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The aim of this study was to explore how therapists believe they may relationally disconnect from other people and their clients, with an overall objective of developing methods for enhancing relational depth in counselling and psychotherapy. Participants were 168 trainee and practicing therapists, who listed their "chronic strategies of disconnections" (CSoDs) in everyday relationships, and then rated the presence of these CSoDs in their therapeutic work. Thirty-nine categories of self-reported everyday CSoDs emerged, organised into seven domains. Most prevalent were behavioural, passive and intrapsychic strategies. Over half of the CSoDs were rated as being present in therapy to a minimal extent, most commonly passive CSoDs, disingenuous CSoDs and humour. Male therapists, and trainee therapists, were most likely to identify their CSoDs as present in therapy.

This article explores how school-based counselling might impact young people's capacity to study and learn. Previous research has indicated that counselling in schools has an indirect positive impact on academic achievement. A mixed methods approach, using a semi-structured qualitative interview and a brief rating scale, was employed with 21 young people who have been recipients of school-based counselling in the UK. The findings from the interviews were analysed thematically. All participants felt counselling had in some way benefited their studying and learning. Counselling was perceived by clients as positively impacting upon their academic achievement by improving their concentration, motivation to study and attend school, behaviour in class and relationships with teachers. The findings replicate evidence from previous research that school-based counselling indirectly benefits young people's capacity to study and learn. (Contains 1 table and 2 figures.)

Aim: The aim of this study was to capture the most salient aspects of first‐session activities by a therapist who consistently had good clinical outcomes. Method: Constructivist grounded theory was used to analyse the first three audio‐recorded psychotherapy sessions with two clients. Results: The analysis generated 12 categories organised into three major domains: (a) promoting clients' sense of agency and the collaborative nature of the therapeutic process; (b) supporting clients' exploration of meaningful contents, balancing responsively between following clients and introducing new dimensions; and (c) creating a climate of emotional security based on empathic presence, authenticity and positive regard. Conclusions: The results show key aspects of the therapist's performance, such as distinguished clinical skills, responsiveness and strong relational abilities. The results support the literature on highly effective therapists. They also contribute to practice and psychotherapist training. Domains and categories from this study may be the basis for a checklist of some essential features to be included in psychotherapists' deliberated practice programmes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present research was to test the feasibility of a randomised controlled trial comparing five consecutive days of regular online jigsaw puzzling (JP) against a no‐treatment control group in improving mental well‐being outcomes in older adults. Methods: Eighteen older adults (65–80 years) were randomly assigned to either the JP (9) or control (9) group and completed a range of mental health and well‐being measures for five consecutive days. We assessed recruitment rates, completion rates and participants' experiences of the intervention. Results: Recruitment issues meant that 18 of the 32 intended participants took part in the trial. All participants completed the trial. Qualitative analysis indicated that participants experienced the JP intervention as accepted, with indications of enhanced enjoyment and self‐esteem at study completion. Conclusion: The present pilot study indicates that testing the efficacy of JP is feasible. A full‐scale clinical trial of this intervention should be considered, which can determine the efficacy of the JP intervention. [ABSTRACT FROM AUTHOR]

Research into psychological interventions for cancer patients has focused on the effectiveness of different treatment methods. Investigating common factors across treatments, such as qualities within the therapeutic relationship, has been neglected. This study explores cancer patients' experiences of moments of profound contact and engagement with their therapist, including any perceived impact. Semi-structured interviews were conducted with ten cancer patients. Eight participants reported having experienced moments of relational depth. Their transcripts were analyzed using thematic analysis. Five themes were identified: "Being physically and psychically vulnerable," "Being rescued from the waves," "Experiencing the calm after the storm," "More than a feeling," and "The therapist as 'a stranger and not a stranger'." Both novice and experienced practitioners should be aware of the potential power of moments of relational depth for cancer patients: to normalize patients' increased vulnerability and emotionality, and to manage breaks and endings with relational sensitivity. [ABSTRACT FROM AUTHOR]

