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In response to the increase in Routine Outcome Monitoring and Clinical Feedback, the Patient-Perceived Helpfulness of Measures Scale (ppHMS) was developed to assess the helpfulness—as perceived by patients—of using measures in psychological treatment. Study 1: The construct of patient-perceived helpfulness of measures was explored using thematic analysis with 15 patients. Six helpful and three unhelpful themes were identified and informed item development. Study 2: 28 items were formulated and rated by experts. Ten items were taken forward for psychometric shortening in a sample of 76 patients. Confirmatory factor analysis (CFA) led to an adequately fitting six-item model with excellent internal consistency, and convergence with the Delighted-Terrible single item of product satisfaction and a single item of measure helpfulness. Study 3: In a stratified online sample of 514 U.K. psychotherapy patients, a five-item model constituted the best fit. The final ppHMS had excellent internal consistency (McDonald's ω =.90), convergent validity with psychotherapy satisfaction (r =.5; p <.001), divergence from social desirability (r =.1), and metric and scalar invariance across measures. Study 4: Analyses were replicated and confirmed in a stratified U.S. sample (n = 602). The ppHMS is a reliable and valid scale that can be used to assess and compare patients' perceptions of the helpfulness of different measures as part of their psychological treatment. [ABSTRACT FROM AUTHOR]

Depression is a worldwide problem requiring more research on clinically effective treatments. This study was based on a conceptualization of the self as multivoiced: constituted of multiple autonomous "I-positions." We aimed to investigate the relational patterns between voices in patients experiencing depression, and the changes which arise through psychotherapy. Transcripts from the first, middle, and final psychotherapy sessions of five individuals treated for depression—all showing reliable improvement—were analyzed. We used the qualitative method of analyzing multivoicedness (QUAM) to identify I-positions, their relationships, and how these changed over the course of the treatment. In all cases we found two opposing I-positions which were in conflict and a third which served to suppress this conflict and limit affect. At midpoint, an emotional I-position emerged which enabled a working through of previous problematic narratives. In the last session there was an increased degree of reflexivity, which heightened the level of dialogicality between existing I-positions. These findings can be used to develop treatments that can identify inner conflict and suppression, and cultivate reflexivity in patients. [ABSTRACT FROM AUTHOR]

Assessing and accommodating patient preferences is integral to evidence-based practice. This qualitative study sought to explore patient perspectives and experiences of preference work in psychotherapy. Participants were 13 UK-based patients who had completed up to 24 sessions of a collaborative–integrative psychotherapy. Ten participants identified as female and three as male. Interviews were conducted at endpoint and analyzed using a team-based, consensual qualitative research approach. Three superordinate domains were developed: Preferences Themselves, Process of Working with Preferences in Psychotherapy, and Effect of Preference Work (or its Absence). Patients typically wanted leadership, challenge, and input from their psychotherapist, and an affirming style. Patients attributed the origin of their preferences to personal history, characteristics, or circumstances; the present psychotherapy; or past episodes of psychotherapy. Some preferences changed over time. Preference work was described as having positive effects on the therapeutic relationship and patients' intrapersonal worlds; however, variantly, non-accommodation of preferences was also experienced as beneficial. Our findings provide in-depth answers to a range of novel questions on preference work—potential mechanisms by which preference work impacts outcomes, factors that may facilitate preference work, and origins of preferences—as well as nuancing previously-established quantitative findings. Implications for clinical training and practice are discussed. [ABSTRACT FROM AUTHOR]

