Charlie Duncan

Objective: To determine the feasibility and acceptability of a cluster RCT comparing school‐based humanistic counselling (SBHC) plus a goal‐based task (SBHC+G) with SBHC alone. A secondary aim was to establish preliminary indicators of change on measures of psychological distress and life functioning. Design: This was a pilot cluster randomised controlled trial. Method: Recruitment and retention of counsellors and young people, as well as measure completion rates and session attendance, were analysed as indicators of acceptability feasibility. ANCOVA tests were used to compare endpoint scores between conditions, controlling for baseline scores, on measures of psychological distress (YP‐CORE) and life functioning (ORS). Results: Recruitment, retention and measure completion rates were acceptable. There were no statistically significant differences between conditions on YP‐CORE or ORS scores at end point. Those in the SBHC+G condition missed significantly fewer sessions (M = 1.7) than those in the SBHC only condition (M = 3.2, p = .04). Conclusion: The trial design was feasible and acceptable and has the potential to be scaled up to a larger, adequately powered study.

Objective: To understand young people's experiences of setting and monitoring goals in the context of school‐based counselling. Design: Qualitative interview study of young people aged 13–16 years old who had undertaken school‐based counselling and who had explicitly set and monitored goals. Methods: Nineteen young people who were predominantly female (89.5%) and around half of whom were of white/European and/or British ethnicity (52.6%) were recruited from 4 secondary schools in London, UK. A reflexive thematic analysis was undertaken to identify themes. Results: Fourteen themes were identified, which reflected both helpful and unhelpful aspects of working with goals. For some young people, goals were motivating, provided a tangible representation of progress, and focused the therapeutic work. For others, goals could mirror a sense of “stuckness” and elicit negative emotions when not progressed towards in a linear fashion. Assigning a number to goal progress meant that some young people felt it did not fully capture the context of their experience, although some did find this practice helpful. Similarly, not all young people found it helpful to monitor progress at every session. Conclusions: Our findings align with the wider adult literature in that experiences of working with goals are mixed. Recommendations for practice include offering choice in the frequency and way goal progress is monitored, and using clinical judgement when working with goals. This might include noticing when goal setting or monitoring is contributing to young people's feelings of low self‐worth and adjusting practice accordingly.

Our primary aim was to assess the associations between outcomes and therapist interpersonal skills (TIS) of empathy, congruence, regard, and unconditionality, as rated by young people. We also aimed to compare these associations against outcome-alliance associations, and to assess whether these associations were specific to a TIS-prioritizing therapeutic practice. Our primary sample was 167 13-16-year-olds who exhibited emotional symptoms and received up to 10 weeks of school-based humanistic counseling plus pastoral care as usual (SBHC + PCAU). Young people were predominantly female (76%), with 45% Black or other minoritized identity. We measured TIS with the Barrett Lennard Relationship Inventory; and used linear regression modeling to assess TIS associations with outcomes on psychological distress, wellbeing, and satisfaction. TIS, most markedly congruence, were significantly associated with outcomes, contributing approximately 3% of change. TIS and alliance explained similar proportions of outcomes, with a model including only congruence showing the best fit on psychological distress and wellbeing. We did not find consistent evidence that the TIS-outcome association was specific to humanistic counseling. Therapists and lay professionals working with young people should strive to develop their interpersonal skills-particularly congruence-within the context of other relationship skills, qualities, and characteristics.

This qualitative study aimed to establish aspects of humanistic therapy that young people (13–16 years old) perceived as helpful and hindering, and to test a novel method for identifying perceived processes of change. A “medium q” thematic analysis was conducted followed by a coding-based “process of change analysis.” Participants were 50 young people in London schools who experienced moderate or severe emotional symptoms and had participated in up to 10 sessions of a school-based humanistic intervention. Participants were predominantly female and ethnically heterogeneous. Therapist qualities most often perceived as helpful were affiliative in nature. Unhelpful therapist activities were silences and a lack of input. Young people described feeling free to talk and open up. Helpful outcomes included feeling unburdened, gaining insight, and improving relationships. “Getting things off their chest,” “Advice and guidance,” “Modeling relationships,” and “insights to behavior change” were identified as specific processes of change in over 50% of young people. Approximately one-third felt hindered by a lack of therapist input, silences, or not feeling able to open up or trust. These findings indicate the potential value of an active, “process guiding” stance in humanistic therapy. Our process of change analysis has potential for identifying perceived change mechanisms in therapy. This work was supported by the Economic and Social Research Council [grant reference ES/M011933/1]. Anonymized qualitative interview transcripts are available on request to the First Author/Chief Investigator. Quantitative, participant-level data for the ETHOS study (with data dictionary), and related documents (e.g., parental consent form), are available via the ReShare UK Data Service (reshare.ukdataservice.ac.uk/853764/). Access requires ReShare registration.

