Ending therapy well is widely acknowledged as crucial for therapeutic gains to be maintained over time, yet numerous authors comment on the paucity of termination research. There appears to be no extant research into counsellors’ experiences of ending time-limited counselling in primary care (CPC), despite this being a rapidly-expanding area of practice, and theoretical literature suggesting elevated stress levels, ideological battles and burnout as counsellors adjust to time-limited working within Improving Access to Psychological Therapies (IAPT) services. When the ‘hallmark’ of a good ending is mutual agreement concerning client readiness, to what extent do traditional models of termination still hold? The aim of this research is provide some preliminary understanding of counsellors’ experiences of endings within this context. A qualitative design was employed. Data were collected in semi-structured interviews with six counsellors, and analysed using interpretative phenomenological analysis (IPA). Four overarching themes emerged: ‘self-experiencing’, ‘the quality of the therapeutic process’, ‘conflicting frameworks’, and ‘towards congruence’. These are related to wider literature and implications for counselling psychology (CoP) are discussed. Limitations and suggestions for future research are explored.

Behavioural Family Therapy (BFT) as a family intervention has previously been evaluated, with specific attention to its effectiveness in reducing relapse rates in psychosis. Less research, however, has focused on the subjective experiences of having BFT and no known research has explored fathers’ experiences of BFT. More generally, limited research has explored fathers’ experiences across other types of family therapy. This is interesting in the light of theories suggesting fathers benefit from family approaches and are considered to play an important part in them (Martin, 1977). A gap in contemporary literature provided a solid rationale to explore this concept further. This research represents an original investigation into the subjective experiences of fathers who have participated in BFT. Semi-structured interviews were carried out with five fathers to explore their experience of BFT. Interpretative Phenomenological Analysis (IPA) was used to analyse verbatim transcripts which generated three themes: Fathers’ Reflections prior to BFT, Fathers’ Reluctance about BFT and Fathers’ Positive views of BFT. The results were considered in relation to existing research in this field, with reference to counselling psychology philosophy. The findings highlighted specific reservations fathers have about the process of family therapy, and drew attention to the significance of engaging fathers in family interventions. This study contributes to knowledge by considering how the above themes inform counselling psychology, other clinical practice, service provision and training. The implications for future research are also discussed.

A recent systematic review suggests the effectiveness of Cognitive Behavioural Therapy (CBT) with brain injury client groups has been inconclusive and limited (Cattelani, Zettin & Zoccolotti, 2010). Although CBT has beneficial results in many specific psychiatric disorders, the rates of positive outcomes for managing psychological difficulties in the acquired brain injury (ABI) client group are still not satisfactory. Mixed or negative results have been reported in the existing literature (Cattelani, Zettin & Zoccolotti, 2010). Indeed, recent literature has highlighted a need to further develop existing CBT approaches for clients with ABI (Wilson, 2011), to assist practitioners in overcoming potential challenges caused by the complexities faced in this field. This qualitative study explores ABI clients’ experiences of CBT to provide better understanding of what may produce a greater therapeutic alliance and positive outcome. Six participants with ABI were interviewed in a semi-structured format about their experiences of CBT. Interpretative Phenomenological Analysis (IPA) was employed to develop an in-depth and coherent understanding of participants’ experiences. Three super-ordinate themes were identified namely, ‘Professional relationship’; ‘Understanding my struggles’; and ‘Acceptance’. Each super-ordinate theme was associated with three sub-themes. Findings of the present study highlight the essential elements for the effectiveness of CBT. These elements are the quality of the therapeutic relationship, the client’s willingness and readiness to engage in therapy, the adaptations needed in therapy to address the client’s limitations, and the need for a balanced focus between the behavioural and cognitive components employed in therapy. Furthermore, findings imply that process-based adaption is as important as technique-based adaption when delivering CBT to ABI clients, suggesting that the quality of therapeutic relationship and the process issues are both relevant to the therapeutic outcome.

During the period of recovery from drug and alcohol misuse the individual starts to move gradually away from former habits and patterns of thinking whilst learning new skills, however returning to a normal diet can be challenging for many recovering substance misusers. Studies involving substance misuse have mainly focused on weight changes and eating behaviours during active substance addiction, whilst research on how substance misusers experience weight changes and how they describe the functions and meaning of food and eating behaviours in recovery from substance addiction is scarce. This is a qualitative study using a constructivist grounded theory approach which aimed to explicate the experiences of food, eating and weight changes from eight women in different stages of recovery (ranging from early, mid and late recovery) from drug and alcohol addiction. The areas identified from ‘the meaning of food’ included: substituting alcohol with food, structure and social benefits. The areas identified from ‘weight changes’ included: weight gain and weight loss, and the areas identified from ‘eating behaviours’ included: distorted eating and dieting. The findings lead to an emerging theory that indicated: ‘Food during recovery involved providing structure to the day, enjoyment of social eating and substituting alcohol with food, particularly sugar rich foods during early recovery to 1. Replace the substances by filling a void, 2. Satisfy the cravings and urges experienced from the substances and 3. Experience a change in mood. The excessive intake of sugar rich food caused weight gain and in turn resulted in dieting and distorted eating behaviours later in recovery’. The theory that emerged from this research should prove useful to substance misuse facilities in order to enhance and incorporate nutrition education into treatment programmes to address food, eating and weight issues faced by women in recovery from substance addiction.

