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The British Association for Counselling and Psychotherapy (BACP) is the largest professional membership body within the field of counselling and psychological therapies in the UK, but there is a mismatch between its membership of >65,000 and its research impact. This article sets out a potential strategic direction as considered by an informal grouping of researchers and teachers in the field. Actionable research plans are outlined at three levels: client–practitioner, local communities, and societies. At the client–practitioner level, data‐informed practice can be readily implemented as a therapeutic aid akin to supervision, providing the potential for integrating research into everyday practice. At the community level, interdisciplinary collaborations together with a focus on equality, diversity, and inclusiveness are paths to building a community of researchers and citizens that includes marginalised populations. The importance of social justice extends to the societal level, connecting with politics at a micro and macro level, and engaging internationally to respond to actual threats (e.g., climate change). Across these three levels, high value is placed on data with its potential for informing and improving practice, but also enhancing the lives of people in communities and societies. Overall, research strategies need to be collaborative (i.e., collegial) and less singular (i.e., individually project‐based), developing cumulative knowledge around specific topics via a 'capture and build' strategy for small projects with strategic oversight by BACP. Clarity of research strategy combined with collaborative and collective action from BACP and leaders in the field can help realise the full potential of BACP's research capacity. [ABSTRACT FROM AUTHOR]

Objective: This study is part of the Student Counselling Outcomes Research and Evaluation (SCORE) initiative that is pooling university counselling service data to improve datasets and evidence for counselling in this sector. This study aimed to explore university counselling staff views about which data should be included in a national minimum data standard (MDS) to provide evidence for counselling in the sector. Method: Semi‐structured focus groups were conducted with university counselling staff including counsellors, service leaders and mental health advisors. They explored data to include in an MDS, current data collection practices, service and sector level data collection barriers. Two researchers performed content analysis involving identifying fields for inclusion. Thematic analysis was used to identify contextual issues surrounding data collection. Ten focus groups were conducted with 41 participants across 26 university counselling services. Results: Content analysis identified fields of information for the MDS within the categories of student characteristics, demographics, clinical assessment and service evaluation. Thematic analysis explored context and culture surrounding data collection, barriers and facilitators, institutional influence and ideal data collection practices. This highlights the need for service support and training around data collection, clear processes, and adequate IT infrastructure and staff resources. Discussion: These findings will inform the development of an MDS as part of the SCORE study. The next stage will involve further development of the MDS and piloting in services. The longer term aim is to implement an MDS across university counselling services, enabling the growth of evidence for the sector which may allow increased funding and service provision. [ABSTRACT FROM AUTHOR]

Aim: Routine outcome monitoring (ROM), including the use of feedback, has become a much vaunted method in psychological therapies but is little used in university/college counselling and mental health services, perhaps because its adoption raises questions for many practitioners and service leaders. There is a need for both clinical‐ and research‐based statements to clarify the reasoning and rationale for ROM. This paper aims to present and respond to common challenges of and reservations about using ROM in student counselling and/or mental health services. Method: The article poses 15 questions and issues about the adoption of ROM drawn from the literature on this topic and further refined by practitioner‐ and researcher‐members of a consortium comprising service leads, practitioners, and researchers working in the field of student counselling in the UK. The questions address nine themes: (1) the purpose and yield of ROM; (2) the burden of measurement; (3) the impact on clients and process of therapy; (4) consistency with therapeutic theory; (5) client groups and settings; (6) concern from practitioners; (7) equality, diversity, and inclusion; (8) implementation; and (9) relationship with the paradigm of practice‐based evidence. Findings: Responses to each of the 15 questions are provided from a methodological, evidence‐based, and clinical perspective. Conclusions: The responses provide practitioners with the necessary information to enable them to make informed decisions as to the value, or otherwise, of adopting ROM, including feedback, in the delivery of counselling interventions, and generating evidence created from clinical practice. [ABSTRACT FROM AUTHOR]

Whole university approaches to student mental health and well‐being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE‐OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE‐OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE‐OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study. [ABSTRACT FROM AUTHOR]

