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Are children in care offered effective therapeutic support?Aim - This thesis aims to answer the question as to whether or not the therapeutic support offered to children in care in the U.K. is effective. There are two parts to the question: ascertaining what the actual offer of therapy consists of; the quality of that offer in terms of therapeutic effectiveness. Background - children in care are significantly more likely than their peers to be involved in offending behaviour, substance misuse, and to be unemployed DfE (2019). There is evidence to suggest that unresolved developmental trauma can contribute to these outcomes (National Audit Office, 2015). It is unclear how focused the government is on supporting effective therapeutic recovery from developmental trauma. Method - Questionnaires were distributed to every local authority in the country, with approval from the Directors’ of Children’s Services. Interviews were attempted. A Foucaultian Discourse Analysis of key pieces of legislation in the field was then completed, and a Thematic Analysis of 28 studies into therapeutic recovery from complex developmental trauma was achieved. Key Findings- The study found that children in care are not systematically offered effective therapeutic support. In fact, there are multiple issues according to the quality of therapies on offer: there is a legal/political/organisational system that is dysfunctional: the offer of therapy is impossible to ascertain across the country; the way in which therapists research their own provision is laden with methodological, political, and ethical issues. However, the evidence supports the idea that we are aware of some key factors that help therapeutic recovery. Implications for Practice - The evidence provided a range of factors to support future development of therapeutic support to children in care, and supported a mapping out of the way in which therapies could usefully be developed in the future. The evidence led to the development of a model of best practice. Conclusion - The thesis ends with some recommendations as to how the profession of psychotherapy and counselling could begin to develop both their knowledge base and way of working with children care to support more effective therapeutic recovery.
Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: An analysis of the EDIE-2 trialBackground: Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses that the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. Methods: Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis. Results: A significant decrease in symptom score for case formulation (coefficient=-23, 95%CI -44 to -1.7, p=0.036) and homework (coefficient=-0.26, 95%CI -0.51 to -0.001, p=0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient= -0.23, 95%CI -0.47 to 0.005, p=0.056). Conclusions: There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
Finding my voice: A qualitative exploration into the perceived impact of person-centred counsellor training upon counsellors who were adopted as a baby.This small‐scale qualitative study explored how qualified person‐centred counsellors who were adopted as a baby perceived the impact of their person‐centred counselling training. The study focused on the adoptees’ experiences of adoption and how these influenced their experience of person‐centred counselling training. Data were analysed using interpretative phenomenological analysis to gain insight into how the participants made sense of their lived experience. The findings supported the difficulties associated with adoption, which not only are present in existing literature and research but also placed an emphasis on the particular vulnerabilities associated with being adopted as a baby. The findings further highlighted the positive impact of person‐centred counselling training on the participants’ personal development, which included the following: increased self‐awareness, self‐acceptance, identity development and ‘having a voice’. The findings confer implications for clinical practice in understanding the experience of adoptees who were adopted as a baby and for trainers in the planning and provision of person‐centred training. The research also identifies the healing aspects of person‐centred counselling training, which facilitated the participants’ positive self‐development. In addition, unique opportunities for counsellors who were also adopted as a baby are suggested and the need for the Adoption Support Fund to be extended to allow an adoptee of any age to access therapeutic support is also identified. The links made between adoption and person‐centred training are an original area of research and are worthy of further exploration.
Moving Forward: New frontiers in treatments for psychological traumaBoth the Diagnostic and Statistics Manual (DSM 5), and the International Classification of Diseases (ICD-11) embed PTSD (and complex PTSD in the ICD-11) as categories of mental health disorders. Although these classification tools offer criteria by which patients can be assessed as to whether they meet the criteria for diagnosis of PTSD, or complex PTSD, they are not able to provide guidance on treatment options. This special section of Counselling and Psychotherapy Research showcases three very new approaches to working with psychological trauma. The first paper by Kip and Finnegan introduces Accelerated Resolution Therapy (ART), which is a brief intervention protocol that is already demonstrating very promising early results, particularly within the military veterans community of those also experiencing traumatic brain injury (TBI). The second paper by psychiatrists Frank Corrigan and Alistair Hull, demonstrates the ways in which the Comprehensive Resource Model (CRM) is an excellent choice of treatment for those suffering from complex post-traumatic stress disorder (CPTSD). The third paper by Brochmann et al., explores the ways in which therapists can work effectively with groups of people who have experienced psychological trauma. Regarding the impetus of moving forward in tailoring treatments for those experiencing PTSD, the papers presented in this special issue provide a valuable starting point to discussions about treatments best suited for particular sub-populations of PTSD sufferers.