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Training and accreditation standards play a critical role in the development of a research‐informed agenda. This commentary on Barkham et al. (Counselling and Psychotherapy Research, 2024) discusses obstacles to fully integrating research into the training and standard agendas, and the potential role that the British Association for Counselling and Psychotherapy (BACP) can play in helping to overcome such obstacles. Knowledge of research evidence is currently limited in training and accreditation standards for counselling and psychotherapy, and course tutors are often not familiar—or engaged—with research findings. In the development of professional standards (for instance, within SCoPEd), the BACP should work to ensure that research competencies are comprehensive, contemporary and explained in a granular manner. Further helpful developments might include an annual research‐oriented conference for trainers and clinical supervisors, a journal dedicated to disseminating research and good practice in training and clinical supervision and/or a training/clinical supervision research network to coordinate activities in these area. BACP events—across all elements of the profession—should strive to address issues of research awareness and participation, and the use of research to inform practice. Critically, across all of these possibilities, BACP's Research Department, alone, cannot be left to support moves to a research‐informed profession. Rather, an organisation‐wide initiative is needed in which appreciation of the research evidence is at the heart of all aspects of the Association's work. [ABSTRACT FROM AUTHOR]

The Cooper-Norcross Inventory of Preferences (C-NIP) is a brief, multidimensional measure of clients' therapy preferences. This study aimed to examine the factor structure and measurement invariance of the C-NIP. Fifteen datasets (N = 10,088 observations) representing the C-NIP in nine language versions were obtained from authors of psychometric studies. Confirmatory factor analysis and exploratory structural equation modeling were used to analyze the data. None of the proposed models adequately fit the data. Therefore, a new model was developed that sufficiently fit most of the C-NIP version 1.1 datasets. The new model was invariant up to the strict and means levels across genders, ages, and psychotherapy experience but only up to the metric level across translations. The C-NIP can be used to compare men and women, people of diverse ages, and people with some vs. no experience with psychotherapy. Lower reliabilities of the C-NIP scales are a limitation. [ABSTRACT FROM AUTHOR]

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]

This paper examines the question of how counselling psychology might move forward into the future. It argues that, for many counselling psychologists, the defining feature of our profession lies in a humanistic value-base; and that, to move forward, we need to look at how that could be more fully actualised. The paper argues that this value-base is most succinctly expressed in Levinas's concept of 'Welcoming the Other,' and it proposes five ways in which this ethic might be taken forward: developing our capacity to see beyond diagnoses, enhancing our responsiveness, focusing more fully on our client's intelligibility, taking a lead in giving psychology away, and developing our evidence base. The paper concludes by suggesting that the key issue is not the survival of counselling psychology as a profession; but the survival, development and proliferation of this value-base. [ABSTRACT FROM AUTHOR]

Introduction: Dissatisfied dropout costs services financially and impacts client well‐being. Research is limited on reasons for dissatisfied dropout in adolescents. Preliminary research suggests it may be due to feeling uncomfortable with silences, not knowing what to talk about, or unresolved ruptures. This study aimed to understand and refine the theory about the reasons for adolescent dissatisfied dropout from school‐based humanistic counselling (SBHC). Method: A theory‐building series of case studies was conducted with three dissatisfied dropout adolescent cases who received SBHC during a randomised controlled trial. Gaps in the theory were established by exploring the themes in one case. Testing and developing the theory with additional cases involved comparing themes and theory statements to case data. The final theory integrated data across the three cases. Results: Therapeutic relationship difficulties and client factors were the principal, overlapping reasons for dissatisfied dropout. Relationship difficulties included a poor therapeutic alliance, the counsellor persisting with their own agenda, repetitive client/counsellor interactions with silences, the client not feeling able to trust the counsellor with a risk issue and a lack of knowledge about humanistic counselling. Client factors included the client's hesitancy and ambivalence to talk about their feelings in the counselling. Conclusion: The results fitted with, but elaborated on and extended, the theory that a poor alliance, silences and misconceptions about counselling may lead to dissatisfied dropout. Emerging findings suggest the client's negative perception about disclosing their feelings and a lack of metacommunication about any difficulties in the therapeutic relationship may lead to dissatisfied dropout from SBHC. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to explore and compare helpful and unhelpful factors reported by young people who received either schoolbased humanistic counselling and the school's usual pastoral care (SBHC + PCAU) or pastoral care alone (PCAU) as part of a randomised controlled trial (RCT) of school-based counselling. Participants (N = 305) were 13–16 years of age and had answered one or more of the three free-text questions in the Experience of Service Questionnaire (ESQ). A thematic analysis was conducted to identify helpful and unhelpful factors, and a quantitative comparative analysis was subsequently used to assess differences between the SBHC+PCAU and PCAU groups. The identified helpful and unhelpful factors were consistent with previous research on school-based counselling, which indicated that having an opportunity to talk and be listened to by a supportive adult, who can offer appropriate guidance, is helpful for young people. Significant differences were found between the SBHC+PCAU and PCAU groups regarding three helpful themes (having a positive experience, having an opportunity to talk, and being offered guidance) and one unhelpful theme (the adult wasn't directive enough). The identified helpful and unhelpful factors were not particularly unique to school-based counselling; rather, they represented a more general statement of what young people believed to be helpful and unhelpful in their interactions with adults. [ABSTRACT FROM AUTHOR]

