the high number of clients who ‘did not attend’ (DNA) for their booked appointment. This paper aims to describe how we tackled this problem within our counselling service by using a Plan-Do-Study-Act (PDSA) cycle (Langley, Nolan Norman and Provost, 1996). The results found that by devising a system whereby clients could self-book their appointments we were able to reduce the DNA rate for first appointments from 31.70% to 2%. This has useful time and financial implications. We would expect that the self-booking approach we have outlined here is adaptable for other counselling services. [ABSTRACT FROM AUTHOR]

The topics of counselling and reconciliation seem controversial in developing countries because of their intrigued relationship. Likewise, the goal and processes are in question across cultures. In this study, qualitative research approach employing a case study method was carried out with deliberately selected elder counsellors in the Oromo community. Data were gathered using interviews and observations in the field. The results indicated that reconciliation is concurrently practised with counselling, which is the most important instrument to manage differences and to calm everyone involved. It serves to maintain peace and stability between conflicting groups and kinship; saves lives and prevents destruction of property; assists in progressing community rules and regulations; and supports family challenges. The research also identified that processes, tools of operation and time to conduct vary between communities. In conclusion, the goal of counselling and reconciliation is to retain peace and stability through thorough discussion, self‐evaluation and redeeming processes. Equally, pre‐ and post‐counselling sessions in reconciliation are useful approaches cohesive with reality and truth‐seeking behaviours to settle disputes in the community. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore patients' experiences and views on psychotherapy in relation to inflammatory bowel disease (IBD), and Crohn's disease (CD) in particular. Method: This descriptive survey study used semi‐structured in‐depth interviews with open‐ended questions and a qualitative content analysis to summarise responses of 12 CD patients with mental health problems undergoing treatment with antidepressants. Results: Of 12 interviewed CD sufferers, only four received any form of psychotherapy. Two psychotherapy users considered it useful and beneficial. Patients who used psychotherapy with good results reported it improved their disease course, most likely due to improving patients' skills in reducing stress and thus, delaying relapse of the disease. Conclusion: Psychotherapy seems to be under used in IBD patients with mental health problems. Psychotherapy may act as a preventer of disease relapse in some patients and this observation needs to be tested with further quantitative studies. Online therapies may be the answer to limited psychotherapeutic resources in gastroenterology clinics. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various articles within the issue including one on the emotional impact of sight loss by Thurston, one on the reasons clients drop out of therapy by Saxon and an article on the effectiveness of using minimally trained volunteer mental health counsellors by Armstrong.

Several letters to the editor are presented in response to articles published in previous issues. Letters are written in response to "Should Your Lips Be Zipped? How Therapist Self-Disclosure and Non-disclosure Affects Clients," by Jean Hanson and "Writing Therapy in Brief Workplace Counselling," by Jeannie Wright, which all appeared in the June 2005 issue.

Marriage is the most respected institution in the world, and it contributes to the foundations of procreation, leadership and peace and is the hub of economic stability. Currently, there are marital disharmony cases which have led to marriage being viewed with a negative perception. This trend is common in Lugari, Kakamega County, Kenya, resulting in psychological torture, issues with child development in terms of learning and discipline, and a long‐term effect on their behaviour as adults. Premarital counselling was conceived for the purpose of helping families to re‐evaluate their feelings about marriage and its values in order to experience marital harmony. This study sought to determine the relationship between premarital counselling and marital harmony among families. It was guided by solution‐focused theory (SFT). The target population for the study was married couples and premarital counsellors. Purposive and simple random techniques were used to select a representative sample of 20 men, 20 women and 10 premarital counsellors in Lugari, Kakamega County. There was a statistically significant relationship between premarital counselling services and marital harmony among families with a correlation of.893. Therefore, there should be awareness of the existing services, and couples intending to marry should seek premarital counselling interventions and continue to attend counselling after formalising their marriage to keep up with the changing times. [ABSTRACT FROM AUTHOR]

