A five-year evaluation of the effectiveness of person-centred counselling in routine clinical practice in primary care

Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study

Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.

Perceptions of the effectiveness of health care for probationers

PURPOSE

This study aims to investigate the views of commissioners, providers and criminal justice staff on how effective current health-care provision is at meeting the health needs of people on probation. Understanding perceptions of what constitutes effective provision, where barriers are encountered and where improvements could be made is an important step towards improving access to care for this hard-to-reach group.

DESIGN/METHODOLOGY/APPROACH

The research was part of a wider study. This paper focusses on findings from case studies conducted via semi-structured telephone interviews with 24 stakeholders in a purposive sample from six geographical areas of England. Interviews were conducted by researchers from a variety of backgrounds and an individual with lived experience of the criminal justice system. Data were analysed using thematic analysis.

FINDINGS

Participants provided examples of effective health-care provision, which largely involved multi-agency partnership working. It was apparent that there are many barriers to providing appropriate health-care provision to people on probation, which are underpinned by the complexity of this population's health-care needs, the complexity of the health-care landscape and problematic commissioning processes.

PRACTICAL IMPLICATIONS

Improvements are needed to provide appropriate and accessible health care that meets the needs of people on probation, thereby reducing health inequalities. These include shared targets, improved funding, clearer pathways into care and giving probation a voice in commissioning.

ORIGINALITY/VALUE

To the best of authors' knowledge, this is the first study of commissioner, provider and criminal justice staffs' views on the effectiveness of current health-care provision at meeting the health needs of people on probation.

A cluster randomized controlled platform trial comparing group MEmory specificity training (MEST) to group psychoeducation and supportive counselling (PSC) in the treatment of recurrent depression

Impaired ability to recall specific autobiographical memories is characteristic of depression, which when reversed, may have therapeutic benefits. This cluster-randomized controlled pilot trial investigated efficacy and aspects of acceptability, and feasibility of MEmory Specificity Training (MEST) relative to Psychoeducation and Supportive Counselling (PSC) for Major Depressive Disorder (N = 62). A key aim of this study was to determine a range of effect size estimates to inform a later phase trial. Assessments were completed at baseline, post-treatment and 3-month follow-up. The cognitive process outcome was memory specificity. The primary clinical outcome was symptoms on the Beck Depression Inventory-II at 3-month follow-up. The MEST group demonstrated greater improvement in memory specificity relative to PSC at post-intervention (d = 0.88) and follow-up (d = 0.74), relative to PSC. Both groups experienced a reduction in depressive symptoms at 3-month follow-up (d = 0.67). However, there was no support for a greater improvement in depressive symptoms at 3 months following MEST relative to PSC (d = -0.04). Although MEST generated changes on memory specificity and improved depressive symptoms, results provide no indication that MEST is superior to PSC in the resolution of self-reported depressive symptoms. Implications for later-phase definitive trials of MEST are discussed.

Cognitive Behaviour Therapy Versus a Counselling Intervention for Anxiety in Young People with High-Functioning Autism Spectrum Disorders: A Pilot Randomised Controlled Trial

The use of cognitive-behavioural therapy (CBT) as a treatment for children and adolescents with autism spectrum disorder (ASD) has been explored in a number of trials. Whilst CBT appears superior to no treatment or treatment as usual, few studies have assessed CBT against a control group receiving an alternative therapy. Our randomised controlled trial compared use of CBT against person-centred counselling for anxiety in 36 young people with ASD, ages 12-18. Outcome measures included parent- teacher- and self-reports of anxiety and social disability. Whilst each therapy produced improvements in participants, neither therapy was superior to the other to a significant degree on any measure. This is consistent with findings for adults.

