Ex‐clients' evaluation of bereavement counselling in a voluntary sector agency

This study aims to carry out an evaluation of bereavement counselling provided by a voluntary charity from the perspective of clients who had availed themselves of the service. A questionnaire survey of ex‐clients of one branch of a major voluntary sector bereavement care organization was carried out. Based on a sample of 89 returned questionnaires (representing a response rate of 45%), findings indicated that paraprofessional voluntary counsellors can provide a counselling service to bereaved people that satisfies the majority of clients who report positive experiences in counselling and post‐counselling outcomes, and generally rate their counselling as helpful. Nonetheless, there was a minority of ex‐clients who did not regard their status, 6 weeks after counselling, as being more positive. Further, the reputation of the voluntary agency within the community and among potential referrers and ex‐clients appears strong, offering additional positive evidence of the status of their bereavement counselling service in the locality.     

What is the prevalence of narcissistic injury among trainee counselling psychologists?

The purpose of this study was to ascertain the level of narcissistic injury among trainee counselling psychologists using the Narcissistic Injury Scale (Slyter, 1991). This 38‐item Likert scale is based on Miller's (1981) definition of narcissistic injury; a specific type of psychological damage which focuses on feelings about the self and past relationships related to self‐development. Theorists suggest that if untreated, narcissistic issues can interfere with client work and lead to a number of problems for trainees, influencing drop‐out rates and increasing burnout. The results of the study indicate that a high degree of narcissistic injury may be prevalent among trainee counselling psychologists and furthermore, that narcissistic injury does seem to be related to the quality of the perceived parent‐child relationship. Consequently, the study suggests that therapeutic work could be affected in those trainees who fail to address their own narcissism. The study provides some tentative support for the utility of the Narcissistic Injury Scale.     

Do psychologically‐minded clients expect more from counselling?

Objectives. The aim of this study was to explore the relationship between psychological mindedness and clients' expectations about counselling. Design. A cross‐sectional design was employed to assess correlations among study variables. Methods. Participants were 104 counselling‐centre clients at a mid‐size, Southwestern US university. Participant volunteers filled out the Psychological Mindedness Scale, life orientation test‐revised (LOT‐R), and the expectations‐about‐counselling questionnaire. Results. Clients who reported higher levels of psychological mindedness (PM) reported greater expectations of self‐involvement in counselling and greater expectations of positive outcome. In contrast, PM was not significantly related to clients' expectations about their counsellors' in‐session behaviour or to expectations about their counsellors' general personality style. Dispositional optimism (LOT‐R) did not play a major role in the relationship between PM and expectations about counselling. Conclusions. High PM clients do seem to expect more from counselling than low PM clients, particularly in terms of self‐involvement in the process and with respect to positive outcome. Consequently, therapists should consider assessing clients' PM, expectations, and the relationship between PM and expectations.     

The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis

Aim: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances. Background: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill‐equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice. Method: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health difficulties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues. Findings: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non‐clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specific factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non‐clients. Conclusion: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care. Copyright © 2009 John Wiley & Sons, Ltd.     

Irish clinical and counselling psychologists' experiences and views of mandatory personal therapy during training: A polarisation of ethical concerns

Although there have been some recent changes in Ireland, the practice of mandating personal therapy during training has traditionally differed between counselling and clinical psychologists. Irish psychologists (n = 258: 170 clinical, 88 counselling) took part in a survey study of experiences and views regarding this practice. Counselling psychologists reported higher rates of lifetime and current attendance at personal therapy compared to clinical psychologists, and nearly all had experienced mandated personal therapy compared to a minority of the clinical group. However, the clinical psychologists had a high rate of attendance at personal therapy compared to that reported for their British peers, indicating a high regard for personal therapy amongst Irish clinicians despite the absence of a training mandate. Five factors were found to be independent predictors of agreement with mandating personal therapy during training—lifetime experience of personal therapy, being a counselling psychologist, experience of mandated therapy, being more recently qualified, and longer attendance at personal therapy. Thematic analysis of the psychologists' open responses regarding mandated therapy indicated that the majority believed that personal therapy was an important part of ethical, effective practice, and valuable in enhancing self‐awareness and learning from the client experience. Ethical concerns about a mandate were polarised between the two psychology specialisms, more counselling psychologists emphasising the dangers and questionable efficacy of psychologists practising psychotherapy without personal therapy experience, and more clinical psychologists questioning the efficacy and ethics of imposing a mandate on trainees. Recommendations are made regarding this issue for trainers of both specialisms.     