The introduction of novel methodologies in the past decade has advanced research on mechanisms of change in observational studies. Time‐lagged panel models allow us to track session‐by‐session changes and focus on within‐patient associations between predictors and outcomes. This shift is crucial as change in mechanisms inherently takes place at a within‐patient level. These models also enable preliminary casual inferences, which can guide the development of effective personalised interventions that target mechanisms of change, used at specific treatment phases for optimal effect. Given their complexity, panel models need to be implemented with caution, as different modelling choices can significantly affect results and reduce replicability. We outline three central methodological recommendations for use of time‐lagged panel analysis to study mechanisms of change: (a) taking patient‐specific effects into account, separating out stable between‐person differences from within‐person fluctuations over time; (b) properly controlling for autoregressive effects; and (c) considering long‐term time trends. We demonstrate these recommendations in an applied example examining the session‐by‐session alliance–outcome association in a naturalistic psychotherapy study. We present limitations of time‐lagged panel analysis and future directions. [ABSTRACT FROM AUTHOR]

This study examined interventions with parents/carers in child and adolescent counselling and psychotherapy (CAP). The aim was to investigate clinicians' rationale behind their decision to work with parents and what types of interventions they use. Furthermore, the nature of clinicians' core training with regard to interventions with parents was investigated. The study used both quantitative data and qualitative textual data from an online survey of 110 CAP clinicians. There was significant agreement, regardless of previous training or level of experience, that clinical work with parents in CAP is beneficial, but little consensus for a rationale or model for best practice. There was a relationship between training, theoretical orientation and whether CAPs felt competent to work with parents. Unexpectedly, a significant number (83%) of integrative practitioners said that there had been 'little' to 'none at all' focus on working with parents on their core training course. Other unforeseen findings were in the domain of working outside generally accepted boundaries for CAP, with a notable number of clinicians making home visits—24.1% with parents alone and 38.9% with parent and child together—along with 47.2% using phone calls and/or email for coaching and support with parents. Many clinicians were candid about their sense of a lack of competence in working with parents, even though at least half were senior, experienced clinicians. A number of these practitioners made specific reference to the wish for further specialist training, with many asking for signposting to where further training could be obtained. [ABSTRACT FROM AUTHOR]

Background: Psychotherapy training is designed to help graduate students develop confidence and competence in their clinical skills. Approach: The present manuscript explores three dimensions of an Aristotelian doctrine of knowledge as related to skill in psychotherapy. Findings: First, a psychotherapist should be knowledgeable about the background information pertaining to psychological theories and current research in the field. Typically, background information is covered in graduate courses and updated through continuing education opportunities for the licensed psychologists. Second, psychotherapists develop competence in technical skills used in psychotherapy sessions. For graduate students, competence in technical skills can be developed through the direct provision of clinical services in supervised placements. For faculty members, technical skills can be maintained through their involvement in ongoing clinical activities. Third, psychotherapy instructors need expertise in practical wisdom to guide clinical judgment and ethical reasoning skills. Expertise develops through years of practice. Conclusions: Graduate students are expected to develop background knowledge and basic competence in clinical skills. Furthermore, faculty members who teach graduate courses on psychological assessment, psychiatric diagnosis and psychological treatments can be expected to attain a level of expertise. Psychotherapy training is improved when faculty instructors have ongoing clinical experience and practical wisdom. The present manuscript confronts the problem and proposes several possible solutions. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study addresses the thorny issue of mandatory personal psychotherapy within counselling and psychotherapy training. It is expensive, emotionally demanding and time‐consuming. Nevertheless, proponents argue that it is essential in protecting the public and keeping clients safe; to ensure psychotherapists develop high levels of self‐awareness and gain knowledge of interpersonal dynamics; and that it enhances therapist effectiveness. Existing evidence about these potential benefits is equivocal and is largely reliant on small‐scale qualitative studies. Method: We carried out a systematic review of literature searched within five major databases. The search identified 16 published qualitative research studies on the topic of mandatory personal psychotherapy that matched the inclusion criteria. All studies were rated for quality. The findings from individual studies were thematically analysed through a process of meta‐synthesis. Results: Meta‐synthesis showed studies on mandatory psychotherapy had reported both positive and hindering factors in almost equal number. Six main themes were identified: three positive and three negative. Positive findings were related to personal and professional development, experiential learning and therapeutic benefits. Negative findings related to ethical imperatives do no harm, justice and integrity. Conclusion: When mandatory personal psychotherapy is used within a training programme, courses must consider carefully and put ethical issues at the forefront of decision‐making. Additionally, the requirement of mandatory psychotherapy should be positioned and identified as an experiential pedagogical device rather than fulfilling a curative function. Recommendations for further research are made. [ABSTRACT FROM AUTHOR]