Idiographic patient‐reported outcome measures (I‐PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem‐based, and seven goal‐based, I‐PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I‐PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient‐centered approach. However, there are several challenges for I‐PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I‐PROM score. Based on the current state of the literature, we recommend that I‐PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I‐PROM data. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to investigate the administration and use of routine outcome monitoring session by session in the context of improving guided‐self‐help interventions when delivered remotely at Step 2 care in the English Improving Access to Psychological Therapies (IAPT) services. Design: Qualitative research using recordings of telephone‐treatment sessions. Method: Participants (11 patients and 11 practitioners) were recruited from four nationally funded IAPT services and one‐third sector organisation commissioned to deliver Step 2 IAPT services, in England. Data collection took place prior to the COVID‐19 pandemic. Transcripts of telephone–treatment sessions were analysed using thematic analysis. Results: Four themes were identified: (1) lack of consistency in the administration of outcome measures (e.g. inconsistent wording); (2) outcome measures administered as a stand‐alone inflexible task (e.g. mechanical administration); (3) outcome measures as impersonal numbers (e.g. summarising, categorising and comparing total scores); and (4) missed opportunities to use outcome measures therapeutically (e.g. lack of therapeutic use of item and total scores). Conclusions: The administration of outcome measures needs to ensure validity and reliability. Therapeutic yield from session‐by‐session outcome measures could be enhanced by focusing on three main areas: (1) adopting a collaborative conversational approach, (2) maximising the use of total and items scores and (3) integrating outcome measures with in‐session treatment decisions. Shifting the perception of outcome measures as impersonal numbers to being process clinical tools ensures a personalised delivery of psychological interventions and has the potential to enhance engagement from practitioners and patients what may reduce drop‐out rates and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

The collection and use of rich data on student mental health are necessary to inform practice and policy, and ultimately lead to improved outcomes. Here, rich data refers to the combination of large and representative data sets, as well as detailed accounts of lived experiences and perspectives. We argue that such data are necessary to respond to the diverse and ever‐changing needs of students while building an evidence base for current and emerging services and staff roles. We provide suggestions for moving towards these goals, argue for adopting diverse research methods to yield data‐informed practice and policy, and introduce a special section in Counselling and Psychotherapy Research to reflect this agenda. [ABSTRACT FROM AUTHOR]

Background: The student mental health landscape in higher education requires preventative strategies that maintain daily functioning as well as early intervention to respond to episodes of mental ill‐health. As a community, this requires capturing the needs of students in the general university population as well as those using counselling and psychological wellbeing services. Aims: This cross‐sectional study aimed to characterise the mental health profile of students in the general university population and identify barriers to help seeking. Methods: A total of 1,956 students from five UK universities completed an online questionnaire comprising the CCAPS‐34 and open‐ended questions about their mental health concerns and intentions to seek help. Mental health profiles were explored using mixed factorial ANOVAs and post hoc simple effect analyses. Help‐seeking behaviours and intentions were identified using conceptual content analysis. Results: Distinctive mental health profiles emerged across faculties and help‐seeking behaviours. Content analysis identified students' help‐seeking experiences, intentions, preferences and barriers. Conclusions: Characterising the mental health profile of students outside of support services, as well as their barriers to seeking help, provides a rich understanding for shaping preventative policies and service provision. Doing so will respond to student mental health needs before they require clinical intervention. [ABSTRACT FROM AUTHOR]

Background: Top‐up training in person‐centred experiential therapy (PCET) was developed in 2011 and is offered, through four university centres, to counsellors working in Improving Access to Psychological Therapies (IAPT) services in England. Research into PCET training has now gained more importance, with the implementation of the IAPT Data Set Version 2.0 in September 2020, which requires IAPT services to report on the qualifications of care personnel. Previous research has explored the experiences of PCET trainees, but there is a need to investigate similarities and differences in the views and experiences of other stakeholders in the PCET initiative. Method: Ten trainers and developers of the model were interviewed, including the full population of those personnel currently delivering the training. The framework method was used in the analysis of transcripts. Findings: Tensions were identified between the individualism of the person‐centred approach and the standardisation expected by IAPT. Participants recognised that manualisation of the PCET model was controversial, but welcomed the coherence of the model and the ability to articulate theory and practice. Practical differences between centres were identified in the delivery of training, raising the question of whether such differences reflect the individualism of the person‐centred approach and the flexibility of the model, or reveal a lack of consistency in the understanding and delivery of PCET nationally. Conclusions: PCET training is an opportunity to improve the consistency of PCET therapists' theoretical understanding and practice, enhancing their status and opportunities for research. Differences between training centres may compromise this consistency. [ABSTRACT FROM AUTHOR]

