2017 National Research Success
Juanita LC&CTA Co Director celebrates with our students at Research Conference
Three groups of our L5 HPD students presented at the BACP National Research Conference in May this year.
We all had a great time and the students enjoyed discussing their research findings with conference delegates including a number of top UK Professors in the counselling/psychotherapy field.
With this success our students leave us not only as qualified and eligible for bacp professional Registration, but as professionals with published research to their name.
See their research abstract below.
An Exploration of the Experiences of Person Centred Counsellors working with Refugees Diagnosed with Post Traumatic Stress Disorder
Dai Edwards, Rachel Wilmot, Remi Arnold, Dahlia Siam, Clare Cox (not pictured) and Sherife Hussein (not pictured).
A Qualitative research project, exploring Person Centred Counsellors' experiences of how culture, language, interpreters and external professional influences can impact on a therapeutic relationship with Refugees diagnosed with Post Traumatic Stress Disorder.
Counsellors’ experiences of working with clients diagnosed with a mental health disorderwho bring religion/spirituality into the therapeutic space
Presenter(s): Chisom Nwankwo, Heather Drobinska
Other Authors: Riana Lewis, Hannah Commodore
Professional Role: Higher Professional Diploma, 2nd Year Students.
Institution/Affiliation: Lewisham Counselling and Counsellor Training Association. (LC&CTA)
Contact details: Chris Brown, Broadway House, 15-16 Deptford Broadway, London SE8 4PA
Email: c/o firstname.lastname@example.org.
Abstract type: Poster Presentation
Five Keywords:Religion/Spirituality, Thematic Analysis, Mental-Health, Impact.
Title of presentation: Counsellors’ experiences of working with clients diagnosed with a mental health disorderwho bring religion/spirituality into the therapeutic space.
Aim/Purpose: To investigate and explore the experiences of counsellors working with clients diagnosed with mental health disorders and the impact religion/spirituality may or may not have on the therapeutic process.
Design/Methodology: We interviewed four counsellors, extending various modalities, with experiences of working with clients’ diagnosed with a mental health disorder according to DSM V criteria (REF). Interviews were semi-structured and audio taped, then transcribed. Thematic analysis informed by the Principals of Phenomenology (Moustakas,1994) was used to analyse our data; identifying common themes and highlighting anomalies, Such methodology allowedus to descriptively detail participants’ subjective and phenomenological experiences of working with this client group; We followed the BACP Ethical Guidelines for Researching Counselling and Psychotherapy (Bond, 2004).
Results/Findings: Ourfindings indicate that clients’ spirituality and/or religious beliefsbrought by the client into the therapeutic space can be an aid to the counselling process; and religious texts appear helpful to some clients in relation to their personal understanding of psychosis and mental illness. Spirituality and religion can be reassuring/helpful to such clients.This appears especially true if a client is in recovery from an addictive illness.
Conversely, clients’ spiritual/religious viewpoints/values can hinder the therapeutic process on an existential level; some clients can spiritualise everythingin terms of Godly or demonic processes at work in their lives; in turn this can block a clients’ progress toward making positive day-to-day life enhancing changesand/or their acceptance of diagnosis.
Research Limitations: Our findings arise from a small respondent sample of counsellors therefore; our results may be unique to the relatively few counsellors who were included in our study. The qualitative method we usedmay mean our findings are of limited generalisability to a wider population of counsellors in other settings (J. McLeod, 2003).
Conclusions/Implications: Our findings indicate that it may be important for counsellors to be aware that clients who are in recovery from an addictive illness highly benefit from having and/or developing spiritual beliefs; a similar conclusion drawn by Williams (2008). It seems clients who spiritualise everything are best supported by counsellors who help such clients to find spiritual/religious meaning in any mental health diagnosis and/or treatment.
- Bond,T. (2010) Ethical framework for Researching Counselling & Psychotherapy. Available at: http://www.bacp.co.uk/docs/pdf/e_g.pdf (Accessed 5th January 2017)
- McLeod,J. (2003) Doing Counselling Research. Available at http://www.amazon.co.uk/KindleeBooks-books/b?ie=UTF8&node=341689031 (Downloaded: 11 January 2015).
- Moustakas, C. E. (1994) Phenomenological Research Methods. United states of America, Sage Publications Inc
- Williams, Martin. (2008), ‘What role does spirituality play in the therapeutic setting as an agent in the recovery from addiction?, Poster Presentation @ BACP Research Conference 2008
- DSM V Lisiting please
In the experience of practitioners in the field is the Person-centred approach helpful when working with clients who experience anxiety and paranoid schizophrenia?
Denise Sherwood, Mudimo Okondo. Darren Neal, Amanda Renz, Adele Stapylton Smith
Presenter(s): Denise Sherwood, Mudimo Okondo.
Other Authors: Darren Neal, Amanda Renz, Adele Stapylton.
