Search

BackgroundIn both routine practice contexts and research studies, evidence from standardized self-report symptom measures, administered pre- and post-treatment, is predominantly used to determine whether psychotherapy has been successful. Understanding the nature of unsuccessful psychotherapy requires an ability to evaluate the credibility of outcome data generated by such techniques. An important body of research has identified discrepancies between outcomes assessed through symptom measures and those obtained from other sources. However, not enough is known about the extent to which such paradoxical outcomes exist.ObjectiveThis study analyzes the relationship between outcomes, as assessed by a standardized self-report measure, and as assessed by ratings of young people’s descriptions of change at post-counseling interviews.MethodsParticipants were 50 young people (13–16 years old) who had taken part in a trial of up to 10 weeks of school-based humanistic counseling. Our primary standardized measure was the Young Person’s CORE (YP-CORE). To assess young people’s experiences of counseling change, three independent raters scrutinized transcripts of post-counseling interviews, and scored levels of helpfulness on a 1 (Not at all helpful) to 10 (Extremely helpful) scale. Inter-rater reliabilities were 0.94 (Cronbach’s Alpha) and 0.96 (McDonald’s Omega). Sensitivity analyses were conducted to explore relationships between helpfulness ratings and other outcome measures, i.e., satisfaction with counseling (ESQ) and the Goal-Based-Outcome Tool (GBO), and process measures, i.e., the Working Alliance Inventory (WAI-S) and the Barret Lennard Relationship Inventory (BLRI).ResultsMultilevel analysis indicated that helpfulness ratings were not significantly associated with changes in YP-CORE scores. Analyzed categorically, 38% of those showing reliable improvement on the standardized measure were below the median for self-described helpfulness, and 47% of those not showing reliable change were at or above the median for self-described helpfulness. Sensitivity analyses demonstrated closer correlations between helpfulness ratings and other outcome measures (ESQ and GBO), and between helpfulness ratings and process measures (WAI-S and BLRI).DiscussionOur results raise questions about reliance on symptom change outcome measures for defining treatment success and failure, given their disparity with clients’ own descriptions of the helpfulness of therapy. Implications for practice and research are discussed.

Tropical storms (TS) are important drivers of short-term changes and affects the coastal and marine environment. Based on in situ observational data from four locations in the coastal area of the northern Beibu Gulf and satellite data, we analyzed the changes in temperature, salinity, and turbidity during the transit of TS “Wipha” in 2019 and assessed the environmental factors controlling chlorophyll a concenteation (Chl-a) increases in the coastal area. Our results showed that in the coastal area, the growth of phytoplankton after the TS was mainly controlled by the nutrient and light availability. The increased input of freshwater by TS, including direct inputs from rainfall and increased river discharge, reduced the salinity. The decrease in salinity may indicate an increased input of nutrient-rich freshwater at all four stations (nutrients input: S1>S2>S3>S4). Nutrient concentration at S1, S2, and S3 implied by salinity was high, but that at S4 was limited. The shorter recovery time of turbidity after TS indicated the faster improvement of light conditions in this area [recovery time: S4 (2 days)< S1 (3 days)< S3 (5 days)< S2 (10 days)]. The high turbidity associated with poor light penetration was an important factor limiting phytoplankton growth at station 2, with a slow recovery of the turbidity to pre-TS levels. The rapid recovery of the turbidity to the pre-TS levels at S1, S3, and S4 suggested good light conditions soon after the TS, and probably led to a significant increase in Chl-a after the TS ([Chl-a]: S1>S3>S4). The less of an increase of Chl-a at S4 was not only related to nutrient restriction but also related to weak mixing of the water column, while the least significant decrease in the SST at S4 implied that the enhancing mixing after TS was limited.