Abstract Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as “I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists’ use of clinical skills.” Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice. [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]

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]

Aim: The purpose of this study was to pilot a randomised controlled trial that aimed to test the hypothesis that counselling utilising a pluralistic framework was more effective than counselling as usual for young people experiencing issues as a result of their addiction. Method: Sixty‐four clients presenting with issues of addiction were allocated to either a counselling‐as‐usual (n = 33) or a pluralistic (n = 31) intervention. Psychometric measures (YP‐CORE and SDQ) were taken at baseline, endpoint and 3‐month follow‐up to compare changes in levels of psychological distress. Results: The use of a randomised controlled trial in practice‐based research was found to be feasible to both clients and the organisation in which the study took place. Recruitment and retention rates were acceptable. No statistically significant differences between groups were found on the primary measure. Discussion: The findings highlight the feasibility and acceptability of conducting such research within this unique context. The findings give preliminary evidence of the effectiveness of both counselling interventions. The absence of significant differences on our primary outcome between the two arms in this trial is not unexpected given its lack of power. Further research should continue to develop protocols to further maximise client retention and counsellor adherence. [ABSTRACT FROM AUTHOR]

Objective(s): To examine the psychometric properties of the idiographic Goal‐Based Outcome (GBO) tool for young people: test–retest stability, convergent validity, and sensitivity to an intervention. Methods: This measure validation study used data from a randomized controlled trial of school‐based humanistic counseling. We used multilevel analyses to assess test–retest stability, convergent validity of the GBO tool against nomothetic measures of mental wellbeing, and sensitivity to an intervention. Results: The GBO tool showed acceptable stability over a 6–24 week period; moderate convergent validity with nomothetic measures of mental well‐being, self‐esteem, and depression; and greater sensitivity to an intervention than a measure of psychological distress. Conclusions: The GBO tool shows evidence of having acceptable psychometric properties and is suitable for monitoring change on individual goals. It may also have the capacity to function as a population‐level indicator of outcomes in conjunction with the use of other measures of mental health and wellbeing. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the reliability, validity, and clinical utility of an idiographic, goal‐focused patient‐reported outcome measure: The Goals Form. Methods: Data were analyzed from 88 participants, across three samples, who had participated in collaborative–integrative psychotherapy at university‐based clinics in the UK. The samples were approximately 70% female with mean age of 30 years old. Results: The psychometric properties of the Goals Form were generally good. Noncompletion of individual items was low, temporal stability tended to be at target levels, and mean change scores showed moderate to good convergent validity against measures of psychological distress. The measure appeared sensitive to change in psychotherapy and was experienced by most patients as helpful. Conclusions: The Goals Form shows acceptable psychometric and clinical properties for routine outcome monitoring in psychotherapy. [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]

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]

