A system of research dissemination for clinical and counselling psychology

This thesis integrates the reflective components of action research, appreciative inquiry and autobiographical methods. Through the thesis, a model of dissemination of research in the fields of clinical and counselling psychology is presented. Its key components include collaboration and collaborative/relational reflection, appreciative inquiry and the researcher-practitioner/reflective-practitioner framework. Other important elements include collaborations that link research, practice and reflection, the identifying and supporting the development of potential leaders, leading research projects and training and conferences. Public Works such as the “Up Skilling the Specialist Mental Health Workforce in Psychological Practice Skills” and The European Journal of Counselling Psychology are used as foundations for this model. The thesis concludes with action planning for the future as part of the action research and appreciative inquiry forward spirals of planning, action, reflection, planning; this includes developments in the field of independent practice of clinical and counselling psychology

Clinical supervision in South Africa: Perceptions of supervision training, practices, and professional competencies

We investigated South African clinical and counselling psychology supervisors’ (n=44) perceptions of supervision training, their supervision experiences, and their perceived competence, confidence and effectiveness in providing supervision. Results indicated that many supervisors prematurely engage in supervision responsibilities and initiate supervision prior to receiving formal training in supervision. With limited regulatory guidelines available on supervision training and practices in South Africa, the findings indicate a need for the South African psychology profession to establish a formal regulatory framework on supervision training and practices. This includes identifying supervision training needs, developing training programmes, and instituting formal training requirements for practitioners who participate in clinical supervision.Significance: The sample of South African clinical and counselling psychologists involved in the supervision of trainee psychologists tended to engage in clinical supervision in advance of obtaining three years of independent clinical practice and prior to receiving appropriate training in providing supervision. There is a need for the Professional Board for Psychology of the Health Professions Council of South Africa (PBP-HPCSA) to appropriately monitor and enforce ethical obligations of psychologists who engage in supervision of trainee psychologists. Psychologists who provide clinical supervision to trainee psychologists ought to take personal responsibility for ensuring that they are appropriately trained and have acquired the necessary competencies to provide supervision before deciding to engage in supervision activities. Formal guidelines and policies regulating clinical supervision are necessary for ensuring psychology supervisors obtain appropriate training in supervision and fulfil mandatory HPCSA accredited supervision training requirements

The Experience of Relationship Dissolution During Counselling Psychology Training – a Thematic Analysis

Most studies addressing the experiences of trainees in the field of counselling psychology have focused on the different components and stresses of the profession; the literature has rarely explored trainees’ intimate partner relationships. This study, however, looks at the experience of a relationship dissolution during counselling psychology training. Drawing on transformative learning theory and models of relationship dissolution, the following research questions are explored: (1) How do trainees experience a relationship dissolution during counselling psychology training? And (2) how does training influence the relationship dissolution? Semi-structured interviews were conducted with ten participants in British Psychological Society (BPS) accredited counselling psychology courses from across the United Kingdom. Thematic Analysis (TA) using a dual inductive-deductive approach was applied to capture both the theoretical framework and the subjective experiences of the participants. Four themes and six subthemes developed; “I can feel the change day by day”, “the course indirectly influenced the break-up”, “the blurring of personal and professional boundaries”, and lastly, “the paradox of endings”. The findings are discussed in terms of their theoretical and clinical implications: firstly, adding possible new insights into the model of breakdown, and secondly, providing suggestions on how to support trainees and prospective trainees to the BPS, the Health and Care Professions Council (HCPC), and those involved in the training process

Understanding mental health difficulties and disclosure within psychology professions

Section A: Supervision is critical in the psychological professions for the development of knowledge and therapeutic skills, as well as for monitoring the safety and effectiveness of interventions. However, supervisee nondisclosure is common and may impact negatively upon the supervisory process and client outcomes. This literature review systematically examined the relationship between supervisee nondisclosure and the supervisory working alliance within the professions of clinical and counselling psychology. Findings relate to content of nondisclosure, psychology culture and expectations, compatibility and supervisory competence, power dynamics, weighing risk, aiding disclosure, alternative strategies, supervisory reactions and the cycle of nondisclosure and the changing supervisory relationship. Practice implications and future research are discussed. Section B: The prevalence of mental health difficulties among trainee clinical psychologists is reported to be high, with low disclosure rates. Clinical psychology training can be stressful, and it has been suggested that trainees are more likely to experience distress and self-doubt because of their inexperience. Despite this, little is known about how mental health issues are navigated within training. This study explored how trainees, clinical supervisors and training facilitators understand and navigate mental health difficulties, support, and time off. Seven main categories were created, using grounded theory methodology: trainee and staff histories and stressful life events, personal attitudes towards mental health difficulties, power and autonomy, questioning workplace competence, complex systemic issues, navigating access to support and time out, mental health in the psychological trenches and learning and hindsight. The culture within clinical psychology and unclear processes and communication may be implicated and are discussed in relation to practical implications

