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Background: The use of ‘walk and talk’ counselling has recently increased due to the COVID-19 pandemic, concurrent with an increased awareness of the benefits of the outdoors, nature and exercise, on mental health. Walk and talk counselling is relatively new and seemingly easy to incorporate for everyday counsellors. There is limited previous research. Aim: This study aimed to investigate how the client experiences walk and talk counselling in a natural outdoor environment. Method: To evaluate the client’s lived experience of walk and talk counselling, online semi-structured interviews, with five adult participants in the United Kingdom (UK) were analysed using the Interpretive Phenomenological Analysis (IPA) method. Findings: The general outlook on walk and talk was positive. There was a feeling of informality, and a relational equalising element, but these aspects did not appear to detract from the professional relationship. There was an appreciation of nature, though there was an element of not noticing it. Timing was more fluid and there were positive and negative aspects of the walking outdoors. Limitations: A small sample limiting wider application of findings. Implications: Policy – Further research is required to support further guidelines and training for practitioners. Practice – The consideration of client preferences and a more fluid approach to contracting, a need for increased awareness of physical and psychological safety and a consideration of the relational dynamic, walking outdoors. Conclusion: Walk and talk is a viable alternative to indoor counselling. It proved useful in a pandemic and for clients who would not consider indoor counselling.\ud \ud Keywords: ‘walk and talk’ ‘outdoor’ ‘wild’ ‘nature’ therapy, counselling or psychotherapy; mental health; client preferences.

There is a dearth of research on counsellor self-care in times of personal stress. Working therapeutically with clients whilst facing personal difficulties may lead to stress and burnout for counse...

Purpose The purpose of this study is to describe the development and content validity of the clinical assessment of body alignment (CABA) to measure body alignment in children with cerebral palsy. Methods Content validity and clinical utility were examined through expert opinion of 283 pediatric physical therapists. Participants reviewed items as matching or not to the domain of body alignment. Clinical utility was evaluated on a 5-point scale. Means and standard deviation were calculated for each attribute. Fleiss' kappa examined interrater reliability of expert responses. Results Percentage agreement was high for 19 items and good for 1 item. Clinicians' ratings showed overall fair to good agreement. Four clinical utility attributes had a net importance score of more than 90%, although interrater reliability was low. Conclusion Content validity of the CABA was supported. Construct validity, reliability, and responsiveness require further study. What this adds to the evidence: The CABA has potential to offer clinicians and researchers a clinically practical measure of postural alignment for children with cerebral palsy. Preliminary investigation of CABA shows good content validity. However, more studies to assess the assessments' psychometrics including construct validity, reliability, and responsiveness are required.

Pre-pandemic research has suggested that video counselling is as effective as face-to-face practice. However, the mass migration of therapy to the online video domain as a result of the COVID-19 pandemic makes it essential to interrogate the evidence base. This paper provides a critical commentary on how video therapy is defined/labelled, the current evidence about whether video therapy is effective, and whether the working alliance and therapeutic relationship functions differently in video counselling. The paper concludes that while the evidence to date is promising, it is limited in quantity and applicability and hence generalisability. Lack of evidence is not evidence that video therapy is ineffective, but the large gaps in understanding highlight the importance, both ethically and empirically, of further research in this area.

Introduction\ud Advanced practice roles for allied health professionals continue to expand and provide key services within pathways of care for patients with musculoskeletal conditions. Despite the extensive utilisation of these roles and previously reported high patient satisfaction, little is understood about how these practitioners interact with their patients and the factors that influence decision-making conversations.\ud \ud Study\ud A qualitative study utilised Interpretive Phenomenological Analysis (IPA) to explore the decision-making process occurring between Advanced Practitioners (APs) and their patients in a musculoskeletal service. AP data were collected through focus groups and analysed using IPA methodology.\ud \ud Conclusions\ud Advanced practice decision-making is a complex process and APs exhibit a range of styles, from paternalistic to shared decision-making. APs may have a personal preference, but exhibit the ability to flex between styles in consultations. Multiple themes emerged from the data that influenced the decision-making process, including AP staff understanding the importance of patient expectations and the complex factors that influence patient interactions. It is important that clinicians have an awareness of the multiple factors that contribute to the decision-making process.