This article considers patient choice in mental healthcare services, specifically the ways that choice is enabled or constrained in patient–practitioner spoken interaction. Using the method of conversation analysis (CA), we examine the language used by practitioners when presenting treatment delivery options to patients entering the NHS Improving Access to Psychological Therapies (IAPT) service. Analysis of 66 recordings of telephone‐delivered IAPT assessment sessions revealed three patterns through which choice of treatment delivery mode was presented to patients: presenting a single delivery mode; incrementally presenting alternative delivery modes, in response to patient resistance; and parallel presentation of multiple delivery mode options. We show that a distinction should be made between (i) a choice to accept or reject the offer of a single option and (ii) a choice that is a selection from a range of options. We show that the three patterns identified are ordered in terms of patient‐centredness and shared decision‐making. Our findings contribute to sociological work on healthcare interactions that has identified variability in, and variable consequences for, the ways that patients and practitioners negotiate choice and shared decision‐making. Findings are discussed in relation to tensions between the political ideology of patient choice and practical service delivery constraints. [ABSTRACT FROM AUTHOR]

Psychological intervention outcomes depend in part on the therapist who provides the intervention (a therapist effect). However, recent reviews suggest that therapist effects may vary as a function of the context in which care is provided and therefore should not be generalized beyond that context. This study statistically analysed therapist effect differences between care sectors delivering psychological interventions. The sample comprised routine clinical data from 26,814 patients (69% female; mean age 38) and 466 therapists in five care sectors: primary care, secondary care, university, voluntary, and workplace. Therapist effects were analysed using multilevel models and Markov chain Monte Carlo credible intervals. The therapist effect was significantly larger in primary care (8.4%) than in any other sector (1.1%–2.3%) except secondary care (4.1%), after controlling for explanatory baseline and process variables as well as accounting for differences between clinics. There were no other significant differences detected between care sectors. These findings support the hypothesis that differences in effectiveness between therapists vary depending on the context in which psychological treatment is provided. Differences in relative therapist impact can vary by a factor of 4–8 across treatment sectors. This should be considered in the application of research evidence, treatment planning, and the design and delivery of psychological care provision. [ABSTRACT FROM AUTHOR]

Against a background of huge changes in the world of university and college students since the turn of the millennium, together with a multitude of reports on student mental health/wellbeing, this article argues that the field of student mental health is hampered by the imprecise use of terms, a rush to action by universities in the absence of a robust evidence‐base, and a lack of overall coordination and collaboration in the collection and use of data. In response, we argue for clearer and more consistent use of definitions of, as well as differentiations between, student wellbeing and mental health, for a longitudinal approach to the student body that captures their developmental transitions to and through university, and a strategic and systematic approach to the use of bona fide measures in the collection of data on wellbeing and on the process of outcomes in embedded university counselling services. Such a coordinated approach will provide the necessary evidence‐base upon which to develop and deliver appropriate support and interventions to underpin and enhance the quality of students' lives and learning while at university or college. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate whether client‐reported expected engagement with therapy predicted therapy outcome. It was hypothesized that higher expected engagement with cognitive behavioural therapy (CBT) or person‐centred experiential therapy (PCET) would predict more symptomatic improvement following therapy and higher likelihood of therapy completion. The Sheffield Expected Engagement with Therapy Scale was administered to 96 clients at pre‐therapy assessment with all meeting a diagnosis of moderate or severe depression with 53 receiving CBT and 43 receiving PCET. Higher expected engagement predicted more symptomatic improvement in CBT but not PCET. Expected engagement only predicted improvement in CBT when clients rated the credibility of CBT as low or moderate. Expected engagement did not predict therapy completion in either therapy. Assessment of expected engagement could be a useful tool in prediction of symptomatic improvement in CBT. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Counselling for Depression (CfD) is a person‐centred experiential therapy developed for implementation in the Improving Access to Psychological Therapies (IAPT) programme. Training in this model has been available across England since 2011. This study aims to investigate counselling practitioners’ experiences of learning the CfD model and implementing CfD in practice settings. Method: Participants were recruited by an email sent to the British Association for Counselling and Psychotherapy's (BACP) CfD Practice Research Network (PRN). Of the 53 CfD practitioners belonging to BACP's CfD PRN, 18 participated in this mixed‐methods piece of research. All 18 participants completed an online questionnaire, and one hour follow‐up semi‐structured interviews were conducted with six of the participants. Results: Descriptive analyses from the online questionnaire indicated a positive experience of CfD training, with practitioners indicating a positive impact on sense of self, practice and skill set. Although a degree of challenge was encountered when training in the CfD model, thematic analysis from the six semi‐structured interviews revealed factors contributing to the positives and challenges experienced on the course. Themes also revealed a predominately negative experience of CfD in practice and service settings, although this was service dependent. Conclusions and implications for practice: The findings can inform future recruitment of trainees to CfD training programmes and the training programme itself. They can also be used to achieve greater congruence between training in CfD and the delivery of the model. Future research may need to focus on the service level factors influencing practitioners’ experiences, and whether this experience is specific to the CfD modality in IAPT. [ABSTRACT FROM AUTHOR]