Abstract: Background: This research aimed to explore clients’ perceptions of the impact of social class and whether, if so how, perceived social class disparities impact upon the therapeutic relationship. Method: A total of 45 completed questionnaires, via an online survey, were returned, comprising 30 middle‐class and 15 working‐class qualified and practising therapists from their role as client. A quasi‐phenomenological approach was taken and thematic analysis used to interrogate the data. Findings: Four primary themes were identified as follows: (1) Perceptions of own social class; (2) Social class as a facilitative aspect of therapy; (3) Negative impact of social class on therapy; and (4) Clients perceptions of their therapeutic relationship. The findings show that where there was social class disparity, it was the explicit recognition and acknowledgement of disparity that were shown to have a positive impact on the client; improving equality, increasing rapport and enabling greater psychological growth. Implications for practice: Therapists’ lack of awareness of social class was shown to lead to inadvertent oppressive and/or classist behaviour. For a client to take full benefit from therapy, therapists must recognise the importance of social class and classism and their impact upon the therapeutic relationship, and be prepared to attend to these dynamics when appropriate. Conclusions: Though many respondents thought social class was an irrelevant factor within their therapeutic relationship, this study illustrates that social class was a silent but powerful force affecting clients’ feelings of equality and the effectiveness of therapy. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The article examines the role of family income on the relationship between change in symptomatic burden and change in life satisfaction during six sessions of naturalistically delivered individual psychotherapy. Method: Five hundred and thirty‐two clients receiving psychotherapy were assessed at baseline and on a session‐to‐session basis with the OQ‐30.2 and with a life satisfaction questionnaire. Data were analysed using a bivariate latent class model with structured residuals that included cross‐lagged and autoregressive components between residual scores at each time point. Adjusted family income and a binary low versus high‐income group variable were added as exogenous baseline covariates at different stages of the analyses. Results: Regardless of income level, clients show improvement in psychological distress and life satisfaction as a function of time during treatment. Initial levels and improvement in life satisfaction are related to initial levels and improvement in psychological distress, and lower family income is related to slower decreases in psychological distress. When the whole sample is analysed, psychological distress and life satisfaction show reciprocal prospective relationships at the within‐person level. When models are estimated by income group, casual relationships at the within‐person level vary as a function of income. Conclusion: Family income level appears to play a significant role in the relationship between symptom improvement and life satisfaction during psychotherapy. [ABSTRACT FROM AUTHOR]

Aim To provide an understanding of the factors that discouraged staff members from using a new web-based platform ( CAMHSweb) with young people in a child and adolescent mental health service ( CAMHS). Although evidence-based service improvement technology like CAMHSweb is becoming more common in child mental health, the staff-level barriers to the use of web-based platforms have not been explored in depth in the literature. Method Semi-structured interviews with six employees were carried out in a London-based child mental health service that a preliminary audit had identified as having a poor utilisation of the platform. All participants had previously been invited to use the platform as part of their clinical work. Results were analysed using thematic analysis (Braun and Clarke, 2006). Findings Three overarching themes covered staff's practical, personal and philosophical barriers to implementation. Interviewees believed that CAMHSweb was too challenging to implement, that it was not an asset to therapists, and that it interfered with the therapeutic process. Discussion and Implications These findings provide a nuanced understanding of the multiple factors that may discourage clinicians from using web-based platforms. This may have implications for researchers or practitioners who aim to design or implement technology in child mental health services. [ABSTRACT FROM AUTHOR]