Professional Role: Higher Professional Diploma, 2nd Year Students.
Institution/Affiliation: Lewisham Counsellor and Counselling Training Association. (LC&CTA).
Contact details: Chris Brown, Broadway House, 15-16 Deptford Broadway, London SE8 4PA.
Email: c/o CB.email@example.com
Abstract type: Poster
Four Keywords: Schizophrenia, Anxiety, Person-Centred, Thematic
Title of presentation: In the experience of practitioners in the field is the Person-centred approach helpful when working with clients who experience anxiety and paranoid schizophrenia?
Aim/Purpose: To investigate, explore and describe whether the Person centred approach is perceived as a helpful therapy when working with clients who have been diagnosed with paranoid schizophrenia and/or anxiety.
Design/Methodology: We interviewed Six Person-Centred practitioners in the field, working with clients’ diagnosed with schizophrenia/anxiety; interviews were semi-structured and audio-taped. Thematic Analysis informed by the Principals of Phenomenology (Moustakas, 1994) was used to analyse our data. We followed the BACP Ethical Guidelines for Researching Counselling and Psychotherapy (Bond, 2010).
Results/Findings: In our respondents’ experience, PCA appears to be helpful when working with this client group and long-term therapeutic alliances seem to be the norm. It further indicated that some clients’ in this group make positive changes in their lives and the approach appeared to assist clients in maintaining their organismic sense of self within their own frame of reference. Some concerns exist in relation to clients’ ability to relationally connect with other people in the community once therapy ceased. Conversely our results also indicate that on occasion therapists were unable to establish psychological/relational contact with some clients as such clients did not respond well to PCA interventions.
Research Limitations: This was localised research thus our findings are based on a small respondent sample, which maybe unique to the relatively few practitioners who were included in our study; thus our findings have limited generalisability (J. McLeod, 2003).
Conclusions/Implications: According to respondents’ subjective experiences, our findings suggest that PCA counsellors need to be aware that working with this client group often leads to long-term alliances, which appear to assist such clients in managing their lives with greater positivity. The PCA practitioner may need to occasionally employ directive techniques when working with this client group. It is noteworthy to mention that our conclusions are similar to those drawn by James and McQueen (2016).
- Bond T & Griffin G(2010) Ethical framework for good practice in counselling & psychotherapy. Lutterworth: British Association for Counselling and Psychotherapy.
- James& McQueen(2016) Person-centred Counsellors’ experiences of working with clients experiencing schizophrenia. Poster Presentation @ BACP Research Conference, 2016
- McLeod, J. (2003) Doing Counselling Research, 2nd edn. London: SAGE Publications Ltd
- Moustakas, C. E. (1994) Phenomenological Research Methods. United States of America: Sage Publications Inc.
Aim and Purpose
This qualitative research project aims to see if the person centred approach is affective when working with people suffering with anxiety and paranoid schizophrenia. During our literature search we found that little was written about the use and value of the person centred approach when working with clients who have anxiety and paranoid schizophrenia. However, we did manage to find some useful information. As a group we were most inspired to pursue this topic because of a video of a TED talk in February 2013, by a woman called Eleanor Longden. Eleanor described her struggle with schizophrenia worsening when people judged her and questioned what she was experiencing. She also said she was able to recover through the help of people who believed in her and when she was given the space to find a way to live with her voices, as opposed to being forced to find ways to ‘cure’ it, she was able to make an outstanding recovery. When referring to these people who helped her she says ‘they empowered me to save myself’. (E. Longden, 2013). This statement and how she described her journey from becoming powerless to empowered, inspired us to continue further as what she describes adheres to the person centred ethos and approach.
Also, within our group we were aware of person centred therapists who had experience of working with clients who suffered with anxiety and paranoid schizophrenia whom we could interview. So, after much dismay and confusion as to what we would choose for our course of research, we decided we had enough material to explore and generate a qualitative research project formulated from our research question:
‘Is the person centred approach helpful when working with clients who are suffering from anxiety and paranoid schizophrenia?’
Our initial motivations for choosing our topic varied and these are reasons that are unique to us each as individuals. For Darren, it was based on his previous experience of working with people with schizophrenia and working with them from their frame of reference, and how he felt that was important. Darren wanted to explore this further. For Mudimo, it was validating the efficacy of the person centred approach when working with acute anxiety disorders. For Adele, it was growing up with a schizophrenic mother and wanting to understand her perspective whilst possibly finding comfort in answers. For Denise, it was mainly an interest in understanding anxiety further and exploring what schizophrenia is because she didn’t have much knowledge about it. For Amanda, she also wanted to learn more about schizophrenia and how the person centred approach might enable (or not) someone struggling with this diagnosis.
With the purpose of exploring further the clinicians experience, we aimed to produce meaningful research and contribute to the field of person Centred counsellors.