Background: obsessive‐compulsive disorder (OCD) is a chronic, debilitating psychological condition. To date, there has been no published research exploring brief humanistic counselling as an intervention for OCD. This study presents a case study of an adolescent client with obsessive‐compulsive difficulties ('Sunil') receiving school‐based humanistic counselling. Aims: (a) To test humanistic counselling for an adolescent client experiencing obsessive‐compulsive difficulties; (b) to help improve brief humanistic counselling in its approach to working with adolescent clients experiencing obsessive‐compulsive difficulties. Method: This research used a mixed methods theory‐building case study, based on a rich case record. Results: The brief counselling did not reduce Sunil's obsessive‐compulsive difficulties. The core conditions were delivered in sessions, and the counselling allowed for the client to share traumatic memories and build peer relationships. However, the counselling did not seem to be directive at targeting Sunil's obsessive‐compulsive difficulties, and the silence in sessions was experienced by the client as awkward. Implications: Further research should be conducted investigating the therapeutic and problematic aspects of brief humanistic counselling for OCD. These include an in‐depth look at the impact of silence on the young person, integration of process‐guiding tools and the counsellor not enabling compulsive in‐session rituals. [ABSTRACT FROM AUTHOR]

In the case of psychological treatments, these outcome monitoring tools consist of psychological self-report scales (patient-reported outcome measures, PROMs), which are filled out by the patient usually before each session to capture ongoing therapeutic change. Routine outcome monitoring (ROM) is the regular assessment of patient outcomes to evaluate clinical progress during the course of therapy. Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper. [Extracted from the article]

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]

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]

The British Association for Counselling and Psychotherapy (BACP) is the largest professional membership body within the field of counselling and psychological therapies in the UK, but there is a mismatch between its membership of >65,000 and its research impact. This article sets out a potential strategic direction as considered by an informal grouping of researchers and teachers in the field. Actionable research plans are outlined at three levels: client–practitioner, local communities, and societies. At the client–practitioner level, data‐informed practice can be readily implemented as a therapeutic aid akin to supervision, providing the potential for integrating research into everyday practice. At the community level, interdisciplinary collaborations together with a focus on equality, diversity, and inclusiveness are paths to building a community of researchers and citizens that includes marginalised populations. The importance of social justice extends to the societal level, connecting with politics at a micro and macro level, and engaging internationally to respond to actual threats (e.g., climate change). Across these three levels, high value is placed on data with its potential for informing and improving practice, but also enhancing the lives of people in communities and societies. Overall, research strategies need to be collaborative (i.e., collegial) and less singular (i.e., individually project‐based), developing cumulative knowledge around specific topics via a ‘capture and build’ strategy for small projects with strategic oversight by BACP. Clarity of research strategy combined with collaborative and collective action from BACP and leaders in the field can help realise the full potential of BACP's research capacity. [ABSTRACT FROM AUTHOR]

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]

A conceptual framework rooted in existentialism is presented to unify psychological and sociopolitical perspectives. Human beings are directional, with well‐being the actualization of highest order directions. Distress emerges through external blocking of directions, or through dysergetic or ineffective internal configurations. Hence, social justice work and counseling have essential, and integrated, roles. [ABSTRACT FROM AUTHOR]

The use of systematic client feedback tools are known to enhance outcomes in adults psychotherapy clients, but their effects with children have yet to be adequately tested. Hence, we piloted a cluster randomised controlled trial of the Partners for Change Outcome Management System (PCOMS) with children aged 7–11 years old; comparing play-based counselling with, and without, the use of this tool. Ten UK primary schools were randomly allocated to either the intervention or control condition. Data were available for 38 children in total: 20 girls and 18 boys, of predominantly a white ethnic origin (mean age = 8.5 years). Clinical outcomes were the total difficulties scores on the teacher and parent completed Strengths and Difficulties Questionnaire (SDQ). Fifty percent of the schools left the trial between initial recruitment and end of data collection, but participant dropout was low and recruitment rates were satisfactory. Participants in the PCOMS condition showed significantly greater reductions in parent completed total difficulties than those in the control condition, with small to moderate effect sizes on all outcomes in favour of PCOMS. Overall, our design appeared feasible, but needs to ensure adequate school retention and counsellor adherence. [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]

This study is a pilot evaluation of a new avatar-based therapeutic tool, ProReal, with psychologically distressed young people within a school setting. In total, 54 young people, aged 12–18 years old, participated in face-to-face avatar-based counselling. Young people used the software to represent themselves and others, their problems and emotions. The primary outcome measure was the Young Person's CORE (YP-CORE). The avatar-based counselling intervention was feasible to implement and acceptable to clients, with 90% rating the help that they received as good, and less than 20% dropout. The intervention was associated with small to medium reductions in psychological distress, psychological difficulties and conduct problems. These improvements, however, were significant for male clients only. Outcomes were greater for counsellors who spent more time in training and using the ProReal software. [ABSTRACT FROM AUTHOR]