Mick Cooper is Professor of Counselling Psychology, as well as Acting Director of the Centre for Research in Psychological Wellbeing (CREW) at the University of Roehampton. Aside from being a research-active practitioner, with research interests in counselling with children and young people as well as humanistic, existential and relational approaches to therapy, Mick is co-developer of the pluralistic approach to therapeutic practice. He has published numerous research articles and texts including his latest book ‘Psychology at the Heart of Social Change: Developing a Progressive Vision for Society’. Mick kindly agreed to be interviewed by two of our editors (Deborah Bailey-Rodriguez & Eva Fragkiadaki) to discuss qualitative research within psychotherapy and counselling research, his own research journey as a therapist and to give us tips and pointers for therapy trainees and bridging the gap between research and therapeutic practice for our Special Issue. [ABSTRACT FROM AUTHOR]

In this study we explored helpful and unhelpful processes in psychological therapy for women with a diagnosis of substance use disorder (SUD). Semi-structured interviews were conducted with eight women, seven of whom were white; and analysed using interpretative phenomenological analysis. Three superordinate themes emerged: What words can't express – finding another language, Identification with my therapist, and Getting towards acceptance. Emerging clinical implications are that therapists should consider strategies for helping clients with SUD "de-shame"; and be willing to challenge their resistance and avoidance from an empathic, accepting, and professional standpoint. Creative methods may help clients to identify and express their feelings, while the availability of therapists with their own histories of recovery may support hope and change. [ABSTRACT FROM AUTHOR]

Parents and carers are likely to take on a significant responsibility for managing an adolescent's mental health and well‐being. Accordingly, their perceptions provide insight into the value of an intervention. This study explored parents' and carers' perceptions and expectations of school‐based humanistic counselling, as received by a socially diverse group of young people (13–16 years old) in secondary schools in Greater London, UK. Semi‐structured interviews from 17 parents and carers were analysed thematically. Two superordinate themes were identified: (a) the context of counselling, and (b) the content of counselling, the latter referring to stages of the therapeutic process and its outcomes. Schools were perceived as an ideal environment for the provision of professional mental health support, as it reaches young people in a natural, convenient setting and therefore promotes and/or widens access to universal support, as well as targeted interventions. Parents and carers further emphasised the importance of overall well‐being, academic performance and social relationships. [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]

Background: The i‐THRIVE Programme is a needs‐based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders. Methods: Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider. Results: Three themes are identified: 'impact of needs‐based groupings on referral', 'impact of collaborative and interagency approach' and 'impact of i‐THRIVE on clinical practice'. Findings suggest that accessibility was seen to be promoted through the integration of a needs‐based approach, flexible re‐referral, signposting and information sharing, the use of goal‐orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal‐focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system. Conclusions: i‐THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole‐system approach supported by sufficient resources across the locality. [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]

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]

The paper presents an introduction of a newly developed, avatar-based virtual reality therapy, as an addition to the therapeutic programme, within a therapeutic community prison in the UK. The participants had six group sessions facilitated by a counsellor. The aim of the project was to investigate whether this approach would improve mental health outcomes for the prisoners, interpersonal relationships within the prison and facilitate the achievement of personal goals for the prisoners. The sample size (n = 4) was insufficient to make firm conclusions about the mental health outcomes. However, the qualitative analysis showed a strong engagement with the programme in addressing personal issues, the development of insight and empathy, and improvements in relationships within the participants and with the counsellor. Further research with a larger sample is needed to establish efficacy of this type of therapy with the prison population. [ABSTRACT FROM PUBLISHER]

Background: Recent research has indicated that school‐based humanistic counselling (SBHC) is effective for young people in reducing psychological distress and facilitating achievement of personal goals. However, the processes by which this form of counselling brings about change are not yet understood. Aim: This study aims to clarify the dynamic processes of change that young people go through when they attend SBHC, in order inform school counselling practice, training and further research. Method: This is a qualitative interview study with 14 participants who had recently completed between two and nine sessions of SBHC as part of a randomised controlled trial (RCT). Interviews were transcribed and analysed using a grounded theory approach resulting in the development of five change process models. Results: Multiple change processes were evident for individual clients; and were labelled relief, increasing self‐worth, developing insight, enhancing coping strategies and improving relational skills. Implications: The data indicate that multiple pathways of change are possible, and that change processes associated with different theories of personality change are not mutually exclusive. The study is limited by a small, selective sample and low testimonial validity, and further qualitative research is needed to understand change processes in SBHC more fully. [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]