Background Health guidelines are developed to improve patient care by ensuring the most recent and 'best available evidence' is used to guide treatment recommendations. The National Institute for Health and Care Excellence's ( NICE's ) guideline development methodology acknowledges that evidence needed to answer one question (treatment efficacy) may be different from evidence needed to answer another (cost-effectiveness, treatment acceptability to patients). This review uses counselling in the treatment of depression as a case study, and interrogates the constructs of 'best' evidence and 'best' guideline methodologies. Method The review comprises six sections: (i) implications of diverse definitions of counselling in research; (ii) research findings from meta-analyses and randomised controlled trials ( RCTs); (iii) limitations to trials-based evidence; (iv) findings from large routine outcome datasets; (v) the inclusion of qualitative research that emphasises service-user voices; and (vi) conclusions and recommendations. Results Research from meta-analyses and RCTs contained in the draft 2018 NICE Guideline is limited but positive in relation to the effectiveness of counselling in the treatment for depression. The weight of evidence suggests little, if any, advantage to cognitive behaviour therapy ( CBT) over counselling once risk of bias and researcher allegiance are taken into account. A growing body of evidence from large NHS data sets also evidences that, for depression, counselling is as effective as CBT and cost-effective when delivered in NHS settings. Conclusion Specifications in NICE's updated guideline procedures allow for data other than RCTs and meta-analyses to be included. Accordingly, there is a need to include large standardised collected data sets from routine practice as well as the voice of patients via high-quality qualitative research. [ABSTRACT FROM AUTHOR]

Background The burden and severity of student mental health continue to increase in parallel with increasing financial pressures on students and services alike. There is a need for a student-specific measure of distress that acknowledges their unique context. This study examined the feasibility, acceptance, and initial psychometric properties of a US measure, the Counseling Center Assessment of Psychological Symptoms (CCAPS), in a UK student sample. Methods A sample of 294 UK help-seeking students from two universities completed the CCAPS-62 and Clinical Outcomes in Routine Evaluation (CORE-10) as a comparator. The factor solution and reliability of the CCAPS-62 were examined. Correlations and clinical boundaries were determined between the CCAPS-62 subscales and CORE-10, and comparisons were made with US published norms. Results The CCAPS-62 demonstrated a strong factor solution that matched the intended subscales. All subscales had good reliability and correlated significantly with the CORE-10. The agreement on caseness between the two measures was 92.8% with 86.3% reaching clinical threshold on both the CCAPS-62 and CORE-10. Severity was most noticeable for academic distress, depression, anxiety, and social anxiety. Compared to US data, UK students showed higher clinical severity for all psychological symptoms. Conclusions The CCAPS-62 is a reliable and psychometrically valid assessment measure to use with UK students without revision. The overall distress indicated is similar to that of the CORE-10, but the individual subscales are more informative of specific student concerns including academic distress, social anxiety, and substance abuse. Potential benefits of administering a student-focused assessment measure in student counselling services are discussed. Key Practitioner Message University students attending counselling in the UK demonstrate clinical severity for academic distress, depression, anxiety, and social anxiety., Compared to university students in the US, UK students present with higher clinical severity on all contextual measures of student psychological distress., It is advantageous for university counselling services to administer a student-specific clinical measure over measures intended for the general clinical population., CCAPS-62 is an acceptable, feasible, and psychometrically valid measure of student psychological distress that can be used in the UK without revision., It is important for university counselling services to continue to provide support from therapists that are trained and experienced in the university context over services intended for the general clinical population. [ABSTRACT FROM AUTHOR]