Shared decision-making about therapeutic methods has been proposed as a way of conceptualising, and assisting, collaboration in the therapeutic alliance. However, little is known about how psychotherapists actually create concrete, moment-by-moment opportunities for clients to share their ideas about what might be therapeutically helpful. We used conversation analysis to examine psychotherapists' questions about what might be helpful in audio-recordings of early sessions of a collaborative-integrative therapy. We examined forty-two sessions involving seven dyads and identified 28 cases of questions either inviting clients' ideas about helpful in-therapy methods or strategies outside the therapy room. Psychotherapists could invite clients' ideas by using simple questions, however clients could find such questions problematic. Alternatively, psychotherapists could add scaffolding: offering support to the client in terms of how they might respond. However, this could erode clients' autonomy to respond with their own ideas. We identified a conversational practice, de-specifying, which overcomes this dilemma: asking questions and providing scaffolding whilst also lessening the pressure on the client to go along with that scaffolding. A therapeutic style which includes scaffolding and de-specifying practices creates an opportunity for the client to contribute where clients are empathically supported, but not directed, in responding. [ABSTRACT FROM AUTHOR]

This study aimed to investigate (a) what clients' within-treatment activity preferences were; (b) whether a match between preferences and psychotherapy approach predicted outcomes and alliance; (c) whether scores on preference dimensions, per se, predicted outcomes and alliance. Participants were 470 clients engaging in one of five approaches with trainee psychotherapists. We used the Cooper–Norcross Inventory of Preferences to identify clients' within-treatment activity preferences; and multilevel modelling to examine the relationship between these preferences – and a match on these preferences – to outcomes and alliance. Clients had an overall preference for therapist directiveness and emotional intensity. We found no evidence of a preference matching effect. Clients who expressed a desire for focused challenge over warm support showed greater progress. Client preferences for focused challenge may be indicative of their readiness to change and indicate a positive prognosis. Further research should directly observe therapeutic practices and assess a range of client variables. [ABSTRACT FROM AUTHOR]

Within the UK, there has been a growth of services delivering online therapy to young people. This study identifies the factors that young people find helpful and unhelpful in synchronous text‐based therapy (STBT), and the processes by which these factors may be of value. Thirteen young people, aged between 14 and 18, were interviewed synchronously online. All participants had had a minimum of four sessions of STBT. Data were analysed thematically. Four main domains of helpful and unhelpful factors were identified: 1) anonymity, 2) access, 3) communication, and 4) control. Control was a particularly important element for young people and was an underlying aspect across all themes. Young people not only valued several aspects of STBT but also recognised its limitations. Further research should explore the contexts in which online counselling may be helpful or not. [ABSTRACT FROM AUTHOR]

Research suggests that bullying is one of the most common presenting issues for young people accessing counselling. In this study, we explored helpful aspects of counselling for young people who have experienced bullying. Semi-structured interviews were conducted with 10 participantsand analysed using thematic analysis. Participants identified five helpful counsellor activities: (a) counsellors' way of relating, (b) creating safety, (c) incorporating creative media, (d) teaching strategies, and (e) offering advice. They also identified four helpful client activities: (f) trusting, (g) talking, (h) expressing emotions, and (i) remembering and applying techniques. Findings suggest that a range of techniques and practices, aligned to different therapeutic orientations, can be of value to these young people. This supports a pluralistic perspective on therapeutic change. [ABSTRACT FROM AUTHOR]

Mental health and general health care research has shown that practitioners can facilitate patient involvement in shared decision making (SDM) and that the approach can benefit patients who wish to take part in decisions around their care. Yet patient experiences of SDM within a psychotherapy context have been little researched. This study examined how clients experienced SDM in a collaborative‐integrative psychotherapy. A grounded theory approach used interpersonal process recall interviewing and supplementary semi‐structured interviews to investigate 14 clients' experiences of SDM in pluralistic psychotherapy for depression. Verbatim transcripts were coded into 819 meaning units across six categories containing 13 subcomponents that comprised a single, core category. The six categories were (a) experiencing decisions as shared, (b) psychotherapists supporting clients to become more active in the decision‐making process, (c) both parties presenting and recognizing expert knowledge, (d) clients felt recognized as an individual and accommodated for by their psychotherapist, (e) clients felt comfortable engaging with the decision‐making process, and (f) daunting for clients to be asked to take part in decision discussions. A core category emerged of "Psychotherapists encourage client participation and progressively support clients to provide information and contributions towards shared treatment decisions that could be led equally, or marginally more by one party." Such support was particularly useful when clients had difficulty contributing as part of decision discussions. Client preferences for SDM change across clients and across decisions, highlighting the importance of practitioners remaining flexible to individual clients when using the approach. [ABSTRACT FROM AUTHOR]

