1. A client focused perspective of the helpful/unhelpful aspects of Counselling for Depression (CfD)
Name: Stacey Goldman
Professional Doctorate Student
University of Salford

2. “Discuss with the person the uncertainty of the effectiveness of counselling and psychodynamic psychotherapy in treating depression”.
(NICE. (2009). Clinical guidelines 90 and 91)

3. Elliot et al. Meta-analysis (2013).
A substantial and rapidly growing body of research data supports the effectiveness of Humanistic Experiential Psychotherapies.
There is a strong causal relationship between HEP and client change;
About 80% of the pre-post gains reported for clients in HEPs can be attributed to the therapy.
It can be concluded that HEPs are equivalent to other treatments in their effectiveness. In particular – virtually identical to CBT. (135 studies)
Elliott, R., Greenberg, L.S.,Watson, J.C., Timulak, L.& Freire,E.(2013). Research on humanistic-experiential psychotherapies. In Bergin & Garfield‘s Handbook of Psychotherapy and Behavior Change. (pp ). New York: John Wiley & Sons.

4. Create a study Identify the aims of the study.
Find a design that will produce the evidence.

5. A client focused perspective of Counselling for Depression
CfD, described as a manualised form of psychological therapy, is specifically designed for counsellors working within the IAPT programme.
There is little research currently on CfD.
As no previous study has considered CfD from a client perspective this study gives voice to the client enabling them to convey their understanding of what they perceive is effective therapy.
To explore the client’s experience of receiving CfD therapy.
To explore the client’s views of helpful and unhelpful aspects of this therapy.
To discover what clients mean by “effective” therapy.

6. Why look at the client view?

7. What therapists do
depends on
what clients do

8. Design/Methodology
Clients receiving CfD completed a Helpful Aspect of Therapy questionnaire after each counselling session. (Llewelyn,1988).
Then attended a semi-structured interview when sessions concluded.
This is a qualitative study using Interpretative Phenomenological Analysis.

9. What was helpful ? Findings – so far .....
Someone to listen to me
Freedom to talk
Someone there for me
I don’t want to be judged
Gains
The work is difficult – but it helps
I don't know how it works - but it's amazing !

10. Someone to listen to me
“Really reliable. Really, I mean, fantastic listener. You know, and heard accurately what I was saying and you know would reflect it if I needed that. Her being able to wait, her knowing when to wait and when to help. Just her skills really, just amazing”.
“Someone was prepared to listen to all my problems”.
“The counsellor was listening to my story, which was my life”.

11. Freedom to talk
“It was a stranger and I knew she didn’t really know my family or people that I knew”.
“You are the person at the bus stop that people can tell everything to”.

12. Someone there for me
“Just being able to articulate and that person being able to hold it for you and be with you in it. It just felt so supportive I think. It felt supportive and that you know, with someone just there for you. For that bit of you, at that time”.
“It sounds a bit like kids in the playground, she is on my side but I don’t know how else to describe it, it was just all of a sudden I had somebody taking my side”.

13. I don’t want to be judged
“I think you can be more trusting with counsellors who are less judgmental towards you”.
“I just thought ‘God I could talk to this woman about anything’ And she is not going to sit here and judge me, she is not going to make me feel bad, it was excellent”.
“She wasn’t there to judge me she was just there to listen to me and help guide me through the process”.

14. “I’ve got my pride back”.
Gains
“Allowing myself to be me. So recognising myself for who I am. Learning to like myself. Learning that I'm valued, that I am of value”.
“I feel stronger”
“I’ve got my pride back”.
“I feel more positive”.
“It was a learning process, definitely, a learning process. A learning about myself and someone enabling me to do that”.

15. The work is difficult “The counselling was excruciatingly difficult”.
“It’s hard to go but it helps”.
“Facing things I don’t want to face”.
“It was always hard work, never easy”.

16. What was unhelpful ? Findings – so far .....
None of the negative findings specifically relate to the model of CfD but are worth bearing in mind.
Time limitation
A shift away from the client agenda
Environmental factors

17. Time limitation
“The time restraints and that is, how can somebody open up and lay it all out bare then somebody comes we have got to wind it up. It was too, you know, too, too short a time definitely, too short a time”.
“Do not look at your bloody watch because that immediately, oh god, time's getting short”.
“I felt a little bit desperate about only having X amount of weeks”.

18. When the agenda shifts away from the client there is potential for the therapeutic relationship to breakdown.

19. Environmental Factors
Stairs up to the counselling room
The waiting room

20. I don’t know how it works – but it’s amazing!
Oh wow! Brilliant! She should have a halo! It was amazing! Like magic!

21. Implications for Practice 1
The therapeutic relationship and the ability of the counsellor to listen is key.
Clients value the safe space to talk and also the freedom to talk to someone outside of their family and friends.
Never underestimate the importance of being non-judgemental.

22. Implications for Practice 2
Clients consider that therapy should not be time limited, but should be open ended according to their needs.
Clients are uncomfortable when the Service agenda takes precedence over their wishes.
The environment a client comes into should meet their needs as much as it possibly can do.

23. Summary
CfD was created to serve a purpose – that of maintaining counselling in the NHS.
Even though it is an integration of two models and despite its manual based design, clients report they like it and find it meets their needs.

24. Thank you for listening.