Summary Background The UK Government's implementation in 2008 of the Improving Access to Psychological Therapies (IAPT) initiative in England has hugely increased the availability of cognitive behavioural therapy (CBT) for the treatment of depression and anxiety in primary care. Counselling for depression—a form of person-centred experiential therapy (PCET)—has since been included as an IAPT-approved therapy, but there is no evidence of its efficacy from randomised controlled trials (RCTs), as required for recommendations by the National Institute for Health and Care Excellence. Therefore, we aimed to examine whether PCET is cost effective and non-inferior to CBT in the treatment of moderate and severe depression within the IAPT service. Methods This pragmatic, randomised, non-inferiority trial was done in the Sheffield IAPT service in England and recruited participants aged 18 years or older with moderate or severe depression on the Clinical Interview Schedule-Revised. We excluded participants presenting with an organic condition, a previous diagnosis of personality disorder, bipolar disorder, or schizophrenia, drug or alcohol dependency, an elevated clinical risk of suicide, or a long-term physical condition. Eligible participants were randomly assigned (1:1), independently of the research team, and stratified by site with permuted block sizes of two, four, or six, to receive either PCET or CBT by use of a remote, web-based system that revealed therapy after patient details were entered. Those assessing outcomes were masked to treatment allocation. Participants were seen by appropriately trained PCET counsellors and CBT therapists in accordance with the IAPT service delivery model. Depression severity and symptomatology measured by the Patient Health Questionnaire-9 (PHQ-9) at 6 months post-randomisation was the primary outcome, with the PHQ-9 score at 12 months post-randomisation being a key secondary outcome. These outcomes were analysed in the modified intention-to-treat population, which comprised all randomly assigned patients with complete data, and the per-protocol population, which comprised all participants who did not switch from their randomised treatment and received between four and 20 sessions. Safety was analysed in all randomly assigned patients. The non-inferiority margin was set a priori at 2 PHQ-9 points. Patient safety was monitored throughout the course of therapy, adhering to service risk procedures for monitoring serious adverse events. This trial is registered at the ISRCTN Registry, ISRCTN06461651, and is complete. Findings From Nov 11, 2014, to Aug 3, 2018, 9898 patients were referred to step three treatments in the Sheffield IAPT service for common mental health problems, of whom 761 (7·7%) were referred to the trial. Of these, we recruited and randomly assigned 510 participants to receive either PCET (n=254) or CBT (n=256). In the PCET group, 138 (54%) participants were female and 116 (46%) were male, and 225 (89%) were White, 16 (6%) were non-White, and 13 (5%) had missing ethnicity data. In the CBT group, 155 (61%) participants were female and 101 (39%) were male, and 226 (88%) were White, 17 (7%) were non-White, and 13 (5%) had missing ethnicity data. The 6-month modified intention-to-treat analysis comprised 401 (79%) of the enrolled participants (201 in the PCET group; 200 in the CBT group) and the 12-month modified intention-to-treat analysis comprised 319 participants (167 in the PCET group; 152 in the CBT group). The 6-month per-protocol analysis comprised 298 participants (154 in the PCET group; 144 in the CBT group). At 6 months post-randomisation, PCET was non-inferior to CBT in the intention-to-treat population (mean PHQ-9 score 12·74 [SD 6·54] in the PCET group and 13·25 [6·35] in the CBT group; adjusted mean difference −0·35 [95% CI −1·53 to 0·84]) and in the per-protocol population (12·73 [SD 6·57] in the PCET group and 12·71 [6·33] in the CBT group; 0·27 [95% CI −1·08 to 1·62]). At 12 months post-randomisation, there was a significant adjusted between-group difference in mean PHQ-9 score in favour of CBT (1·73 [95% CI 0·26–3·19]), with a 95% CI exceeding the 2-point non-inferiority margin. There were two deaths, one death by suicide in the PCET group and one due to chronic obstructive pulmonary disease in the CBT group. Both were assessed by the responsible clinician to be unrelated to the trial. In terms of using emergency departments for depression-related events, four people (three in the PCET group; one in the CBT group) made more than a single use and six people (three in the PCET group; three in the CBT group) made a single use. One patient in the PCET group had inpatient treatment for a depression-related event. Interpretation This trial is the first to examine the two most frequently administered psychological therapies in the IAPT service. The finding of non-inferiority of PCET to CBT at 6 months supports the results from large, routine, non-randomised datasets from the IAPT programme. Given the high demand for psychological therapies and the need for patient choice, our findings suggest the need for continued investment in the training and delivery of PCET for improving short-term outcomes, but suggest that PCET might be inferior to CBT at 12 months. Funding British Association for Counselling and Psychotherapy Research Foundation.