Background In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being. Methods The sample for dropout comprised patients ( n = 10 521) seen by 85 therapists, who attended at least the initial session of one-to-one therapy and completed a Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment. The subsample for patient deterioration comprised patients ( n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE-OM at pre-treatment and post-treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics. Results Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52). Conclusions The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix., Therapist effects on patient dropout and deterioration appear to act independently., Being unemployed as a patient was the strongest predictor of both dropout and deterioration., Patient risk to self or others was also an important predictor. [ABSTRACT FROM AUTHOR]

Background Many outcome measures for young people exist, but the choices for services are limited when seeking measures that (a) are free to use in both paper and electronic format, and (b) have evidence of good psychometric properties. Method Data on the Young Person's Clinical Outcomes in Routine Evaluation ( YP- CORE), completed by young people aged 11-16, are reported for a clinical sample ( N = 1269) drawn from seven services and a nonclinical sample (N = 380). Analyses report item omission, reliability, referential distributions and sensitivity to change. Results The YP- CORE had a very low rate of missing items, with 95.6% of forms at preintervention fully completed. The overall alpha was .80, with the values for all four subsamples (11-13 and 14-16 by gender) exceeding .70. There were significant differences in mean YP- CORE scores by gender and age band, as well as distinct reliable change indices and clinically significant change cut-off points. Conclusions These findings suggest that the YP- CORE satisfies standard psychometric requirements for use as a routine outcome measure for young people. Its status as a free to use measure and the availability of an increasing number of translations makes the YP- CORE a candidate outcome measure to be considered for routine services. [ABSTRACT FROM AUTHOR]

Objectives This theory-building case study examined the zone of proximal development ( ZPD) in psychotherapy within the assimilation model. Theoretically, the ZPD is the segment of the continuum of therapeutic development within which assimilation of problematic experiences can take place. Work within a problem's current ZPD may be manifested as a Winnicottian ability to play, that is, an ability to adopt a flexible reflexive stance to the presenting problem and be involved in joint examination of possible alternatives. Play may be recognized in the client's receptivity to and creative use of the therapist's formulations of the presenting problems. Design and methods A case was selected from a comparative clinical trial of two very brief psychotherapies for mild to moderate depression, the Two-Plus-One Project (Barkham, Shapiro, Hardy, & Rees, 1999, J. Consult. Clin. Psychol., 67, 201). Martha, a woman in her late forties, received two sessions of psychodynamic-interpersonal therapy 1 week apart and a follow-up ('plus one') session approximately 3 months later. Dialogical sequence analysis was used to analyse the transcripts of the three sessions. Results The analysis revealed Martha's problematic action pattern, which remained unchanged throughout the three sessions. Her ability to use and elaborate the therapist's formulations depended on the referential object that the therapist addressed; in particular, she seemed unable to play with the therapist's formulations of her more problematic experiences. Conclusions The case helped elucidate how the ZPD is content dependent. Winnicott's conception of playing emphasizes the quality of client response as an indicator of this content sensitivity. Differing breadths of major problems' ZPD, manifested as differing abilities to play with therapists' formulations may explain why some clients improve in psychotherapy while some do not. Practitioner points Accessing very problematic content may be very difficult even though the client's ability to mentalize other material appears ordinary., Mildly depressed clients who have developed powerful care-taking coping strategies may not respond to very brief therapeutic interventions., A client's minimal acknowledgements may mislead the therapist into supplementing the client's failing self-reflection rather than addressing the issue that provokes this failure. [ABSTRACT FROM AUTHOR]

