Det övergripande syftet med denna kandidatuppsats är att utforska hur professionella hjälpare inom psykiatrin i Norrland etablerar och upprätthåller hjälpande relationer samt vilken syn de har på betydelsen av relationen för behandlingens utfall. I studien intervjuades fyra kuratorer som var anställda på psykiatriska kliniken i Norrland, varav två kvinnor och två män som representerade olika mottagningar. Det insamlade materialet analyserades med hjälp av en hermeneutisk metod och strukturerades upp med hjälp av kvalitativ innehållsanalys. I resultatet framkom det att intervjupersonerna såg relationen som väldigt viktig, både för att få till stånd en behandling men också för att upprätthålla en pågående behandling. Relationen i sig ansågs vara en bärare av hjälpen såväl som en hjälp i sig. Vi fann också att relationskompetens är en nödvändighet för att en behandling ska fungera. Begrepp som lyftes var autenticitet, att behandlaren är genuin, vågar visa känslor och reaktioner gentemot patienten. Ännu en faktor som särskilt påtalades var vikten av att som behandlare ha ett icke-dömande förhållningssätt gentemot patienten och se denne på ett realistiskt vis, vilket innebär att behandlaren ser patienten för den person den är.

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Refugee youth are identified as a high risk group due to the likelihood of exposure to trauma (UNICEF, 1996) and frequent reports of anxiety, depression and Post Traumatic Stress Disorder(PTSD)(Ellis, MacDonald, Lincoln, & Cabral, 2008). However they tend to underutilize mental health services(Fenta, Hyman, & Noh, 2006). This study explored the ways in which educational cultural brokers support the psychological well-being of refugee youth. Using a qualitative case study (Merriam, 2009), four cultural brokers and three mental health practitioners were interviewed and data was analyzed thematically. Two broad themes were identified encompassing informal supports and formal supports. Sub-themes that represented informal supports were: (1) Facilitating cultural integration and sense of belonging, (2) Bridging to settlement services, and (3) Providing supportive counselling. Sub-themes describing formal supports were: (1) Facilitating referrals, (2) Educating, (3) Providing contextual information, and (4) Providing cultural interpretation. The practice implications of this research are discussed. / Counselling Psychology

This qualitative study explored experiences of prematurely terminating adult individual therapy from the perspectives of therapists as clients in England. The aims of the study were to gain an overview of the experience of prematurely terminating therapy; to understand the experience of dissatisfaction when this is given as a reason for prematurely terminating therapy; and to inform and thus help improve practice. Rates of premature termination from counselling and psychotherapy remain high despite a considerable body of research into possible predictors of this phenomenon. Few studies have explored clients’ experiences of premature termination in depth. Clients often report dissatisfaction as a reason for premature termination, and this experience is under-researched. From practitioners’ perspectives, little is known about indicators of dissatisfaction, and how to manage premature termination if it occurs. The study was conducted in two stages. The purposeful sample were therapists who, as clients, prematurely terminated personal therapy after attending at least two sessions. Participants self-selected as having prematurely terminated therapy. Stage one used an online qualitative survey to gain an overview of participants’ experiences of premature termination, and the 40 usable responses were analysed inductively using thematic analysis. The survey was used to recruit participants for stage two. In stage two, six semi-structured interviews were carried out with participants who had prematurely terminated therapy for reasons of dissatisfaction. The data were analysed using interpretative phenomenological analysis. Overall, the major themes created were: feeling dissatisfied; client becomes unable to continue therapy; and communication about the premature termination. The findings confirm the importance of the working alliance in therapy, and illuminate how the alliance failed to develop in experiences of dissatisfaction. It is argued that understanding clients’ experiences could enable practitioners to recognise the presence of dissatisfaction, and adapt therapy, if appropriate, to minimise avoidable premature termination. The need for therapy to ‘add value’ was also identified. The findings indicate a failure by some therapists to act in a relational way when clients prematurely terminated therapy, thereby disrupting the dominant discourse about the importance of the therapeutic relationship. Clients’ needs at the point of premature termination were identified. The findings of this study are not generalisable but may be transferable. The study concludes that therapists’ management of how therapy ends is just as important as the management of how it begins, regardless of how it ends. This has implications for practice and training. Areas for further research are identified.