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]

Aim The purpose of this study was to identify dimensions for a new pair of supervisory tools: the supervision personalisation form ( SPF) and the supervision personalisation form - assessment ( SPF-A). These are intended to help tailor supervisory work to the individual supervisee's needs and preferences. Method Semi-structured qualitative interviews were conducted with 15 accredited supervisors (four males and 11 females), principally counsellors and psychotherapists of an integrative or humanistic orientation, to identify the main dimensions along which their supervision practice varied. Data were analysed thematically using principles from grounded theory. Results Eleven dimensions of supervisory practice were identified: (1) Offering more, or less, theoretical input; (2) Focusing on the supervisee's strengths vs. focusing on their difficulties; (3) Focusing more, or less, on the supervisory relationship; (4) Providing more, or less, structure; (5) Focusing on the client's issues vs. focusing on the supervisee's issues; (6) Offering more, or less, self-disclosure; (7) Drawing from one, or more than one, orientation; (8) Offering more, or less, techniques and exercises; (9) Suggesting reading and reflection outside of supervision vs. not doing this; (10) More, or less, talking; (11) Directly challenging the supervisee vs. not directly challenging them. Discussion These 11 dimensions have been transposed into items for the SPF and SPF-A, which are now available for use in supervisory practice. However, further testing, evaluation and refinement of the forms is needed. [ABSTRACT FROM AUTHOR]

This article reviews the scientific foundations and efficacy of existential therapies. We discuss underlying epistemologies, clinical and therapeutic assumptions and overall effects. We follow a pluralistic methodological paradigm, where possible describing systematic literature reviews, meta-analyses and community-representative surveys. Promising evidence was found for clinical and therapeutic assumptions and positive overall effects. [ABSTRACT FROM AUTHOR]

This article presents the findings from a qualitative study conducted to understand the experience of therapists who described themselves as working pluralistically. Structured, open-ended interviews were conducted with seven participants, and data was analysed using Interpretative Phenomenological Analysis. Within the domain of personal experiences, participants described a feeling of congruence between their personal philosophy and pluralism, but struggled to define their role as therapist and felt there was a lack of research into the pluralistic approach. Within the professional domain, participants described their experience of working with clients: including collaboration, transparency and reconciling tensions. [ABSTRACT FROM PUBLISHER]

A qualitative study was conducted of therapists’ experiences of using two clinical tools that have been designed to stimulate dialogue with clients about their preferences for style of therapeutic working: the Therapy Personalisation Form (TPF) and the Therapy Personalisation Form – Assessment (TPF‐A). Ten therapists who had used the tools in clinical practice were interviewed about their experiences, with data analysed thematically. Therapists were generally positive about the clinical utility of the tools: they felt that they were helpful means of finding out what clients wanted from therapy such that it could be tailored accordingly, and could also serve as valuable sources of reflection and learning about their own practices. In addition, they believed that the forms were empowering for clients and helped to move the therapeutic relationship forward. In terms of limitations, the participants felt that the forms could lead to increased therapist self‐criticism and over‐moulding to the clients’ wishes, and may be too complex or bureaucratic for some clients. The results suggest that the TPF and TPF‐A may be of value to therapist and clients, though more research is needed on clients’ experiences of using this measure. [ABSTRACT FROM PUBLISHER]

Aim: To investigate young people's views on the effects of school‐based counselling, and what they found helpful and unhelpful. Method: Eleven semi‐structured interviews were conducted and thematically analysed. Findings: Participants expressed predominantly positive views of school‐based counselling with changes in three main domains: emotional, interpersonal and behavioural. Participants viewed these changes as having had an important effect on their lives. The most commonly cited helpful aspects of counselling were related to talking or getting things out, and counsellor qualities. Conclusions: School‐based counselling is viewed positively by those who have experienced it, and appears to be an appropriate and valuable intervention for young people. [ABSTRACT FROM AUTHOR]