The aim of this analysis was to explore whether pre-treatment intervention preferences were related to outcomes for patients with persistent sub-threshold and mild depression who received one of two treatment types. Thirty-six patients took part in a two-arm, parallel group, pilot randomized controlled trial that compared short term (3 month and 6 month) outcomes of person-centred counselling (PCC) compared with low-intensity, CBT-based guided self-help (LICBT). Patient preferences for the two interventions were assessed at baseline assessment, and analysed as two independent linear variables (pro-PCC, pro-LICBT). Eight out of 30 interactions between baseline treatment preferences and treatment type were found to be significant at the p < .05 level. All were in the predicted direction, with patients who showed a stronger preference for a treatment achieving better outcomes in that treatment compared with the alternative. However, pro-LICBT was a stronger predictor of outcomes than pro-PCC. The findings provide preliminary support that treatment preferences should be taken into account when providing interventions for patients with persistent sub-threshold and mild depression. It is recommended that further research analyses preferences for different treatment types as independent variables, and examines preferences for format of treatment (e.g. guided self-help vs. face-to-face). [ABSTRACT FROM AUTHOR]

Within the major therapeutic paradigms, observational instruments have been developed to assess orientation-specific interventions or processes. However, to date, no such instrument exists to assess existential practices. Recent research indicates the key practices of existential therapists, and forms an empirical basis on which to develop an observatory grid. This paper describes the development of such a grid, and its exploratory testing with eight clients of four Portuguese existential psychotherapists. A total of 32 sessions were observed and both speaking turn and whole-session analysis showed that it was feasible to assess existential therapy using the instrument, although psychometric findings recommend further refinement of the tool. Session-rating data suggest that the chief practices applied by existential therapists were relational, followed by the use of hermeneutic interventions and reformulations. Interventions based on phenomenological and existential assumptions were observable in practice but limited in frequency. Further refinements and developments of the observational grid, together with additional research - using a range of therapists from different schools of existential therapy - are recommended. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world). The intervention was piloted in eight secondary schools in the UK in 2016. Aims: Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness. Materials and Methods: Interviews were semi‐structured and were analysed using thematic analysis. Results: The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness. Discussion: There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds. Conclusion: Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling. [ABSTRACT FROM AUTHOR]

Aim To investigate what clients found helpful and unhelpful in counselling following breast cancer. Method Fourteen women with a diagnosis of primary breast cancer were asked to complete a Helpful Aspects of Therapy ( HAT) form (Llewelyn, 1988) following each of their counselling sessions at a branch of a UK breast cancer charity, and these were analysed using grounded theory. Findings Participants identified six core helpful aspects of counselling, which were focusing on self, expressing and exploring feelings, problem solving, experiencing a helpful therapeutic relationship, experiencing relief and gaining reassurance, and understanding other(s). Unhelpful aspects of counselling identified were experiencing unwanted thoughts/feelings/behaviours, and the therapist trying something that did not fit/work for the client. Conclusions Participants indicated that counselling following breast cancer helped them to get back in touch with themselves, process strong emotions and resolve specific problems. By identifying a range of helpful processes, the analysis supports a pluralistic model of therapeutic change. [ABSTRACT FROM AUTHOR]