Many young people experience poor mental health, which, if left untreated, can have detrimental effects into adulthood. Person-centered and humanistic therapies are widely used for this population. However, the evidence for their effectiveness is limited, and tools to assess person-centered therapy's 'core conditions' with young people is also lacking. The Barrett-Lennard Relationship Inventory Observer Form (BLRI Obs-40) assesses the therapist-provided conditions of empathy, congruence, level of regard, and unconditionality of regard. This study assesses the psychometric properties of the BLRI Obs-40 with young people, using data from 136 audio recordings of school-based humanistic counseling. The scale's internal consistency was high and the five-month test-retest reliability was satisfactory. Inter-rater reliability, however, was poor. Confirmatory factor analyses (CFA) supported the original four-subscale dimensionality of the scale. The BLRI Obs-40 showed good convergent validity with the Person-Centered and Experiential Psychotherapy Scale adapted for young people (PCEPS-YP). The BLRI Obs-40 may be used with young populations for practice, supervision, and research. However, further exploration of, and evidence for, the scale's psychometric properties are recommended to validate its use. Extended training of raters will be essential to enhance the scale's inter-rater reliability. [ABSTRACT FROM AUTHOR]

What is meaningful in life? This is a question many individuals ask at least once in their lifetime. Many researchers have also asked this question, and a large body of literature seems to answer in theoretical and academic terms. But what is the meaning of meaning in clinical practice? That is, what is the role of meaning in psychotherapy, recovery, and positive mental health? And how could meaning in life be addressed in practices: What clinical competencies are needed? To answer these and other questions, a broad panel of researchers and practitioners met at the world conference of the International Network for Personal Meaning (INPM) in Toronto in July of 2016. A passionate debate followed, particularly on the question of the meaning of meaning in clinical practice. In this article, five panel members—Mick Cooper, Clara Hill, Robert Neimeyer, Kirk Schneider, and Paul Wong—elaborate their perspective on these two questions. At the end of the article, the moderator, Joel Vos summarizes, their differences and agreements, and suggests a pluralistic, multidimensional perspective on meaning for practitioners. Despite some fundamental differences, the authors report many similar perspectives on the meaning of meaning in clinical practice and on clinical competencies. This debate could be used as an example of how practitioners could also converse with their clients; the process of exploring the question, "What does meaning mean to you here and now, in our therapy room?" could be meaningful in itself. [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]

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. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the nature of metatherapeutic communication (MTC), defined as dialogue between therapists and clients on the nature of the therapeutic work and the means by which it can be of greatest help to clients. Twelve counselling psychologists, working pluralistically with 35 clients experiencing depression, described on post-session forms moments of negotiation and collaboration around the therapeutic work. Two main dimensions of MTC were identified: the subject matter of the MTC and the temporal focus of the MTC. In addition, MTC varied by the time at which it took place. These findings provide a framework for understanding the nature of MTC in counselling and psychotherapy, and the opportunities for implementing it in practice. [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]

Authors agree that a range of different existential therapies exist. However, not much has been written about what is characteristic and distinctive of each existential therapy, and the few claims that have been made are mainly hypothetical. Practitioners from the four main branches of existential therapy were asked about the authors and texts that have most influenced their practice and the practices they considered most characteristic of existential therapy. From all over the world, 29 daseinsanalysts, 82 existential-humanistic, 573 existential-phenomenological, and 303 logotherapy and/or existential analysis practitioners participated in this study. Data show that the scope of influence of an author is pretty much limited to the branch he or she is related to and only a few authors, in particular Frankl and Yalom, influence practitioners from all four branches. Five categories of practice are shared among the main existential branches as the most characteristics of existential therapy, with phenomenological practices being the most shared category: But the frequency of each of these categories of practice differs significantly depending on respondents’ training or affiliated branch. Data corroborate the idea of different existential therapies, with logotherapy and/or existential analysis being the most markedly different branch of them all. [ABSTRACT FROM AUTHOR]