Aims Psychotherapeutic supervision is a human-to-human encounter in which counsellors and psychotherapists regularly present their client case work. There are multiple theoretical and practical perspectives about what supervision is and how to do it. Yet, little is known about the day-to-day lived experiences of psychotherapeutic supervisors. This article reports on a key finding from a Heideggerian hermeneutic phenomenological research study which was concerned with uncovering what it is really like being a psychotherapeutic supervisor. Participants told many stories about experiences of heightened responsibility. They recounted how experiences of anxiety in specific supervisory encounters were intertwined with burdensome experiences of responsibility. Existing theories, practices and prescribed ethical guidelines on managing supervisory responsibility were of limited assistance to supervisors grappling with troubling supervisory experiences. Instead, to cope with the burden of responsibility, psychotherapeutic supervisors had common human experiences of 'leaping-in and leaping-ahead' of their supervisees, leading to hidden and unintended consequences for supervisees and supervisors. Conclusions Responsibility is inescapable in supervisory encounters and is fuelled by a mood of anxiety. The phenomenon of responsibility could be rendered more intelligible, in supervision consultation, by privileging, uncovering and dwelling in psychotherapeutic supervisors' day-to-day lived experience of being-responsible, while being mindful of what we already know about responsible supervisory practice. [ABSTRACT FROM AUTHOR]

Aim: This study examines the emotional impact that clinical work with asylum seekers and refugees has on practitioners who work with them. This examination takes place by unpacking on the one hand, notions of risk and trauma whilst on the other hand, notions of meaning among practitioners. Method: The study analyses the discourses deriving from eight semi‐structured interviews that were conducted with specialist practitioners who have worked with asylum seekers and refugees in a psychotherapeutic context. Findings: The findings of the study reveal that clients’ traumatic experiences permeated practitioners’ discourses and had a profound impact on practitioners’ way of perceiving the world and themselves. Despite this impact, the findings also show that clinical work with asylum seekers and refugees is constructed as meaningful and rewarding for practitioners. Practitioners appear to locate their clinical work in a wider context of social engagement that envelops a notion of social responsibility towards vulnerable individuals and which allows them to feel that they can make a positive contribution to their community. Importantly, practitioners’ social engagement with clinical work appears to counterbalance the traumatising impact that work with asylum seekers and refugees has upon them and to produce a meaningful experience. [ABSTRACT FROM AUTHOR]

Background: Emerging research coming from the person‐centred and psychodynamic traditions in the past 15 years has examined the traumatic dimension of suicidal behaviour on clinicians. However, there is limited empirical literature on the impact of suicidality on Irish psychotherapists. In Ireland, it is estimated that 500 citizens die by suicide each year, while approximately 11,000 accident and emergency admissions are the consequence of suicide attempts. Aim: This elicits the question, how does suicide prevention impact Irish mental health professionals who work solely with these vulnerable populations? Method: In this article, the process of interpretative phenomenological analysis (IPA) was applied to the narratives of seven experienced therapists. Findings: The Irish Poet W.B. Yeats coined the famous refrain ‘All changed, changed utterly, a terrible beauty is born’ in his poem ‘Easter 1916’ (as cited in Martin, ). This quote aptly encapsulates the reality of seven experienced Irish psychotherapists who work exclusively in the field of suicide prevention. Three salient superordinate themes emerged: (1) Overworking; (2) All changed, changed utterly/identity disruption; (3) A terrible beauty is born/A spiritual practice. Discussion: Clinicians were ‘changed, changed utterly’ with identity disruption evident in their self, bodies, intimate relationships and professional identity. ‘A terrible beauty was born’ was demonstrated in the overarching theme of the restorative nature of client engagement in the life of the therapist. This was particularly evident in humanistic practitioners, who were acutely aware of their own sublimation of melancholia. Conclusion: Most striking across all seven transcripts was the mix of the corrosive nature of suicide prevention on the self of the therapist, combined with unparalleled opportunities for personal growth and spiritual reformulation. [ABSTRACT FROM AUTHOR]