One Language and Two Mother Tongues in the Consulting Room: Dilemmas of a Bilingual Psychotherapist

The purpose of the present study is twofold: first, to explore the bilingual therapist's experience of working in a second language; and second, to explore the major functions of language within the therapeutic setting. Interpretative phenomenological analysis is used to explore in depth the experience of 16 bilingual therapists of different professional orientations: psychoanalysts, psychotherapists, counselling psychologists, clinical psychologists and counsellors. Semi‐structured life‐world interviews were employed in accordance with the exploratory nature of the research. Four major themes were identified: ‘Listening and understanding the client’; ‘Interventions and interpretations’; ‘Potential impact of language on the therapeutic encounter: Therapist's point of view’; and ‘Therapist's experience of self’. The data demonstrated differences in the understanding of functions of language within the therapeutic setting among psychotherapists. The importance of the symbolic functions of language in therapeutic discourse is discussed. In addition, the specifics of language within the therapeutic encounter are explored and outlined.     

‘Chipping in’: Clinical psychologists’ descriptions of their use of formulation in multidisciplinary team working

Objectives. To investigate clinical psychologists’ accounts of their use of psychological case formulation in multidisciplinary teamwork. Design. A qualitative study using inductive thematic analysis. Methods. Ten clinical psychologists working in community and inpatient adult mental health services who identified themselves as using formulation in their multidisciplinary team work participated in semi‐structured interviews. Results. Psychological hypotheses were described as shared mostly through informal means such as chipping in ideas during a team discussion rather than through explicit means such as staff training or case presentations that usually only took place once participants had spent time developing their role within the team. Service context and staff's prior experience were also factors in how explicitly formulation was discussed. Participants reported that they believed that this way of working, although often not formally recognized, was valuable and improved the quality of clinical services provided. Conclusions. More investigation into this under‐researched but important area of clinical practice is needed, in order to share ideas and support good practice.     

Grief and bereavement issues and the loss of a companion animal: People living with a companion animal,owners of livestock,and animal support workers

Companion animals play various roles in people's lives and these roles can impact on loss, grief, bereavement and mourning when the animal has been lost, whether that is through death, when missing, or when relinquished. This paper considers not only companion animal owners, but also those who own farm animals and those who work in animal service occupations. The focus is on adult clients, not children. Practical strategies are offered for the counsellor who is working with a bereaved pet owner, farmer, and service provider.     

Competent Poverty Training

Despite numerous calls to the discipline, attention to poverty and social class remains minimal in psychology even though most human experience is significantly affected by social ranking. As a result, educators lack models for training in the context of poverty. Recent and concerted efforts to define and implement competency‐based models for the practice of professional psychology have resulted in the creation of Competency Benchmarks (American Psychological Association, 2011). Here, these Competency Benchmarks frame the integration of best practices in working with poor and working‐class clients with what we know about what constitutes good training. The result is a competency‐based approach for those who are training psychologists‐to‐be to work effectively with economically challenged clients.     

Evaluation of exclusion prenatal and exclusion preimplantation genetic diagnosis for Huntington's disease in the Netherlands