This research is concerned with some aspects of the counselling process within Marriage Guidance Council Counselling sessions. The first area of investigation chosen was the interaction of the counsellors image of the ideal client with her perceived image of real clients. Unfortunately, it was not possible to pursue this investigation since not all of the counsellors images of who would benefit from counselling were sufficiently stable over time. This was felt to be due to the test used (the California Q set). The second chosen area of investigation was the client counsellor verbal interaction in first counselling sessions studied using transcripts of ten female and four male clients and two couples counselled by the researcher and one woman and one couple counselled by another counsellor. The content was analysed using attribution theory. Clients made attributions from a wider range of categories than experimental studies normally allow for, the most frequently used category was emotion and attitude attributions, this is a neglected category which needs further study. The results did not support previous findings that people make Significantly more situational than personality attributions about their own behaviour. Clients have response strategies they use to reply to the counsellor, some of these are blocking strategies since they result in the counsellor dropping the subject being discussed; others are positive responses since they lead to the client· and counsellor engaging in a dialogue. All clients living with their partners who returned for a second session engaged in at least one extended dialogue with the counsellor about an attribution made by the counsellor. None of the clients who failed to return engaged in an extended dialogue with the counsellor.

Whilst the literature underpinning counselling psychology generally acknowledges that values and ethics are inherent in therapy1, the different ways in which they feature and to what effect are under-explored areas. Though therapeutic literature would seem to recommend that counselling psychologists take a critically reflexive approach to values and ethics, the extent to which counselling psychology training engenders this kind of thinking is unclear. This research project therefore set about examining the ways in which values and ethics were constructed in the talk of final year trainee counselling psychologists discussing values and ethics in counselling psychology training and practice. Four focus groups comprising a total of nineteen participants were conducted and transcribed. The transcripts were analysed using Willig’s (2008) six-stage approach to Foucauldian discourse analysis, identifying and exploring the ways in which participants constructed values and ethics in counselling psychology training and practice. The analysis examined the implications of the different constructions identified for counselling psychology training and practice and the subjective experience of counselling psychologists within these contexts. Three discursive constructions of values and two of ethics were identified, drawing on four discourses. The use of each discourse produced its own effects, offering participants different subject positions with different consequences for their therapy practice and subjective experience. The relationship between contrasting constructions of values and ethics from within an institutional and a humanistic discourse dominated discussion and appeared to have greatest impact on participants’ practice and subjectivity. Tensions were experienced between the differing demands of the institutional and humanistic discourses, resulting in feelings of dissonance and discomfort, as participants tried to mediate between contrasting constructions in an attempt to forge a coherent sense of identity and practice involving both.

This research explores how counselling psychologists construct of the diagnosis of ‘schizophrenia’ and their perceived ability to work with this client group. The diagnosis of ‘schizophrenia’ does not feature prominently in counselling psychology literature, and there is a distinct lack of empirical research pertaining to how counselling psychologist construct this diagnosis, as well as accounts of their experiences of working with this client group. The literature review commences with: an exploration of the context of counselling psychology with particular reference to theory, practice and research; the diagnosis of ‘schizophrenia’ in relation to the medical model debate; and, the implications of ‘schizophrenia’ for the theory and practice of counselling psychology, with a particular reference to diagnostic categories. A version of discourse analysis known as ‘critical discursive psychology’ is used to analyse how eight counselling psychologists talk about and around the diagnosis of ‘schizophrenia’ in semi-structured interviews. The analysis demonstrated a number of repertoires used in relation to the diagnosis of ‘schizophrenia’ and how these counselling psychologists use them in different ways. The analysis suggested that through the use of these repertoires the counselling psychologists negotiated their relationship with their clients, their ‘identity’ as counselling psychologists and the organisations they worked for. It was also found that there were a number of difficulties in their relation to the diagnosis of ‘schizophrenia’, such as how to negotiate the balance between phenomenology and empiricism, as well as the sometimes detrimental effects the institution had on the counselling psychologists. The research also raised questions concerning methodology and the use of critical discursive psychology in studying this topic, as well as issues regarding the conflicting epistemological positions of counselling psychology and critical discursive psychology.