Binge Eating Disorder (BED) appears to have a fairly equal prevalence in men and women. However, men with BED have been overlooked in research as studies have mainly focused on women. As a result, there appears to be a limited understanding of men’s experiences and treatment needs of BED, including from a Counselling Psychology perspective. A qualitative study was undertaken to explore men’s experiences and understanding of BED including their experiences in seeking, accessing and receiving treatment. Semi-structured interviews were carried out with six men who had a diagnosis of BED. Data was analysed using Interpretative Phenomenological Analysis resulting in four super-ordinate themes: the experience of BED; the process of understanding; the stigmatised male self and the experience of treatment. The experience of BED was described as a divergent experience of negative and positive facets, characterised by a futile struggle to control their eating. The men described living a constrained life with BED similar to living in an inescapable trap. In trying to make sense of their BED, the men discussed the function of BED in their lives and they compared BED to an addiction. The experience of BED in men encompassed feelings of isolation and stigma due to having what they perceived as a female and/or homosexual disorder. These men discussed their strong adherence to male stereotypes of masculinity and having BED was perceived as unacceptable and emasculating. The participants’ struggles with treatment were emphasised as they sought to find unavailable support and received what they felt to be inadequate treatment care. The applicability of these findings for professional practice and Counselling Psychology practice are discussed and include exploring men’s recommendations towards tailoring treatment to meet their needs, for example all-male group therapy and addressing masculinity and stigma.

Counselling psychology’s Professional Practice Guidelines state that "counselling psychologists will consider at all times their responsibilities to the wider world". (Division of Counselling Psychology, 2005, p.7). It is suggested that the way in which counselling psychologists construct their relationship with the wider world could impact on practice, training, research and counselling psychology professional identity. A critique of the extant literature found that this issue has not previously been researched. Five counselling psychologists were asked in semi-structured interviews about their responsibilities to the wider world. Foucauldian Discourse Analysis was applied to the transcript of the interviews. Different constructions of the relationship between counselling psychology and the wider world were identified in the transcript and located in four wider discourses: professionalism, scientific, social activism and guru. Common themes across responsibilities constructed by participants utilising the different discourses included: the wider world being outside of the consulting room; difficulties defining responsibilities; and responsibilities being weighty. Responsibilities to communicate knowledge were constructed using three of the discourses. Both the guru and scientific discourses were mobilised to construct responsibilities to engage with technologies of the self (Foucault, 1988). In contrast the professionalism discourse was used to construct a responsibility to perform to others in order to appear professional. The implications of these constructions for counselling psychology, and the discourses mobilised by participants, are discussed.

Psychological research in the field of childhood trauma indicates that the earlier the age of onset and the more severe the traumatisation in terms of intensity, duration and repetition, the more extensively impaired individuals become. In such cases long-term, phase-oriented treatment is recommended. Over the last decade, the NHS has undergone significant changes in the delivery of psychological therapies. There has been a substantial rise in the use of evidence-based practice and time-limited psychological treatment has become a focal point in the delivery of clinical interventions within community mental health services working mainly with complex traumatised individuals. As such, there appears to be a tension between clinical need, resources available, and a requirement to adopt a more results-driven, time-limited therapeutic framework as the primary treatment. This research sought to examine how clinicians contend with the dilemma of working within a time-limited frame with developmentally traumatised clients. Semi-structured interviews were conducted with seven NHS psychologists. Findings suggest that the imbalance between demand and resources generates an imbalance of emotional resources and a tentative model is presented outlining the process of progressive emotional depletion experienced by participants as a direct result of the various and conflicting demands placed on them by the client, the organisation and the clinical task. Key implications arising from this research surround the implementation of Eye Movement Desensitization and Reprocessing (EMDR) for the management of dilemmas on a client, organisational and clinician level. Implications of this for theory and practice are discussed with an emphasis on enhancing knowledge in the field of Counselling Psychology and recommendations for future research are provided.