A small scale qualitative project, undertaken by an interdisciplinary domestic violence research group involving academic researchers and research assistants, with colleagues from Independent Domestic Abuse Services (IDAS), investigated youth aggression and violence against parents. Following the literature review, data was generated through several research conversations with young people (n = 2), through semi-structured interviews with mothers (n = 3) and practitioners (n = 5), and through a practitioner focus group (n = 8). Thematic analysis and triangulation of the data from parents, practitioners and young people, elicited interconnected and complex overarching themes. Young people could be both victim and perpetrator. The witnessing or experiencing of domestic aggression and violence raised the concept of ‘bystander children’. The impact of young people experiencing familial violence was underestimated by parents. For practitioners, the effects of working with domestic violence was shown to be significant - both positively and negatively.

In the UK, domestic violence (DV) is one of the most common safeguarding concerns children and young people report (CAADA, 2014). However, little is known about how children experience participation in interventions that aim to support their recovery if they have been affected by DV. This study aims to understand children’s experiences of participating in a group programme facilitated by a DV organisation in the UK. Interviews were conducted with four children (aged 7–10) using a flexible, creative and child-led approach. A thematic narrative analysis was used, using a small story approach to narrative data. Results indicate that issues of children’s agency, choice and intersecting identities are central to not only how children experience DV but also how they experience recovery. Findings highlight the experiential and relational aspect of therapeutic spaces that can enable children to form relationships and construct meaningful identities. Conclusions suggest that children need to be consulted in inclusive ways in order to contribute to the development and accessibility of services designed to support them when they have been affected by DV.

Domestic violence (DV) affects around 20% of the population globally and is linked with complex mental health conditions and difficulties in client therapeutic engagement. Developing therapeutic competency to meet the standards for independent, professional practice is a significant part of counsellor training. A competency framework for DV is a useful addition to the literature. This framework has been systematically developed from a client informed DV counselling model (grounded theory) and integrates well with existing international publications. It highlights high level and wide-ranging counselling skills, specialist knowledge and specific personal characteristics for working with this client group, beyond the level required for independent practice. This framework could be used as a basis for pre- and post-qualification counsellor training, recruitment and assessment.

Research in a community-based bereavement support service has revealed a proportion of clients for whom an assessment session which focuses on meaning-making mitigates the need for ongoing professional intervention. We suggest that such in-depth assessment sessions may consolidate resilience by helping clients construct meaning in relation to their loss. We support our position with four case studies using assimilation analysis.

This critical literature review explored how adult survivors of child sexual abuse experienced adjustments to their self-structure through meaning-making in therapy. Following extensive searches of academic databases, 15 studies were identified for the review. Using thematic analysis, eight themes emerged. The eight identified themes of trust, acknowledgement, evolution, acceptance, integration, congruence, relational, and agency represented distinct but interrelated components of self-structure. The findings also indicated that self-structure components may be both intra- and interrelational in nature and that movement in one theme may facilitate movement in another. While recognizing that the nature of the research captured a composite of experiences, it was found that there was a consistent movement and fluidity as to how participants arrived at an adjusted position for each of the themes. A suggested theoretical framework was developed showing the components of the self-structure impacted by meaning-making and the nature of the adjustments made. Recommendations are made regarding future research.

Aim This methodological paper outlines a participatory and reflexive research approach in the context of in‐depth, small‐scale and preliminary qualitative research conversations with a vulnerable population. Developing a participatory and reflexive methodology The project involved developing in‐depth research conversations with three mothers and their children who had experienced domestic violence. Underpinned by poststructural feminism and relational ethics, a participatory approach to facilitate informal, nondefensive, participant‐centred conversational spaces for the women and children was developed. Creating both the relational medium and the dialogical processes through which to engage with the women and children prompted multiple and complex challenges for the research team. Some members of the research team had prior experience of domestic violence, generating implications for ethical and reflexive research practice. Implications for research practice The study highlights the complexities and challenges of developing a participatory approach with vulnerable populations including the quandaries faced, the importance of critical reflexivity during in‐depth qualitative inquiry and the value of utilising a project steering group to support research governance. All members of the research team were emotionally impacted by the research work and the relational engagement with participants. A collaborative, peer‐supervisory approach to support the researchers, the research processes – and, ultimately, the participants – was essential. Two case vignettes are included to exemplify researcher experiences.