In 1980, the various symptoms of combat stress were formally classified as post-traumatic stress disorder (PTSD), now an established condition with supporting research on its prevalence, possible causes and treatment options. As a diagnosis, however, it is marked by persistent questions about its validity as a conceptualisation of this group of symptoms. This kind of questioning stance is characteristic of counselling psychology as a discipline, which attempts to straddle both the scientific and therapeutic worlds of psychology. This latter, more subjective and interpretative world is currently absent from PTSD research and there is a consequent lack of understanding as to the perspective of those who have a PTSD diagnosis and who have undergone treatment for it. This research aims to fill this gap in the literature by asking veterans diagnosed with combat-related PTSD to describe and explore their experience of therapy. Six male participants were recruited on a voluntary basis from Combat Stress, the UK’s leading charity specialising in the care of veterans’ mental health. All participants served on a full time basis for the Armed Forces in a combat role and have since been diagnosed with combat-related PTSD by a Combat Stress psychiatrist. The data was collected using semi-structured interviews lasting around one hour. Analysis of the data was conducted using Interpretive Phenomenological Analysis (IPA), an inductive method which aims to explore and understand how a phenomenon is experienced from the perspective of those involved. Two master themes emerged, ‘being misunderstood’ and ‘developing understanding’, each with three subthemes. These themes explore these participants’ accounts of the internal confusion caused by PTSD symptoms and the external struggle to be understood by others and receive necessary help. These themes also engage with how the participants report a growing commitment to therapy, their developing relationships with themselves and their therapists, and the value of normative experiences in a safe environment. Together these themes form an interpretative answer to the research question: how do veterans diagnosed with combat-related PTSD experience therapy? The themes are explored in depth and links are drawn between them and the wider literature. The implications of this for counselling psychology practice are discussed, and suggestions for further research are made.

In response to a perceived lack in this area, this study has investigated how White trainee counselling psychologists construct their experience of training in the area of racial difference, and how they discursively explore and negotiate their own potential for racial prejudice within the therapeutic encounter. Using the framework of Critical Discursive Psychology (CDP), data from eight interviews and two focus groups have been discursively analysed and are presented as one of an ever evolving number of possible analyses. The present analysis of the data has found that as the participants grapple with their professional identities as counselling psychologists in training, they inhabit one of three omnipresent discursive fields, which in turn create distinct subject positions. The discursive fields of ‘colour-blindness’, ‘interculturalism’ and ‘pluralism’ all offer the trainees alternative constructions of practice which are drawn on depending on which professional representation appears to be at stake. In particular, the participants struggle to balance the desire for value free openness associated with a pluralistic approach, alongside a need for professional competency characterised by a dependence upon generalised understandings of other racialised groups as supported by an intercultural perspective. However, whilst trainees themselves wrestle with matters of ethics and competence, the present analysis highlights the unintended contributions to racism and racial prejudice which are created when the trainees inhabit alternative discursive fields and their related subject positions. Throughout this process of professional positioning, this study identifies how incidents of racial prejudice appear in the trainees talk, both directly and indirectly. This deconstructive process offers a window into the presence of unintentional racism, and generates some suggestions for the practical application of the findings presented. In addition, via a reflective process these findings are discussed and there is a questioning of the methods used, including an examination of how the interviews/focus groups were conducted and how the data were analysed.

Clinical supervision is viewed as being an essential and integral part of both trainee and experienced therapists’ development. The cultural shift towards Evidence Based Practice has led to increased practitioner accountability and a requirement to ensure that patients gain access to the best-available mental health care. Supervision is heralded as the vehicle through which best practice can be obtained and, as a result, a strong demand for more research to support supervision practice has emerged. Most of the existing research is based on trainees with very little attention given to the views of more experienced or ‘expert’ practitioners. This study aimed to explore ways in which clinical supervision impacts the practice of experienced Counselling Psychologists by asking seven experienced practitioners (with 7-31 years of post-accreditation experience) to describe how they see their lived experience of supervision as having helped or hindered their practice. Data were collected using open-ended semi-structured interviews and were analysed using Interpretative Phenomenological Analysis (IPA). Participants’ experiences clustered into three superordinate themes: a) Factors which Help Supervisee; b) Factors which Hinder Supervisee; and c) Impact on Working with Clients. The empirical findings suggest that clinical supervision can have both a helpful and hindering impact on practice and that experience-levels play a significant role in determining the way in which learning in supervision is viewed and experienced, the attitude with which supervision is approached, and the expectations of the supervisory alliance. In particular, these experienced practitioners adopted an open, flexible, curious and sometimes humorous attitude towards learning in supervision, valuing supervisor flexibility and insight whilst deploring supervisor rigidity. Furthermore, these experienced practitioners did not express a need or desire for a mutually strong supervisory alliance in supervision. Rather, the analysis revealed a one-way need to be able to trust and respect the supervisor for his/her insight and expertise. Findings are discussed in relation to existing literature and research. In addition, questions are raised about the positivist approach to knowledge which underpins most supervision research and it is argued that a broader conceptualization of knowledge might serve to expand our understanding of this important phenomenon. Implications for counselling psychology and for further research are explored.