This qualitative study explores person-centered practitioners' perceptions of what is helpful in their work with clients who experience psychotic processes and the impact that they believe this practice has on their clients. In-depth interviews with 20 British person-centered practitioners focused on how they worked with clients who experienced psychotic process, what they perceived as helpful, and how they believed these practices helped their clients. Analyses used a grounded theory approach. In addition to standard person-centered therapy, practices with this client group often incorporated Pre-Therapy and other elements acquired through advanced training. Emerging themes in perceived useful practice included "getting beyond labels and illness" and "working with particular care and attention." Results suggest the importance of specific therapeutic conditions, especially unconditional positive regard. The perceived therapeutic change most often described was increased social adjustment. Some clients were also perceived by therapists as showing lessened risk of harm to self or others and improvement in self-awareness, mood, resilience and other areas. [ABSTRACT FROM AUTHOR]

It is widely acknowledged that the therapeutic relationship is important to therapeutic outcome. In recent years, there has been additional evidence to suggest that specific, identifiable moments of relational depth between client and therapist can also have a major positive impact on the progress and outcome of therapy; however, the question of how such moments occur remains largely unexplored. Are they solely initiated by the therapist, or does the client have a role too? This article explores clients’ perceptions of the factors facilitating an experience of relational depth. Findings suggest that immediately prior to such an experience the clients themselves have reached a state of readiness, and as making a positive decision to bring their vulnerability to the fore in the therapeutic relationship, thereby facilitating a potential moment of change. Findings are discussed in relation to contemporary theory with implications for practice given. [ABSTRACT FROM PUBLISHER]

This study explores the qualities of the therapeutic relationship that are associated with profound moments of interpersonal connectedness. Using a phenomenological approach, qualitative, semi-structured interviews were conducted with 14 participants, all of whom had been clients of predominately person-centered counseling. Therapists with whom participants did experience moments of relational depth were experienced as being trustworthy, real, genuinely caring, and earnest in their desire to understand. In relationships where they felt there were no moments of relational depth, participants described their therapist as distant, powerful, interpreting, misunderstanding, or saying the right words but not really meaning it. Findings are discussed in relation to theory and previous studies, and suggestions for further research given. [ABSTRACT FROM AUTHOR]

Within the United Kingdom there is a significant revival of therapeutic counselling services in schools. This study looks at three factors which may affect students' willingness to attend such a service: location of the service (school-based or external); format (individual or group); and sex of counsellor. The views of 584 students from four Scottish secondary schools were surveyed. Approximately three- quarters of students expressed a preference for seeing a counsellor in their school. Over 80 percent of students expressed a preference for seeing a counsellor on their own, and this was particularly marked in older pupils. There was also a preference within the sample for female counsellors, particularly amongst female respondents, and most markedly amongst young female respondents. Implications of these findings are discussed in the light of related qualitative research, and methodological limitations of the study are highlighted. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore therapists' experiences of meeting their clients at a level of 'relational depth'. This was defined as a feeling of profound contact and engagement with another, in which the therapists experienced high levels of empathy, acceptance and transparency towards their clients, and experienced their clients as acknowledging their empathy and acceptance in a genuine way. Participants were primarily experienced person-centred therapists, five of whom were female and three of whom were male. Data was gathered through the use of qualitative, unstructured interviews within the broader framework of a person-centred and phenomenological methodology. All interviewees described experiencing moments of relational depth with their clients, and substantial commonalities emerged in their descriptions. These included heightened feelings of empathy, acceptance and receptivity towards their clients; powerful feelings of immersion in the therapeutic work; increased perceptual clarity; and greater levels of awareness, aliveness and satisfaction. At these times, the therapists also experienced their clients as highly transparent; articulating core concerns and issues; and reciprocating the therapist's acknowledgement of them in a flowing, bi-directional encounter. These findings are discussed in relation to recent research on 'presence' and 'flow' and it is proposed that relational depth can be conceptualised as a form of 'co-presence' or a co-experiencing of the person-centred 'core conditions'. Limitations of the study and areas for further research are discussed. [ABSTRACT FROM AUTHOR]