This study aimed to develop a self-report measure of pluralistic thought and practice. Following pilot development, a 23-item inventory was placed on an online survey site, and 474 participants satisfactorily completed the measure. Respondents were trainee or qualified therapists, predominantly female, based in the UK, and of a humanistic or integrative/eclectic orientation. A principal components analysis resulted in two scales, Pluralistic Philosophy and Pluralistic Practice, which had good internal consistency (Cronbach’sα = .72 and .80, respectively). Confirmatory factor analysis showed good model fit for this two factor solution. The Therapy Pluralism Inventory (TPI) has potential for use in training and research, although additional validity and normative data are needed. [ABSTRACT FROM PUBLISHER]

Existential psychotherapy is a recognized and widespread therapeutic paradigm, with almost 100 years of clinical intervention. Despite some evidence of its effectiveness, existential psychotherapists have been criticized for a lack of a coherent framework of practice. Existential authors have been reluctant to make explicit their therapeutic methods, and an encompassing consensual understanding of its core constitutional practices has yet to be reached. To begin to address this, an online international survey was conducted and 971 existential practitioners from 46 countries and different theoretical and cultural backgrounds gave 2,611 responses to the question "which three specific therapeutic methods or practices would you consider most characteristic of existential therapy?". Responses were content-analyzed and a total of 77 different specific practices were identified and clustered into 17 subcategories and 5 overarching categories of practice. Phenomenological practices, methods associated with specific existential branches, practices informed by existential assumptions, relational practices, and practices of other therapeutic paradigms were found to be considered the most characteristic categories of an existential practice. An empirically based, encompassing, and structured taxonomy of existential practices is now available. New avenues are opened for research concerning the applicability and effectiveness of these fundamental existential practices. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to examine clients' perspectives regarding the helpful aspects of pluralistic therapy for depression. Method Thirty-nine clients received psychological treatment in a multi-site study exploring alternative interventions to standardised 'evidence-based' approaches. Eighteen of them consented to a face-to-face or telephone change interview at the end of their treatment. Change interviews aim to elicit clients' perspective regarding changes that they noticed during, and after, therapy and also the possible causes of these changes. Their descriptions were transcribed and analysed thematically using explicit coding of themes which were audited by the research team. Findings The data were categorised in three a priori domains consisting of specific themes. The first domain constitutes of client-originated helpful factors including clients' positive perspectives of therapy, clients' overall effort to change and clients' contribution in the decision-making process of therapy. Therapists were perceived as helpful when they were accepting and respectful, empathic, responding to clients' needs, making clients feel comfortable, challenging, empowering, using techniques, flexible and reassuring. Treatment outcomes such as change in perspectives, behaviour and response to problems as well as increased insight were also considered helpful factors of therapy. Conclusion These findings suggest that clients in pluralistic therapy are active agents of change and their willingness to engage with treatment is crucial. Helping clients feel comfortable by creating a safe therapeutic environment, challenging dysfunctional patterns associated with depression and empowering them to believe that change is possible through reassurance and non-intrusive guidance were considered beneficial. [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]

The aim of this article is to address the question, “What kind of future society would we, in the humanistic psychology movement, want to see?” The article argues that a “good” society is one in which people can actualize their wants to a maximum extent, and where each person has an equal opportunity to do so. The article suggests that this maximization of wants can be achieved through the development of synergies: means of actualizing wants that help, rather than hinder, others from actualizing their own wants. On this basis, it is argued that a future society should encourage the actualization of wants that are inherently synergetic—such as the desire for relatedness and compassion for others—while also helping people find non-dysergetic ways of actualizing more individualistic wants. In particular, it is argued that a society that values creativity and diversity can help people actualize their desires for competence and significance without undermining this in others. Finally, the article considers strategies for ensuring equality of opportunity to actualize wants, before discussing the role that humanistic psychology can play in this process. [ABSTRACT FROM AUTHOR]

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]