van Rij MC, de Die‐Smulders CEM, Bijlsma EK, de Wert GMWR, Geraedts JP, Roos RAC, Tibben A. Evaluation of exclusion prenatal and exclusion preimplantation genetic diagnosis for Huntington's disease in the Netherlands. Individuals at 50% risk of Huntington's disease (HD) who prefer not to know their carrier status, might opt for exclusion prenatal diagnosis (ePND) or exclusion preimplantation genetic diagnosis (ePGD). This study aims to provide a better understanding of couples' motives for choosing ePND or ePND, and surveys couples' experiences in order to make recommendations for the improvement of counselling for exclusion testing. This qualitative retrospective interview study focussed on couples who underwent ePND or ePGD for HD in the period 1996–2010. Seventeen couples were included of which 13 had experienced ePND and 6 ePGD. Mean time‐interval since exclusion‐testing was 3.9 years. Couples' moral reservations regarding termination of pregnancy (TOP) or discarding healthy embryos were counterbalanced by the wish to protect their future child against HD. Seven couples had terminated a total of 11 pregnancies with a 50% HD risk, none showed regret. ePGD was used by couples who wanted to avoid (another) TOP. ePND and ePGD are acceptable reproductive options for a specific group of counsellees. To guarantee sound standards of care, it is imperative that candidate couples be given in‐depth non‐directive counselling about all possible scenarios, and adequate professional and psychological support prior to, during and after ePND/ePGD.     

A qualitative study exploring genetic counsellors' experiences of counselling children

The identification of healthy carriers by newborn screening programmes raises questions about how and when the carrier results will be conveyed to child. There is currently a lack of information concerning how best to convey carrier information to children. This is a serious gap in the literature and practice. This study examined genetic counsellors'' experiences of counselling children to explore how to support and inform children about their carrier result. Practising members of the United Kingdom (UK) Association of Genetic Nurses and Counsellors took part in semi-structured telephone interviews. Respondents described the communication process and identified barriers and facilitators of communication. Age, illness experience and maturity were variously discussed as facilitators; all of which are integral to psychological theories of children''s understanding of illness. Adaptive family communication, school tuition and educational materials were also seen as influencing counselling efficacy. Relevant materials that children could keep were also seen as important to enhance children''s autonomy. Yet, such resources were rare, constituting a barrier to communication. Counsellors reported communication was further impeded by maladaptive family communication and resistance from children to engaging in counselling. By exploring the facilitators and barriers inherent in communicating genetic information to children, guidance can be offered to counsellors, researchers and parents. This study indicates that some factors (eg illness experiences) previously identified by psychological theories may act in complex ways within this setting. Importantly, the factors identified as being most influential when communicating with children about genetics are amenable to change through interventions, support and training.     

Ripley's Game: Projective identification,emotional engagement,and the counselling psychologist

Counselling psychology's dual emphasis on the use of the self as both vehicle of therapeutic change and legitimate focus of inquiry and research is one of the features by which the profession may be distinguished from related fields such as clinical psychology or psychotherapy. This paper discusses the relevance of the psychoanalytic concept of projective identification in understanding the extent, nature and subtlety of the ways in which the therapist's ‘self’ and emotions may be deployed within the therapeutic relationship. Illustrated with reference to the film ‘Ripley's Game’ and a clinical case vignette, Searles's (1978) advocacy of ‘a richness of emotional participation’ within clinical work is discussed in relation to the pluralist philosophy of counselling psychology; implications for the training and personal development of counselling psychologists are also briefly explored.     

Factors associated with risky sexual behaviour among clients undertaking HIV testing and counselling services at a secondary referral hospital Lagos,Nigeria

BackgroundThis study determined the prevalence of risky sexual behaviour and its associated factors among clients who accessed HIV counselling and testing services at a secondary referral hospital in Lagos, Nigeria.MethodsA retrospective review of clients'' records was conducted. The Client Intake Form of people who accessed HIV counselling and testing services at Mainland Hospital in Lagos, Nigeria between July 1, 2016, and December 31, 2017, were reviewed. Multivariate analysis was conducted to determine the associated factors of risky sexual behaviour.ResultsA total of 4273 client''s records were analyzed, 3884 (90.9%) reported having sex before HIV counselling and testing (HCT). The prevalence of risky sexual behaviour among clients was 41.5%. More males and HIV positive clients had unprotected sex with a casual partner three months before HIV counselling and testing (p < 0.05). More singles than the married had unprotected sex with casual partners (p <0.001) and multiple sexual partners (p =0.002). The prevalence of risky sexual behaviour reduced with advancing age. Being single and having an HIV infection were associated with risky sexual behaviour in this study.ConclusionAge, marital status and HIV status were associated factors of risky sexual behaviour.     