Introduction: Goal‐oriented practices involve practitioners working collaboratively with clients to identify, develop and focus on objectives for the therapeutic work. It has been suggested that the key mechanism underpinning goal‐oriented practices with young people is the development of epistemic trust via the foundation of open communication, along with shared decision‐making: including young people in decisions about their care. However, goal‐oriented work in practice is variable in scope and content, with no research consensus on what it entails, the mechanisms of change and reported outcomes. Method: This research aims to map the extent, range and nature of the evidence‐base for goal‐oriented practices, including gaps, through a synthesis of the available empirical evidence from the past 20 years. A scoping review of 9783 studies published from 2003 onwards was conducted. Results: In total, 116 studies were identified for inclusion in the review, focusing on goal‐oriented practices specifically related to the mental health and wellbeing of children and young people aged 0–18 (including caregivers as relevant). Alongside presentation of the key elements of the included studies, three themes were developed relating to the features of mental health and wellbeing goal‐oriented practice in the contexts of the studies: Conceptual and Empirical Constructs of Goal‐Oriented Practices, Quality and Making ‘Good’ Goals, and The Socio‐Cultural Contexts of Goal‐Oriented Practice. Conclusion: Several areas for future research are identified that will build on this evidence, and further understanding in this area. Work towards the development of best practice principles will move practice towards transparency in the understanding and delivery of goal‐oriented practices.

Introduction: This research explored the views of staff in secondary schools on school counselling for young people. Data were drawn from the Effectiveness and Cost Effectiveness Trial of Humanistic Counselling in Schools (ETHOS) study, an RCT of school counselling across 18 state‐funded secondary schools in London. Methods: Qualitative semi‐structured interviews were held with school staff ( n = 16) from a sub‐sample of 10 participating schools from the RCT. The interviews explored the perceived impact of school counselling on the school and students. Thematic analysis was conducted using the NVivo qualitative data analysis software. Results: Three key themes were identified: (1) school context: rising mental health need and varying provision for mental health; (2) school staff perspectives on the impact of counselling: increased openness and improvements in mood, dedicated space to open up, putting skills into practice, one size does not fit all, and role of personal connection; and (3) long‐term impact of counselling in schools: integration as central to success and counselling as a stepping stone for further support. Conclusion: This research provides insights into school staff views of secondary school counselling in the context of delivery through a research trial. Effective ways of integrating counselling services into schools are identified.

Question For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents’ well-being and psychological need? Study selection and analysis Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023. Inclusion criteria: parents of CYP aged 5–18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study. Findings 32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender. Conclusions The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required. PROSPERO registration number CRD42022344453.

Mental health and well‐being outcomes in psychotherapy and counselling have largely been studied through the use of standardised nomothetic measurement. A key limitation is that nomothetic measurement and current statistical analyses do not necessarily capture the outcomes of the complicated and individual psychotherapy processes. There is an increased interest in the use of idiographic patient‐reported outcome measures (I‐PROMs), which are uniquely useful because they may explore areas of importance that are unexplored by nomothetic outcome measures. We argue that to optimise the value of I‐PROMs, it is necessary to consider their contribution alongside standardised nomothetic measures. However, there are important considerations with respect to whether or not I‐PROMs from different clients, or indeed from the same client, can be meaningfully explored at a team/service level, and alongside standardised nomothetic outcomes. We provide worked examples on real client data to show that delineating four quadrants of analysis is important to explore the breadth of information: (a) individual progress on single items, (b) individual progress by aggregated scores, (c) team/service‐level progress by goal item/theme and (d) team/service‐level progress by aggregated scores.

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.

Objective(s): To examine the psychometric properties of the idiographic Goal‐Based Outcome (GBO) tool for young people: test–retest stability, convergent validity, and sensitivity to an intervention.Methods: This measure validation study used data from a randomized controlled trial of school‐based humanistic counseling. We used multilevel analyses to assess test–retest stability, convergent validity of the GBO tool against nomothetic measures of mental wellbeing, and sensitivity to an intervention.Results: The GBO tool showed acceptable stability over a 6–24 week period; moderate convergent validity with nomothetic measures of mental well‐being, self‐esteem, and depression; and greater sensitivity to an intervention than a measure of psychological distress.Conclusions: The GBO tool shows evidence of having acceptable psychometric properties and is suitable for monitoring change on individual goals. It may also have the capacity to function as a population‐level indicator of outcomes in conjunction with the use of other measures of mental health and wellbeing.