Aim: Homeless young people have historically been regarded as hard to reach in the provision of counselling services. However, they are under‐represented in research that seeks to understand clients’ views on accessing counselling. This study aimed to bridge this gap by asking young, homeless people who had accessed counselling what they thought were the main barriers to counselling and how they could be overcome. Method: A qualitative methodology was adopted due to the aim of understanding participants’ experiences in depth. Semi‐structured interviews were conducted with six participants residing in hostels, and these were analysed using thematic analysis. Findings: The barriers to counselling included resistance to opening up, stigma, denial about needing help, past experiences of help‐seeking and lack of familiarity with therapy. Facilitating factors included patience and consistency of offer, simple explanations and demystifying and normalising counselling to make it seem less threatening. Implications: The findings overlap with previous research on barriers and facilitators with non‐homeless adolescents. In addition to this, by drawing on literature on homelessness, this article considers how some of these factors are further compounded for those who are also homeless. Some implications are considered for practitioners hoping to improve their engagement of young, homeless people in counselling. These are mainly in the areas of reframing the language in which counselling is promoted, greater flexibility, and providing opportunities to interact with counsellors. It also makes the case for a change in practitioner attitudes. [ABSTRACT FROM AUTHOR]

Context:The challenge of producing ethical representational practices is of critical interest to both practitioner-researchers and research theorists. For practitioners becoming researchers a central ethical question may be how to manage a relational presence in writing their research, in ways that acknowledge participants, the research relationship, and a researcher's own subjectivity.Focus: The article offers examples from practitioner research to illustrate and theorise how researcher subjectivity is managed through the use of witnessing practices as a representational strategy. Witnessing practices – translated into counselling research from narrative therapy – offer researchers a strategy to take up a reflexive, relational presence in research reports.Discussion: Researcher witnessing honours the contributions of research participants as well as making visible the shaping effects of the research on a researcher's life. Through witnessing self and other, and thus declaring presence, privilege and partiality, re-presentational ethics are made transparent. [ABSTRACT FROM PUBLISHER]

Background: Some people with psychological distress do not seek professional help but opt instead for self‐help strategies to reduce their symptoms. Little is known about these strategies. Aim: To investigate which self‐help approaches might be employed to reduce the effects of emotional distress, and the reasons for these choices. Method: Semi‐structured interviews with 11 clerical employees generated data analysed using grounded theory. Findings: Managing distress is a complex and multi‐dimensional process unique to each individual. The use of self‐help options is determined by the interconnection between the person's core beliefs, their social networks, and ideas about coping. Such beliefs may hinder help‐seeking. People tend to engage in activities that are familiar to them already, rather than attempt new ones. The purpose of self‐help strategies is to distract the person from their problems and to contribute to physical and mental well‐being. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Domestic abuse is known to have detrimental effects on all members of the family, yet it is often difficult for victims to leave. It is therefore important to research available intervention programmes for perpetrators who want to change their behaviour. Intervention programmes for perpetrators are informed by different theoretical and philosophical approaches, such as pro-feminism, psychopathology or biopsychosocial theories. However, there is little consensus to the most effective intervention and there is a paucity of qualitative research on the perspectives of the perpetrators who attend the available therapies. Aim: The aim of this research was to discover the perceptions of change of 18 male, heterosexual perpetrators with female partners who self referred to a community-based therapy service providing abuser schema therapy (AST). Method: A qualitative methodology was adopted using semi-structured interviews on completion of therapy, and at three, six, nine and 12 months follow-up. A content analysis was conducted and data was coded and mapped against a priori variables. Findings: The findings indicated that the four highest rated variables were: (1) a reduction of anger, (2) an increase in communication and assertiveness skills, (3) an increase in ability to think prior to behaviour, and (4) responsibility for personal power. The findings are discussed in relation to the perceived changes for perpetrators. Conclusions: In conclusion, this study seeks to contribute to the development of future effective interventions to reduce aggression within the home. [ABSTRACT FROM AUTHOR]