The role of theory and research in clinical practice: an investigation of therapists' perceptions of the scientist-practitioner model according to stage of professional development and professional allegiance

The scientist -·practitioner model has been widely espoused as the optimum model of professional training and practice for clinical psychologists and increasingly, the related professions of counselling psychology and counselling. However, it has also proved to be contentious regarding the extent to which it reflects or informs the realities of professional practice. This debate has taken on a new meaning in the current health care climate with the increasing emphasis on using research to achieve evidence-based practice'. This study explores clinical psychologists', counselling psychologists' and counsellors' beliefs about the scientist-practitioner model. Key themes relevant to this, and the related areas of theory, research and clinical formulation, were identified through in-depth, qualitative interviews and then tested further by using a survey instrument devised to reflect these themes. The results suggested differences between the professional groups in beliefs about research and the scientist-practitioner model and also indicated the influence of work setting. Differences in idiosyncratic definition of the scientist-practitioner model also emerged, which appeared to be related to beliefs about its value. Implications for training and professional practice are discussed and the contribution of the study to the existing literature and wider debate are reviewed

Counselling in primary care : a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services

Research on embedded counselling:an emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field

Twelve tips for teaching brief motivational interviewing to medical students

Background: Shifting from paternalistic to patient-centred doctor-patient relationships has seen a growing number of medical programs incorporate brief motivational interviewing training in their curriculum. Some medical educators, however, are unsure of precisely what, when, and how to incorporate such training. Aims: This article provides educators with 12 tips for teaching brief motivational interviewing to medical students, premised on evidence-based pedagogy. Methods: Tips were drawn from the literature and authors’ own experiences. Results: The 12 tips are: (1) Set clear learning objectives, (2) Select experienced educators, (3) Provide theoretical perspectives, (4) Share the evidence base, (5) Outline the “spirit”, principles, and sequence, (6) Show students what it looks like, (7) Give students a scaffold to follow, (8) Provide opportunities for skill practice, (9) Involve clinical students in teaching, (10) Use varied formative and summative assessments, (11) Integrate and maintain, and (12) Reflect and evaluate. Conclusions: We describe what to include and why, and outline when and how to teach the essential components of brief motivational interviewing knowledge and skills in a medical curriculum

Cats, elephants, alligators and the fantasy of the Sopranos: A qualitative study of the experiences of commissioners and managers delivering IAPT services using the Any Qualified Provider policy

Background: Primary Care Psychological Therapy services (PCPT) face pressure to deliver effective services due to the increasing prevalence, complexity and societal costs of Common Mental Health Disorders (CMHDs). Furthermore, commissioners and managers deliver services within a complex system of evolving policy and healthcare practice where successive policy changes, such as Improving Access to Psychological Therapies (IAPT), have significantly shaped PCPT design. Any Qualified Provider (AQP) represents one policy aimed at addressing financial pressures, extending patient choice and stimulating quality-assured competition. AQP shares features with several NHS developments which will arguably impact Counselling Psychology going forward, such as partnership working in ‘Sustainability and Transformation Partnerships’, and the increased use of ‘Payment by Results’. However, to date, there has been little significant discourse within Counselling Psychology around AQP, service design and the practical implications of policy changes.Aims: This research investigated the impacts of AQP on existing IAPT services and considered implications for Counselling Psychology in the context of policy change and new models of care for effective PCPT. It aims to inform and support clinical leaders with an awareness of the wider impacts of policy to improve the real-world effectiveness of services to address the rising problems with mental health.Method and analysis: Semi-structured interviews with a cross section of commissioners and managers in different regions and organisations generated leadership perspectives on AQP. Thematic Analysis offered a broad overview of the impacts of AQP in IAPT.Results: Four superordinate themes were identified: Resources and AQP delivery; Partnership working in AQP; Bureaucracy in AQP; and Patient experience in AQP.Conclusions: AQP offers insights into the partnership working of clinical leaders in a local IAPT service, and their adaptations to financial and bureaucratic pressures. To address increasing CMHDs, PCPT needs adequate funding to provide quality patient-centred care. Clinical leaders are willing and able to work within new quasi-market structures, but they prioritise clinical and relational values. Policy makers should embed these values in policies impacting PCPT to ensure the quality of services. This is an area where Counselling Psychology could – and should – engage more effectively with service design and policy