Background: Evidence suggests that eating disorders appear to be a significant issue in the United Kingdom. Report also suggests that people with eating disorders have a higher rate of mortality, with Anorexia Nervosa having the highest risk of mortality within eating disorders. Adolescents are most likely to be at risk suggesting closer attention should be given to this population. Despite the move towards outpatient services, inpatient treatment remains important to Anorexia Nervosa treatment for adolescents due to its life threatening features. Studies however indicate that a high number of patients who are discharged from inpatient treatment often relapse. Qualitative studies into the experiences of anorexic sufferers has shown that improvement during the recovery process may lead to new difficulties particularly in regards to managing their negative feelings without restricting their dietary intake. Most studies that have explored the experiences of people with Anorexia Nervosa tend to report more on their experience of treatment interventions. Furthermore, the limited research literature on recovery tends to focus more on adult experiences whilst little attention is given to the experience of adolescents. Aim: This study aims to contribute towards the topic as it explores the experiences of adolescents during the recovery process from Anorexia Nervosa after receiving inpatient treatment. Methodology: Semi-structured interviews were conducted with four adolescents who had been discharged into the community following inpatient treatment for Anorexia Nervosa. Results: From the analysis, the following four super-ordinate themes emerged from the data: self & recovery; relational; the world against me: back in the world; and psychological recovery vs. physical recovery. Conclusions: The findings highlight the impact of inpatient treatment on adolescents as well as the different roles played by parents, friends, and therapists in maintaining the course of recovery for adolescents with AN following their discharge from inpatient treatment. The findings also inform counselling psychologists as to how best to help adolescents manage the challenges they may face in the later stages of their recovery after discharge from inpatient treatment. Evaluation of the current study is followed by recommendations for future research.

Rationale: This study set out to provide an open investigation into how trainee counselling psychologists in the UK experience working with cognitive behavioural therapy (CBT) in their placements. Research and commentary by qualified and trainee counselling psychologists have expressed some concern about how well the profession’s values are upheld when they are working with CBT within the NHS and IAPT settings. However, it is unclear how widely these concerns are shared amongst counselling psychologists the majority of whom work in the NHS. Furthermore, the relevance of these concerns to trainees who may work with CBT in a wide range of other clinical settings within the public, charitable, and private sector was uncertain. Method: Interpretative phenomenological analysis was used to explore six final-year trainee counselling psychologists’ lived experience of working with CBT in their placements. Data was collected through semi-structured interviews via Skype. Findings: It uncovered three interconnected superordinate themes: (i) Pure CBT work vs. integration (ii) CBT conflicts with counselling psychology’s values, and (iii) Deconstructing & assimilating CBT. These findings were interpreted and discussed in relation to the existing literature. The key finding was that the participants’ belief in professional values often led them to feel frustrated with their work in CBT placements and with supervisors that expected them to only work with CBT as a stand-alone-approach. In this regard, the participants’ primary training in person-centred therapy or psychodynamic therapy and their preference for integrative approaches was deemed significant. The dissatisfaction reported by the participants concerning their CBT experiences was largely consistent with previous studies. The methodological limitations of the study are discussed and recommendations are made for further research to investigate the extent of these concerns and what could be done to address them.

Background/Aims: In the United Kingdom (UK), South Asians (SAs) are at a higher risk of developing problem gambling (PG), whilst rates of gambling activity remain the same across the population. Similar findings across other minority groups in Western jurisdictions indicate that culture and ethnic minority status may play a role in the development from recreational gambling activity to PG. However, there is a dearth of research into SA men's experience of cognitive behavioural therapy (CBT) for PG in the UK and elsewhere. Existing research suggests that SA men with psychological difficulties under-utilise mental health services in the UK. Understanding the experiences of SA problem gamblers who attend therapy could be integral in providing culturally appropriate interventions and adequate services where counselling psychologists work. Design: Participants were seven second-generation SA men aged between 23 and 39 who had received individual and/or group CBT from a National Health Service (NHS) within the last year. Interpretative Phenomenological Analysis was applied to verbatim accounts of semi-structured interviews. Results: Three superordinate themes were generated during analysis: 'Experience of CBT' (which refers to preconceptions of therapy, thoughts and challenges during therapy, issues of confidentiality); 'Culture' (which discusses stigma from the SA community, issues with identity and pressures from the family); 'CBT Framework for gambling' (which explores the learnings gained in therapy, addressing culture in therapy and advice for others). Conclusion: Participants emphasised the issues that SA men can encounter in therapy for PG with regards to cultural factors. These included adhering to collectivist and British values, meeting family and community expectations whilst negotiating their identity, and in reconciling stigma towards gambling. It is therefore suggested that training facilities and practitioners should consider developing more directed interventions, such as individual therapy, to better address these clients' cultural needs.