The Cooper–Norcross Inventory of Preferences (C-NIP) is one of the most widely used measures of psychotherapy preferences. However, its psychometric properties have not been examined in non-Western samples. Research on disparities between the preferences of mental health professionals and their clients is also limited. We evaluated the C-NIP's psychometric properties and measurement invariance in Chinese lay clients and mental health professionals and evaluated the latent mean differences between clients' and professionals' scores on the C-NIP's four scales (preference for therapist vs. client directiveness, emotional intensity vs. emotional reserve, past vs. present orientation, and warm support vs. focused challenge). This cross-sectional investigation involved 301 lay clients and 856 mental health professionals who completed the Chinese version of the C-NIP. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP. ESEM provided stronger evidence than CFA for the four-factor model in both samples. The four scales had adequate internal consistency in both the lay clients (αs =.68–.89) and the mental health professionals (αs =.70–.80). Partial scalar invariance was established across these two populations. Chinese mental health professionals preferred less therapist directiveness, past orientation, and warm support—but more emotional intensity—than Chinese lay clients (ds = 0.25–0.90). Culture-specific cutoff values (norms) to identify strong therapy preferences were established. This study supports the application of the C-NIP to non-Western populations and suggests that discrepancies between the preferences of lay clients and mental health professionals are a cross-cultural phenomenon. Public Significance Statement: This study confirms the factor structure and measurement invariance of the Cooper–Norcross Inventory of Preferences (C-NIP) in Chinese psychotherapy populations. The study further reveals systematic differences between lay clients' and mental health professionals' treatment preferences in the Chinese clinical context. These disparities suggest that professionals should be cautious in projecting their therapy preferences onto their clients. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to deepen an understanding of the practices that bereaved clients find helpful in counselling. Method Semi-structured qualitative interviews were conducted with seven clients who had participated in counselling for bereavement within a voluntary organisation in Scotland. Data were thematically analysed within an overall framework of interpretative phenomenological analysis. Findings Respondents identified five helpful aspects of counselling. First, the independence of the counsellor: That they were outside the family and social network. Second, the counsellor's skilled listening: Being attentive, welcoming, demonstrating competence and being 'to the point'. Third, the non-directivity of the counselling work: Being allowed to take the lead and to talk on a range of issues, both bereavement and non-bereavement related. Fourth, having their unhelpful thinking challenged, being encouraged to see things from a broader perspective and through addressing their feelings of guilt and anger. Fifth, by having their responses to bereavement normalised through psycho-education and therapist self-disclosure. Conclusion The findings support previous research which suggests that both more, and less, directive interventions can be helpful for clients who experience bereavement. This is consistent with a pluralistic perspective, which holds that no one therapeutic orientation has a monopoly on helpful therapeutic practices. The findings suggest that helpful practice with bereaved clients may involve a client-led approach in which there is the establishment of a strong, supportive and attentive therapeutic relationship, but in which the therapist also brings in more directive interventions to help the client normalise and address their feelings. [ABSTRACT FROM AUTHOR]

Background: The term outdoor therapy can be used to refer to a wide range of outdoor programmes including adventure therapy and wilderness therapy. Much of the research in the outdoor therapy field has focused on outcomes of these programmes rather than exploring the actual processes that are inherent in these experiences. Aim: This study investigated participants' perspectives of helpful aspects of outdoor therapy experiences. Method: By means of an international online survey, participants reported what was helpful about their experiences of outdoor therapy. A mixed method approach was used, with the qualitative data being analysed with the use of grounded theory methodology to conduct thematic analysis. The quantitative data was analysed using descriptive and inferential statistics. Findings: A total of 43 complete responses were received. Quantitative and qualitative analysis established that being in the outdoors was the most helpful factor. Of 19 given aspects ‘to be outdoors’ was ranked the highest and ‘being outdoors’ emerged as a main category in the thematic analysis (84%, (n=36)). ‘Group related aspects’ were all rated higher, on average, than ‘your relationship with therapist’. Such findings contradict previous research on how important the therapeutic relationship is in facilitating positive therapeutic encounters. Conclusion: Although very much a preliminary survey, findings suggest that further investigation into the meaning attached to being outdoors and how this might affect/impact upon the therapeutic relationship is needed. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy.Method: In-depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis.Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem-solving and CBT.Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings.Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes - aligned to a range of different orientations - can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group. [ABSTRACT FROM PUBLISHER]