Background Many outcome measures for young people exist, but the choices for services are limited when seeking measures that (a) are free to use in both paper and electronic format, and (b) have evidence of good psychometric properties. Method Data on the Young Person's Clinical Outcomes in Routine Evaluation ( YP- CORE), completed by young people aged 11-16, are reported for a clinical sample ( N = 1269) drawn from seven services and a nonclinical sample (N = 380). Analyses report item omission, reliability, referential distributions and sensitivity to change. Results The YP- CORE had a very low rate of missing items, with 95.6% of forms at preintervention fully completed. The overall alpha was .80, with the values for all four subsamples (11-13 and 14-16 by gender) exceeding .70. There were significant differences in mean YP- CORE scores by gender and age band, as well as distinct reliable change indices and clinically significant change cut-off points. Conclusions These findings suggest that the YP- CORE satisfies standard psychometric requirements for use as a routine outcome measure for young people. Its status as a free to use measure and the availability of an increasing number of translations makes the YP- CORE a candidate outcome measure to be considered for routine services. [ABSTRACT FROM AUTHOR]

The article attempts to map out the distribution of existential therapies around the world and sets a comprehensive and systematic sketch of today's existential therapy panorama. It also provides updates on the one published within the journal two years ago and presents the whole list of existential therapy institutions worldwide.

Background: There is a growing body of data to show that participation in school‐based counselling is associated with significant reductions in psychological distress. However, this cannot be taken as evidence that school‐based counselling is effective, as improvements may have happened without the intervention. Aims: The purpose of this study was to develop a method of estimating the amount of ‘natural’ change that might be expected in young people who would attend school‐based counselling, such that the effects of the intervention over and above this amount could be identified. Method: Young Person's CORE (YP‐CORE) scores from 74 participants allocated to waiting list control conditions in four pilot trials of school‐based counselling in the UK were re‐analysed using regression models, and a formula was found for estimating the outcomes for young people were they not to receive counselling. This was termed their Estimated Non‐intervention Outcome (ENO), and could then be compared against the young person's Actual Outcome (AO), to give an estimated intervention effect (EIE). Results: The formula for the ENO was 4.17 + 0.64 × baseline score. Using this, we calculated a mean EIE for 256 young people in a cohort evaluation study of school‐based counselling, which showed that the counselling was associated with large and significantly greater change than would be expected without the intervention (Cohen's d = 0.91). Discussion: The method presented in this paper is a simple means for improving the accuracy of estimations of treatment effectiveness, helping to adjust for changes due to spontaneous recovery and other non‐treatment effects. [ABSTRACT FROM AUTHOR]

Background: The outcomes of counselling in UK primary schools are still largely unknown, and no clear predictors of change have been identified. This study is the largest evaluation to date of change and predictors of change in this sector. Method: The outcomes of Place2Be's play‐based counselling intervention for 3222 distressed children, aged 4–12, in 178 schools across the UK were evaluated. A naturalistic quantitative design was used, and the primary outcome was changed from baseline to endpoint on the teacher‐rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score. Outcome predictors were analysed using multilevel modelling. Results: The intervention was associated with significant reduction in psychological distress, with an effect size (Cohen's d) of.48 and clinical improvement of 50.3% of children. Greater improvements were found for children with higher baseline levels of distress, girls and bilingual children, while improvement of the children with a statement of educational needs was progressively compromised with increasing level of special educational needs. Discussion: Robust evidence now exists that a play‐based counselling model is associated with significant reductions in psychological distress in primary school children. However, more qualitative and quantitative research is needed to assess the effectiveness of this intervention and the key factors that predict change. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to replicate and extend a pilot evaluation of the effectiveness of school‐based humanistic counselling for psychological distress in young people. Method: Data were available on 32 young people who were randomised to either school‐based humanistic counselling or waiting list conditions for one school term. The primary outcome measure was of psychological distress using the Young Person's CORE (YP‐CORE), at six and 12 weeks post‐assessment. Secondary measures at these time‐points were of psychological difficulties, self‐esteem, levels of depression, and attainment of personal goals; with longitudinal evaluation of outcomes at six months post‐assessment. Results: On the primary outcome measure, participants who received counselling were significantly less distressed at six weeks than those in the waiting list group but not at 12 weeks, with effect sizes (Cohen's d) of 0.59 and 0.39 respectively. Reductions in psychological distress were maintained at follow‐up. Discussion: Although the present findings, in isolation, are equivocal, they contribute to a body of evidence that supports the effectiveness of school‐based humanistic counselling. However, the principal lesson learnt from this study was the need for rigorous training of researchers, counsellors and pastoral care teachers to ensure adherence to protocols. [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]