Aims: This article focuses on the historical origins of Practice‐based Research Networks (PbRNs), particularly in the UK, and provides an overview of exemplar networks, together with a consideration of the obstacles and opportunities of such networks. Method: A selective narrative review was carried out relating to the origins of PbRNs together with a selective systematic review using the SCOPUS database to consider landmark articles in this field. Results: A historical account is provided with the origins of PbRNs deriving from pioneer GPs working alone, with their ideals then becoming embedded in family practice. Key articles are presented and also consideration given to the threats to their survival. Conceptual and developmental models of PbRNs are presented that reflect the variety of networks but also common hallmarks. Finally, the opportunities are summarised that PbRNs offer for providing a vehicle for research that is linked more closely to communities of practitioners, people, and patients. Conclusions: PbRNs provide the opportunities for including practitioners in the research effort by being part of a community. Results will have direct relevance to their practice and advances in data analysis provide more valid means of analysing data. But there are also continuing threats due to lack of infrastructure funding and a gap between PbRN activity and trials methodology that needs to be addressed. [ABSTRACT FROM AUTHOR]

Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, 'component analyses' aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support 'real time' clinical decision-making to prevent treatment failure or relapse) might be one promising way forward. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Psychology as a science offers an enormous diversity of theories, principles, and methodological approaches to understand mental health, abnormal functions and behaviours and mental disorders. A selected overview of the scope, current topics as well as strength and gaps in Psychological Science may help to depict the advances needed to inform future research agendas specifically on mental health and mental disorders. From an integrative psychological perspective, most maladaptive health behaviours and mental disorders can be conceptualized as the result of developmental dysfunctions of psychological functions and processes as well as neurobiological and genetic processes that interact with the environment. The paper presents and discusses an integrative translational model, linking basic and experimental research with clinical research as well as population-based prospective-longitudinal studies. This model provides a conceptual framework to identify how individual vulnerabilities interact with environment over time, and promote critical behaviours that might act as proximal risk factors for ill-health and mental disorders. Within the models framework, such improved knowledge is also expected to better delineate targeted preventive and therapeutic interventions that prevent further escalation in early stages before the full disorder and further complications thereof develop. In contrast to conventional 'personalized medicine' that typically targets individual (genetic) variation of patients who already have developed a disease to improve medical treatment, the proposed framework model, linked to a concerted funding programme of the 'Science of Behaviour Change', carries the promise of improved diagnosis, treatment and prevention of health-risk behaviour constellations as well as mental disorders. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: There is a need for a generic, short, and easy‐to‐use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE‐10 in response to this need. Method: Items were drawn from the CORE‐OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE‐OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow‐up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE‐10 in its standalone format. Results: The internal reliability (alpha) of the CORE‐10 was.90 and the score for the CORE‐10 correlated with the CORE‐OM at.94 in a clinical sample and.92 in a non‐clinical sample. The clinical cut‐off score for general psychological distress was 11.0 with a reliable change index (90% CI) of 6. For depression, the cut‐off score for the CORE‐10 was 13 and yielded sensitivity and specificity values of.92 (CI=.83–1.0) and 0.72 (CI=.60–.83) respectively. Conclusion: The CORE‐10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings. [ABSTRACT FROM AUTHOR]

Objectives. The question of how effective therapies are in routine practice is crucial. The answer depends on how we define effectiveness. Both the definition of who was treated and the index chosen to represent outcome can affect estimates dramatically. Design. We used data from the Clinical Outcomes in Routine Evaluation (CORE) Primary Care National Practice-Based Evidence database-2005 on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from 33,587 patients and examined rates of improvement in psychological therapies in UK National Health Service (NHS) primary care services using various definitions of effectiveness. Methods. We constructed successively more restrictive sub-samples of patients, including practice-based analogues of several types of intent-to-treat (ITT) groups and completer groups. We focussed on patients scoring above clinical cut-off at intake, but we also considered samples that included sub-clinical patients. We assessed two types of recovery rates, improvement rates, mean pre-post change, and pre-post effect sizes for each sub-sample. Results. There was wide variation in the overall effectiveness of treatments as a function of which subset of data was considered and which specific criterion of recovery rate was adopted. Recovery rates and pre-post effect sizes ranged from 19% to 65% and 0.60 to 1.95, respectively. Conclusions. Because estimates of effectiveness could have significant policy implications, clarity on the meanings of the differing constructions is essential. [ABSTRACT FROM AUTHOR]