The adoption of a pluralistic perspective on research design, processes of data collection and analysis and dissemination of findings, has the potential to enable psychotherapy research to make a more effective contribution to building a just society. A review of the key features of the concept of pluralism is followed by a historical analysis of the ways in which research in counselling, psychotherapy and related disciplines has moved in the direction of a pluralistic position around knowledge creation. Core principles of a pluralistic approach to research are identified and explored in the context of a critical case study of contemporary research into psychotherapy for depression, examples of pluralistically oriented research practices, and analysis of a pluralistic conceptualisation of the nature of evidence. Implications of a pluralistic perspective for research training and practice are discussed. Pluralistic inquiry that emphasises dialogue, collaboration, epistemic justice and the co-existence of multiple truths, creates opportunities for individuals, families and communities from a wide range of backgrounds to co-produce knowledge in ways that support their capacities for active citizenship and involvement in open democratic decision-making. To fulfil these possibilities, it is necessary for psychotherapy research to be oriented towards social goals that are sufficiently relevant to both researchers and co-participants to harness their passion and work together for a common good.

Abstract Background One in ten children in Britain have been identified as experiencing a diagnosable mental health disorder. School-based humanistic counselling (SBHC) may help young people identify, address, and overcome psychological distress. Data from four pilot trials suggest that SBHC may be clinically effective. However, a fully powered randomised controlled trial (RCT) is needed to provide a robust test of its effectiveness, to assess its cost-effectiveness, and to determine the process of change. Methods/design The Effectiveness and Cost-effectiveness Trial of Humanistic Counselling in Schools (ETHOS) is a two-arm, parallel-group RCT comparing the clinical and cost-effectiveness of SBHC with Pastoral Care as Usual (PCAU) in school settings. Eligibility criteria for young people include being between 13 and 16 years of age and experiencing moderate to severe levels of emotional distress. Participants are randomised to receive either SBHC or PCAU. SBHC is delivered in up to 10 weekly, individual sessions in their school with a qualified, experienced counsellor who has also received training using a clinical practice manual. Adherence to the SBHC model is assessed by a sub-team of auditors and in clinical supervision. PCAU consists of the schools’ pre-existing systems for supporting the emotional health and well-being of students. The primary outcomes are psychological distress measured using the Young Person’s Clinical Outcomes in Routine Evaluation (YP-CORE) and costs evaluated using the Client Service Receipt Inventory (CSRI). Secondary outcomes include psychological difficulties, levels of depression, anxiety and self-esteem, well-being, school engagement, educational outcomes and achievement of personal goals. Qualitative interviews with participants, parents and school staff will look to identify the mechanisms of change in SBHC. Researchers administering the measures are blind to allocation. The trial requires n = 306 participants (n = 153 in each group), with 90% power to detect a standardised mean difference (SMD) of 0.5. An intention-to-treat analysis will be undertaken. Discussion This RCT is powered to detect clinically meaningful differences, and will make a major contribution to the evidence base for mental health provision for adolescents. It will have implications for all stakeholders, including policy-makers, statutory advisory bodies for child welfare, head teachers, children and young people practitioners, child welfare and parenting organisations, and young people. Trial registration Controlled Trials International Standard Randomised Controlled Trial Number (ISRCTN) Registry, ID: ISRCTN10460622. Registered on 11 May 2016.

Abordar y acomodar las preferencias del cliente en psicoterapia se asoció consistentementecon mejoras en los resultados del tratamiento; sin embargo, pocas medidasclínicamente útiles y psicométricamente aceptables están disponibles para este propósito. Elobjetivo fue desarrollar una herramienta clínica multidimensional breve para ayudar a que losclientes articulen el estilo terapéutico que desean en la psicoterapia o consejería. Una encuestaonline compuesta por 40 ítems de preferencias de terapia fue completada por 860 sujetos, principalmentemujeres (n = 699), británicos (n = 650), blancos (n = 761) y profesionales de la saludmental (n = 615). Un análisis de componentes principales aisló cuatro escalas que representanel 39% de la varianza total: Directividad del terapeuta vs. Directividad del cliente, Intensidademocional vs. Reserva emocional, Orientación pasada vs. Orientación presente y Apoyo calurosovs. Cambio focalizado. Estas escalas recogen las dimensiones de la actividad del terapeuta ycubren la mayoría de las principales dimensiones de preferencias identificadas en la literatura.Los coeficientes de consistencia interna oscilaron entre 0,60 y 0,85 (M = 0,71). Se establecieronpuntos de corte provisionales para fuertes preferencias en cada dimensión. El Inventario dePreferencias Cooper-Norcross-18 ítems (C-NIP) es una medida multidimensional con utilidadclínica, pero se necesitan datos adicionales de validez.