Aims: This study examines the relationship between expert supervisors' professional experiences and their views about the importance of different psychotherapy techniques. Method: Thirty psychodynamic-interpersonal (PI) supervisors and 13 cognitive-behavioural (CB) supervisors (N=43) were instructed to rate 20 therapeutic techniques according to how characteristic each technique is of an ideally-conducted session within their theoretical orientation. The measure used for this assessment was the Comparative Psychotherapy Process Scale. Results: Findings demonstrated that supervisors' beliefs about ideal therapeutic techniques are related to their number of years in post-graduate clinical practice, training, and supervising trainees, as well as to the number of publications they have authored. Further, experience within a given orientation tends to lead to a greater endorsement of techniques within that orientation, although this finding is more uniform for CB supervisors than PI supervisors. Finally, differential types of experience lead to differential focusing on specific techniques. Discussion: The clinical importance of these findings is explored. [ABSTRACT FROM AUTHOR]

Social science research specific to the identification and prevalence of unsuitable students within counselling, psychology, and social work training programmes is briefly reviewed in this article. This area of enquiry relates to the gatekeeping responsibilities of professional educational programmes, to ensure that their graduates are competent to provide ethical and effective practice to the public. Key issues which impede the usefulness of this gatekeeping literature to counselling educators are raised. These include: methodological inconsistencies which limit the comparison of findings and hence the drawing of sound conclusions; the lack of definitional clarity relating to the construct of gatekeeping; and the confusing array of nomenclature used to represent students' failure to meet acceptable professional standards. It is apparent from this overview that there are common factors irrespective of nomenclature that are associated with students at risk of not becoming competent entry-level practitioners. This suggests that a structured approach to terminology is appropriate. There is also evidence to suggest that encountering such students is a regular occurrence for faculty, with students indicating higher numbers of impaired students than educators. A working definition of gatekeeping is provided and nomenclature suggested. [ABSTRACT FROM AUTHOR]

Evidence in the literature suggests that some groups have greater difficulty accessing psychological treatment than others. The present study set out to provide benchmarks from the CORE National Research Database, focussing on four primary outcomes following a client's first contact session – (1) accepted for therapy, (2) assessment only, (3) referred to another service, (4) unsuitable for therapy. Data from 34 primary care counselling services were collected which had used CORE-PC as a service resource for at least two years. For each of the four assessment outcomes, the mean, standard deviation and 25th, 50th and 75th percentiles were calculated. Across the 34 services, an average of 81% clients were accepted for therapy with 25th, 50th, and 75th percentile values of 74, 82 and 89% respectively. The results indicate that working with benchmarks is an area in need of further research. Implications for policy and practice are discussed and attention given to the client's experience of seeking therapy. [ABSTRACT FROM AUTHOR]

There have been many theories of the process of loss and bereavement, from Freud, to the present day. Early theories of bereavement described a process which, following various stages and associated tasks, ended at the relinquishment of the bond to the deceased. In more recent years theories have taken different directions, identifying how bereaved people re-learn life, recreate biographies, and continue relationships to the deceased. Some research studies of bereavement have investigated the counsellors' perspective, but there are very few studies of the client's experience and most studies have focussed on outcomes of counselling. This qualitative study, using semi-structured interviews, provides an insight into the bereaved client's perspective on the content and process of their counselling experiences. Taking as its focus the client's sense of the presence of the deceased, this study aimed to identify whether or how counsellors facilitate exploration of this experience and which theories they use in client work. The main finding is that 80% of the counsellors were not perceived by participants to have worked with them satisfactorily in relation to their sense of presence of the deceased or in relation to the story of the death itself. [ABSTRACT FROM AUTHOR]