Aim: Given that various systematic reviews of supervision literature have revealed how little is known about supervision, that studies are not usually routed in practice, and that a multitude of diverse measures are used, the primary aim of this project was to support and encourage practitioner research related to supervision using a prescribed common set of instruments. Method: Funded by the British Association for Counselling and Psychotherapy (BACP), a Supervision Research Practice Network (SuPReNet) was established. A toolkit (a series of measures) that could be used routinely by practitioners was selected following the assembly of available measures of supervision and an assessment of them. Findings: The appraisal, conducted by the three authors, yielded five core measures, free for anyone to use, and accessible through the SuPReNet website. The measures are being piloted through a practice research network at a university counselling and psychotherapy research clinic where supervision data are being collected through a special module of CORE Net. Discussion: The potential yield from this initiative for practitioners, researchers, and the developing evidence-base is discussed and a model proposed for the next generation of research on supervision. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to evaluate articles which had been published in the "British Journal of Clinical Psychology" and the "British Journal of Social and Clinical Psychology between 2006 and 2010 and were found to have had an impact on researchers. A discussion of the impact that the articles have had on the field of clinical psychology is presented.

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 (I) 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. [ABSTRACT FROM AUTHOR]

Objectives. Students are reported to have more symptoms of mental health problems than other young people. Disordered eating and self-harm are common but evidence on comorbidity, especially in community samples, is limited. This study aimed to examine their co-occurrence, onset timing, and the help-seeking of UK university students. Methods. Two surveys were administered to undergraduate students at a single UK university. One was administered electronically (UNIversity Quality of Life and Learning survey) and completed by 5,045 students. The second, questionnaire-based, was completed by 805 students (Student Well-Being study). Both surveys included questions about disordered eating, self-harm thoughts and behaviours, and psychological well-being. Results. A strong relationship was found between reports of disordered eating and self-harm, with co-occurrence observed in 4.5 and 4.9% of students in the two surveys. Disordered eating and self-harm often pre-dated university entrance and there was no evidence of increasing levels of pathology by university year group. A younger age of onset of disordered eating behaviours was reported in those with co-occurring disordered eating and self-harm. Help-seeking rates were low. Conclusions. The risk of co-occurrence and earlier onset-timing of disordered eating are consistent with a limited clinical literature. Information on co-occurrence of mental health problems, their history, and low rates of help-seeking identifies some of the challenge to universities and practitioners. These results suggest the value of access to screening resources and the involvement of service-users in shaping the support provided. [ABSTRACT FROM AUTHOR]

Background: There is a need for a user-friendly measure of change for use in school and youth counselling services which is easy for practitioners to administer and score, and which is appropriate for brief interventions. Aims: To develop such a measure and to present psychometric data on reliability, validity and sensitivity to change for the measure. Method: We employed a three-stage approach: first, creating a pool of potential items; second, developing an 18-item version; and third, refining to a final version comprising 10 items. We called the measure the Young Person's CORE (YP-CORE). Results: The measure comprised eight negative and two positive items and included a single (negatively-framed) risk-to-self item. Psychometric properties were all acceptable. Sensitivity to change was good and yielded an average improvement of 10 points on the YP-CORE in a clinical group, broadly equivalent to changes in adult versions (e.g. Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM)). Conclusion: Initial validation work showed the measure to be well designed and sensitive to change. Analysis showed considerable variability as a function of age and gender suggesting the need for the collection of a large and diverse data set in order to produce gender and age-specific norms. [ABSTRACT FROM AUTHOR]

Purpose. Clinical guidelines for the treatment of depression have not yet realized their potential for improving the delivery of the psychological therapies within national healthcare systems. Current guidelines emphasize treatment efficacy and issues in service delivery are relatively neglected. Hence, there is a hierarchy of evidence in which randomized efficacy trials are given primacy over naturalistic (i.e. practice-based) data. Such a strategy is inadequate to address important questions about best delivery of safe and acceptable psychological therapies and exacerbates divisions between research and practice communities. Methods. Selected narrative review. Results. Both randomized controlled trials and practice-based studies have shortcomings that can be ameliorated by the adoption of practical clinical trials embedded within large cohort studies - that is, comprehensive cohort studies. Conclusions. Comprehensive cohort studies have the potential to deliver an evidence base which is both rigorous and relevant. This could satisfy the scientific community as well as allowing practitioners and service users to be fully involved and committed to the process of collecting evidence and implementing guidance. We argue this would be a sound foundation upon which to build an evidence base upon which to develop future clinical guidelines for depression. [ABSTRACT FROM AUTHOR]