This positional paper originates from our need as researcher/practitioners to establish a meaningful epistemological framework for research into bereaved people's journey through loss and grief over time. We describe how the field of grief research has a long and established biological basis, in keeping with a positivist epistemology. However, there has been a diminution of the influence of logical positivism in twenty-first-century counselling research. We argue that in grief counselling research, naturalistic observation of the grieving process within a logical positivist paradigm, remains a valid and valuable construct. We posit an observational protocol for the grief counselling process which minimises the intrusion of research method into the therapeutic process. We offer this as a means of conducting qualitative research within a bereavement counselling service. Further, we suggest that the development of an observational protocol for a client's grieving process has potential implications for develo...

Background NICE guidelines state cognitive behavioural therapy (CBT) is a front-line psychological treatment for people presenting with depression in primary care. Counselling for Depression (CfD), a form of Person-Centred Experiential therapy, is also offered within Improving Access to Psychological Therapies (IAPT) services for moderate depression but its effectiveness for severe depression has not been investigated. A full-scale randomised controlled trial to determine the efficacy and cost-effectiveness of CfD is required. Methods PRaCTICED is a two-arm, parallel group, non-inferiority randomised controlled trial comparing CfD against CBT. It is embedded within the local IAPT service using a stepped care service delivery model where CBT and CfD are routinely offered at step 3. Trial inclusion criteria comprise patients aged 18 years or over, wishing to work on their depression, judged to require a step 3 intervention, and meeting an ICD-10 diagnosis of moderate or severe depression. Patients are randomised using a centralised, web-based system to CfD or CBT with each treatment being delivered up to a maximum 20 sessions. Both interventions are manualised with treatment fidelity tested via supervision and random sampling of sessions using adherence/competency scales. The primary outcome measure is the Patient Health Questionnaire-9 collected at baseline, 6 and 12 months. Secondary outcome measures tap depression, generic psychological distress, anxiety, functioning and quality of life. Cost-effectiveness is determined by a patient service receipt questionnaire. Exit interviews are conducted with patients by research assessors blind to treatment allocation. The trial requires 500 patients (250 per arm) to test the non-inferiority hypothesis of −2 PHQ-9 points at the one-sided, 2.5% significance level with 90% power, assuming no underlying difference and a standard deviation of 6.9. The primary analysis will be undertaken on all patients randomised (intent to treat) alongside per-protocol and complier-average causal effect analyses as recommended by the extension to the CONSORT statement for non-inferiority trials. Discussion This large-scale trial utilises routinely collected outcome data as well as specific trial data to provide evidence of the comparative efficacy and cost-effectiveness of Counselling for Depression compared with Cognitive Behaviour Therapy as delivered within the UK government’s Improving Access to Psychological Therapies initiative. Trial registration Controlled Trials ISRCTN Registry, ISRCTN06461651. Registered on 14 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1834-6) contains supplementary material, which is available to authorized users.

The current research explores young adults’ beliefs, awareness and understanding surrounding help-seeking behaviour in relation to barriers preventing access to counselling support. The literature ...

Relational Ethics in Practice presents a new collection of narratives on ethics in day-to-day therapeutic practice.

This chapter1 draws on aspects of research, theory and practice to set out concepts and metaphors that are allies for effective and ethical practice. With the ethical dimensions of client-practitioner relationships receiving increased attention in the helping professions and associated literature, practitioners need to identify ways of mediating the tensions and challenges inherent in client and therapy work.

This research was part of a multiple case-study, theory-building project, observing the moments of assimilation and accommodation in clients relearning their post-bereavement world. The aim was to chart moments of therapeutic change in the bereavement counselling process, identifying appropriate therapeutic interventions. The subject, a male client was bereaved by a road traffic death at age 11. He had not effectively grieved until he began counselling 34 years later. The counselling sessions were digitally recorded by the researcher who was also the practitioner. The recordings assisted the practitioner both in observing the client’s struggle between primitive emotions and rational self and encouraging the client to construct new meaning narratives. This approach enabled the client to view his own process; becoming a student of his own psychological change. During weekly counselling sessions, key moments of assimilation and accommodation were observed. The client was able to take these changes into his real world between sessions, and report back on their significance and effectiveness; self-judged by improvements in his perceived psychological wellbeing. There was practitioner/client consensus on key moments and the client stated that the outcomes were life-changing. It would be imprudent to draw conclusions from a single case study. However, a theory-building methodology allows each new case study to add a small degree of confidence to the theory being constructed. There is an omnipresent risk of researcher subjectivity in judging the significance of moments of psychological change. Multiple case studies would allow the theory to be refuted or modified. We call for more counsellors to become practitioner researchers by adopting this observational, theory-building methodology. Working in this way may lead to more focused therapeutic intervention and a concomitant diminution of grief.