Person-Centred Rehabilitation Counselling: Revisiting the Legacy of Carl Rogers

This article explores the relevance of Carl Rogers' person-centred approach (PCA) to rehabilitation counselling. His major theoretical contribution concerning the primacy of the client's actualising tendency and the six ‘core conditions’ of the counsellor–client relationship deserves greater recognition in vocational rehabilitation. The most widely known and researched core conditions have focused upon the proverbial triad: congruence (genuineness), unconditional positive regard and empathy. However, all six core conditions are discussed with emphasis placed on recent refinements to Rogers' original theory and their importance to rehabilitation counselling. Evidenced-based research concerning the impact of PCA-oriented rehabilitation counselling is lacking. It is argued that the efficacy of PCA can be extrapolated from meta-analyses in other fields of psychotherapy and education.

Developments in infertility counselling and its accreditation

Infertility counselling was placed in a unique position by the passage of the Human Fertilisation and Embryology Act 1990 and the requirement that couples being treated should be offered counselling. However professional counselling was, and largely still is, at a stage at which there was no universal agreement on the knowledge, standards or qualifications required for practice. Nevertheless, infertility counselling became the first example of counselling to be required by statute, beyond the more generalised requirement in adoption birth records access. Counselling is intended to describe skilled talking therapy offered by a professional with specific training and qualifications directed to helping individuals and couples to achieve goals they own themselves. The therapeutic intervention of counselling is primarily directed to helping clients in a stressful situation to deploy their own coping skills effectively and thus make the difficult choices inseparable from ART. Counselling outcome research consistently demonstrates the effectiveness of the sort of counselling delivered in assisted conception units with mild-moderate anxiety and depression delivered by skilled and experienced practitioners. This article reviews the role of counsellors as members of the assisted conception clinical team and the status of regulation and accreditation in this very new profession.

Developing Adaptive Change Capabilities Through Client-Centred Therapy

Clients undergo change as a function of engaging in a therapeutic experience. To date, little research into the residual effects of therapy have been completed using client-centred therapy. Some therapies provide didactic experiences to gain and practise skills and understandings so they can be recalled after the conclusion of therapy. Other therapies preclude such interventions and instead emphasise the insights of the client and the transformative therapeutic alliance to facilitate change. This research is an investigation of the possibility that client-centred therapy provides clients with experiences to allow insight into, and understanding of processes to optimally facilitate change through therapy. The aims of the research were to establish: whether factors known to enhance change in therapy increased for clients from the beginning to the end of therapy; whether the clinical group (n = 28; intervention) scores differed from a nonclinical group at both time points (n = 22; control); and establish whether gender differences were present. Analyses showed that nonclinical respondents’ scores at Times 1 and 2 were consistently higher on all factors compared with clinical respondents. The findings indicated that scores did not vary significantly between Time 1 and 2 for either the clinical or the nonclinical groups of respondents. The state/trait-like characteristics of the factors are discussed in reference to their application in therapeutic and applied settings.

Systematic review of practice-based research on psychological therapies in routine clinic settings

PURPOSE

To review the published material on practice-based research and to compare results with benchmarks derived from efficacy studies.

METHODS

Electronic and manual searches were carried out up to and including 2008. Studies were screened for content relevance and selected according to specified inclusion criteria. Data were extracted from all studies that met criteria and were quality assessed using an adapted version of a checklist designed for the appraisal of both randomized and non-randomized studies of health care interventions. Studies were synthesized according to (1) the type of problem being treated and (2) study design using descriptive and meta-analytic methods where appropriate.

RESULTS

Psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems (uncontrolled effect size = 1.29; 95% CI = 1.26-1.33, N = 10,842). When benchmarked against data from efficacy studies, practice-based studies yielded effect sizes that fell short of the selected benchmark. In contrast, the practice-based studies achieved the benchmark for percentage of clients meeting a stringent criterion for recovery.

CONCLUSIONS

Clients receiving treatment as normally delivered within routine practice report significant relief of symptoms. However, the result of comparisons with efficacy benchmarks is dependent on the outcome index used. Notwithstanding this, substantive factors are also likely to contribute. Therefore, in addition to attending to methodological issues, further work is required to understand the relative contribution of these factors.