Background. Randomized trials of the effects of psychological therapies seek internal validity via homogeneous samples and standardized treatment protocols. In contrast, practice-based studies aim for clinical realism and external validity via heterogeneous samples of clients treated under routine practice conditions. We compared indices of treatment effects in these two types of studies. Method. Using published transformation formulas, the Beck Depression Inventory (BDI) scores from five randomized trials of depression (N = 477 clients) were transformed into Clinical Outcomes in Routine Evaluation-Outcome Measure (COREOM) scores and compared with CORE-OM data collected in four practice-based studies (N = 4; 196 clients). Conversely, the practice-based studies' CORE-OM scores were transformed into BDI scores and compared with randomized trial data. Results. Randomized trials showed a modest advantage over practice-based studies in amount of pre-post improvement. This difference was compressed or exaggerated depending on the direction of the transformation but averaged about 12%. There was a similarly sized advantage to randomized trials in rates of reliable and clinically significant improvement (RCSI). The largest difference was yielded by comparisons of effect sizes which suggested an advantage more than twice as large, reflecting narrower pretreatment distributions in the randomized trials. Conclusions. Outcomes of completed treatments for depression in randomized trials appeared to be modestly greater than those in routine care settings. The size of the difference may be distorted depending on the method for calculating degree of change. Transforming BDI scores into CORE-OM scores and vice versa may be a preferable alternative to effect sizes for comparisons of studies using these measures. [ABSTRACT FROM AUTHOR]

Aims. To investigate the effectiveness of psychodynamic-interpersonal therapy (PIT) in a routine clinical practice setting. Methods. Full pre-post data were available on 62 out of a total of 67 patients aged between 19 and 60 years. Patients were seen over a 52-month period (2001-2005) receiving a course of PIT therapy (mean number of sessions = 16:9, median number of sessions = 16). The outcomes were assessed using a range of outcome measures: the 32-item version of the Inventory of Interpersonal Problems (IIP-32), the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and the Beck Depression Inventory - Second Edition (BDI-II). Study data were benchmarked against comparative national and local data. Results. There were significant pre-post reductions on all measures: IIP-32 effect size (ES) = 0:56; CORE-OM ES = 0:76; BDI-II ES = 0:76. Reliable and clinically significant change was achieved by 34% of clients on the BDI-II and by 40% of clients on the CORE-OM. Clients with high pre-therapy levels of interpersonal problems had poorer outcomes. Conclusion. Benchmarking our results against both national and local comparative data showed that our results were less favourable than those obtained where PIT had been used in efficacy trials, but were comparable with reports of other therapies (including cognitive behavioural therapy (CBT)) in routine practice settings. The results show that PIT can yield acceptable clinical outcomes, comparable to CBT in a routine care setting, within the context of current limitations of the practice-based evidence paradigm. [ABSTRACT FROM AUTHOR]

Background. It is important to know the stability of standard outcome measures prior to therapy over differing periods of time that map onto the realities of waiting times in routine service settings. Method. We studied 1,684 clients who completed one or both the targeted measures Clinical Outcomes in Routine Evaluation-Outcome Measures (CORE-OM) and Beck Depression Inventory-I (BDI-I) two times, at intervals of up to 12 months, prior to beginning psychotherapy. We also selected an additional 1,623 clients who completed the CORE-OM (N = 1, 623), BDI-I (N = 980) or both at referral, but had no records of further contact with the service. Results. There was little change in the mean CORE-OM or BDI-I scores between referral and clinical assessment. The test-retest correlations showed substantial stability on both measures, declining only moderately at the longer intervals studied. Conclusion. The high test-retest correlations for periods of up to 6 months suggest that psychological disturbance was both reliably measured by the CORE-OM and the BDI-I, and reasonably stable among clients waiting to be assessed. Implications for routine practice are discussed. [ABSTRACT FROM AUTHOR]