Sexual Feelings and Behaviors in the Psychotherapy Relationship: An Ethics Perspective

Sexual intimacies with clients are inappropriate behaviors under all circumstances. Yet, psychologists who adhere to rigid rules about boundaries and multiple relationships in an ill‐guided effort to avoid such occurrences may find that they actually harm clients by acting in ways that are inconsistent with clients’ treatment needs and goals. Boundaries and multiple relationships are discussed and strategies for negotiating them effectively are presented. A thoughtful and deliberative process is described for responding to the inevitable feelings of attraction toward clients that at times arise, and steps for addressing psychotherapists’ vulnerabilities are presented. Ethics principles and standards as well as decision‐making considerations are presented so that psychologists will be better prepared for addressing these important issues in psychotherapy.     

为什么成为心理治疗师/咨询师——心理治疗师/咨询师的职业动机研究评述

本文回顾了国外有关心理治疗师/咨询师职业动机的研究,旨在梳理和归纳他们选择该职业之原因,了解他们在职业活动中获得的精神回报。文中将心理治疗师/咨询师的职业动机归纳为七种:①助人;②自我治疗;③照顾他人;④寻求亲密关系;⑤获得控制感;⑥自恋;⑦其他动机。并进一步分析了上述职业动机与个体的创伤、亲职化、丧失与孤独、良师益友及个人治疗等经历之间的关系。     

Listening to the Voices of the Poor and Disrupting the Silence About Class Issues in Psychotherapy

By its very nature, a life of poverty is harmful to the emotional well‐being of poor and working‐class women and men. Psychology, for the most part, has unwittingly played a part in this oppression by pathologizing the poor and maintaining barriers to mental health care. This article presents findings from qualitative studies that illustrate lived experiences and insights from poor and working‐class people in the community at large and in the therapeutic settings in particular. Drawing from these narratives, recommendations are made to psychologists who seek to subvert the normative silence around class issues and take on the work of providing class‐aware services to men and women in poverty.     

Children’s autonomic functioning moderates links between maternal rejecting attitudes and preschool aggressive behaviors

Substantial theoretical and empirical literature suggests that the extent to which children's early experiences contribute to the development of aggressive behaviors may depend on the psychophysiological regulatory capacities of the child. This study adds to this literature by examining the relations between mothers’ rejecting child‐rearing attitudes and children's aggressive behaviors, as well as whether children's parasympathetic regulation, both at rest and in response to anger‐inducing films, moderate these links. Using the data collected from 88 preschoolers (m_age = 51 months), the results revealed that the positive association between mothers’ rejecting child‐rearing attitudes and children's aggressive behaviors was moderated by respiratory sinus arrhythmia (RSA) reactivity to anger. More rejecting child‐rearing attitudes predicted more aggressive behaviors only for children who showed mild RSA suppression to RSA augmentation. Conversely, and consistent with the differential‐susceptibility model, children who showed mild RSA suppression to RSA augmentation had the fewest aggressive behaviors when mothers reported less rejecting child‐rearing attitudes.     

The communication of secondary variants: interviews with parents whose children have undergone array‐CGH testing

Children with unexplained developmental disabilities or congenital anomalies are increasingly being referred for genetic diagnostic testing using array‐comparative genomic hybridisation (array‐CGH) and next‐generation sequencing (NGS) technologies. Their parents will have to deal with the secondary variants that will inevitably arise. We conducted 16 prospective semi‐structured interviews with native Dutch‐speaking parents whose children had undergone clinical array‐CGH testing. The interviews explored the parents' experiences, expectations and opinions, specifically regarding the communication of results. Concrete examples of ‘unexpected results’ were provided to help guide the discussion, differing in severity, treatability, time of onset, level of risk, and carrier status. Data was analysed using content and narrative analysis methodologies. Parental motivations for and against the disclosure of unexpected results cluster around four main themes: actionability; knowledge; context; and characteristics of the result. Most parents wished to know all types of results. Disclosure was framed within a holistic, contextual, family‐wide view. Genetic counselling should aim to integrate explorations of the motivations of parents surrounding the disclosure of results with good clinical care.