Clients talk about their experience of the process of counselling

Negative experiences in psychotherapy from clients' perspective: A qualitative meta-analysis

OBJECTIVE

A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy.

METHOD

A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported.

RESULTS

A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients' experiences, which fell into four broad clusters: therapists' misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment.

CONCLUSION

Clients' negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.

A systematic review and meta-analysis of clinician behaviors and characteristics related to alliance building with youth clients

The literature on developing alliance with youth clients has severely lagged behind that of adults. To date, there has been no meta-analytic review and limited qualitative synthesis of clinician variables which may contribute to the alliance with youth clients. Systematic literature search found a total of 49 relevant citations. Of the identified articles, 13 (27.08%) reported quantitative methods. Results of the qualitative review suggested that the majority of this research has focused on developing an emotional bond and a sense of collaboration. Meta-analysis found significant relations between alliance building and reducing variables and alliance (r_{alliance building} = 0.17; r_{alliance reducing} = -0.24). This analysis revealed specific behaviors particularly facilitative to youth alliance development, including collaborating with the client, finding common ground, exploring subjective experiences, orienting to treatment, providing praise, and enhancing facilitative conditions. In contrast, clinician lapse and pushing the client to talk were most predictive of a worse alliance. These results indicate certain behaviors which may be particularly important for clinicians to facilitate and not impair youth alliance formation. There is a need for greater youth alliance formation research to better determine how alliance formation may differ across stages of development and treatment modalities.

Significant Events Identified by Clients Engaged in Existential Psychotherapy: A Descriptive Phenomenological Exploration

This research focuses on the descriptions of significant events experienced in the context of existential psychotherapy as described by five clients. The results include a set of eidetic dimensions in which the human relationship stands out as being particularly meaningful. Clients considered the therapy process to be significant for a number of different reasons, ranging from the development of the capacity to cope with difficulties to a basic sense of increased self-understanding. Significant events in therapy are sometimes preceded by tensions between the therapist and the client, which, in turn, promote turning points and breakthroughs in the therapeutic relationship. The results also seem to corroborate the affect and interdependence of the relational dimensions of psychotherapy, such as common factors, and more specific ingredients, such as the techniques used by the therapist. However, the experience of significant events is multifaceted and dynamic, and only a holistic perspective would seem to do justice to the complexity of these interrelated phenomena. Implications for practice and research are discussed.

The Experience of Counseling Among a Singaporean Elderly Population: A Qualitative Account of What Clients Report as Beneficial

Adjustments that accompany ageing pose a challenge to the mental health of the elderly. Psychologically based counseling has been documented in Western societies as an appropriate intervention for elderly persons with depressive episodes. There is however very little research documenting how Asian elderly populations experience and benefit from counseling. This study addresses this research gap through a qualitative study based on post-counseling interviews with a sample of 41 elderly persons who received counseling at a dedicated organisation catering to the elderly in Singapore. The qualitative data revealed that clients benefitted from counseling through better emotional management - they received emotional support, found emotional healing and learnt to deal with the emotions associated with grief and loss. Clients also reported that counseling assisted them in decision making processes - older persons were able to conceive of alternatives to their predicament, obtained insights to embark on change, were enabled to take the perspective of others and found validation for their decisions. While many elderly clients greatly appreciated and benefitted from this service, citing demonstrable changes, among the very old such changes were uncommon. Cultural explanations for these differential reports and possible directions for much needed future research are provided.

The evolution of cognitive behavior therapy for schizophrenia: current practice and recent developments

Cognitive behavior therapy (CBT) evolved from behavioral theory and developed to focus more on cognitive models that incorporated reappraisal of thinking errors and schema change strategies. This article will describe the key elements of CBT for schizophrenia and the current evidence of its efficacy and effectiveness. We conclude with a description of recent concepts that extend the theoretical basis of practice and expand the range of CBT strategies for use in schizophrenia. Mindfulness, meta-cognitive approaches, compassionate mind training, and method of levels are postulated as useful adjuncts for CBT with psychotic patients.