We first spent some time looking at the definition of schizophrenia and anxiety and what it meant to us. There was some difficulty in terms of finding literature where these two specific diagnosis (schizophrenia and anxiety) were concurrent specifically. Most of the literature appeared to focus on either society’s anxiety around schizophrenia or clinicians anxiety around working with people with schizophrenia.
Carl Rogers said symptoms showed a reduction when working with schizophrenia in a PCA. “So we are perhaps not overstating the total picture if we say that an emphatic understanding by another enables a person to become a more effective growth enhancer, a more effective therapist for himself or herself.” (Rogers. 1980 pg159)
During our research we discovered how differences in cultural perceptions and responses (or treatment) varied from western clinical approach, lead to different outcomes. A study explored how the values of a society, either collectivistic or individualistic could affect emotion processing and mood induction in schizophrenics. One example in South Korea found that people suffering from schizophrenia, because of closer family ties and support in the community “they displayed less social friction, higher affiliative qualities and higher social competence than other groups of psychotic patients.” (Banerjee. 2012 p3) Although this literature might not disclose the nature of the culture environment in which close family structures isolate and ‘hide away’ people with this diagnosis.
It was when we watched a TED talk by Eleanor Longden (Feb, 2013) and she spoke of her own experiences of schizophrenia, that we started to see how “acceptance” was a very powerful tool in helping people manage their lived experience. Ms Longden spoke of how when the “voices in her head” were perceived externally (a friend was alarmed when she heard Eleanor could hear voices) this changed the nature of her schizophrenic experiences to a more frightening and oppressive experience. The voices started as an objective commentary, but once she had shared her experience to a friend, their reaction of fear and anxiety impacted on her and the voices. They became harsher and more demanding. When the medical world got involved things went from bad to worse. It was only when Eleanor decided to listen to the voices, to engage with them, to understand they just represented parts of her, protecting and warning her to be safe, that her experience began to change to a more hopeful and positive place. So, it was only through self acceptance and understanding, that her ‘voices’ were a symptom of previous trauma, and this enabled her to change her terrifying experiences to a more embracing positive position.
Our literature findings helped lead us to our research question, after some deliberation, as we felt that there may be a gap in the research and therapeutic field to quantify if the PCA is a helpful therapy when working with Paranoid Schizophrenia and Anxiety bearing in mind that what we had read was “acceptance” seemed to have the most positive impact on a schizophrenic sufferer…
A vast majority of the literature, as already stated above, appeared to focus mostly on anxiety in others, including the professional field, and how others (society) perceived the nature of the diagnosis and it was felt by our group that there was very little conclusive or explorative research into the effectiveness of talking therapy on this client group.
We explored a wide range of articles and academic writings published on the internet. The following are some of the articles we reviewed:
Subjective experiences of stigma. A focus group study of schizophrenia patients, their relatives and mental health professionals. (B. Schulze, M C Angermeyer, January 2003, King’s College Library services)
What counselors need to know about schizophrenia. (B Bray, August 2016)
When does severe anxiety turn into paranoia and then schizophrenia? (Medhelp.org – online conversations)
The Effect of State Anxiety on Paranoid ideation and Jumping to Conclusions. An Experimental Investigation. (Schizophrenia Bulletin, 2009. T. Lincoln et al)
Fear of Schizophrenia (Anxiety Care UK, anxietycare.org.uk)
Cross-Cultural Variance of Schiphrenia in Symptoms, Diagnosis and Treatment. (A. Banerjee, 2012, Georgetown University)
The conclusive feeling from our research group was that we hoped that our research would go on to contribute to the field of literature research in to the effectiveness of the PCA when working with people with Paranoid Schizophrenia and Anxiety.
Research Approach and Methodology
We chose to apply a phenomenological approach to our research due to the nature of our question because our aim is to investigate a single phenomenon; “how helpful is the Person Centred Approach when working with people suffering from schizophrenia and anxiety”. We are not trying to prove a hypothesis. As Creswell (1998, pg 51) states “a phenomenological study describes the meaning of the lived experience for several individuals about a concept or phenomenon.” In our research we wanted to explore this phenomenon following what Moustakas (1994) described as phenomenological analysis as a way of interpreting interviews by extracting common themes across the interviews and then creating a conceptual link between them. We followed the Duquesne Method of Empirical Phenomenology, revised by Moustakas (1994) carrying out the suggested methodological steps that included collecting transcribed interviews from participants who describe their experiences while working in a PCA with clients suffering from schizophrenia and anxiety. Then while reviewing them we looked for any common ideas or themes that each interview had imbedded in the data. We highlighted several of them and identified any common themes that revealed itself. We also considered any individual singular experiences to include. The methodology is to be used in an attempt to gather information and data which may or may not fully described the phenomenon.
As we understand, the phenomenological methods are effective in high-lighting the experiences and perceptions of individuals from their own perspective which could ultimately challenge normal existing assumptions. So theoretically results could be used to either support or challenge policy or practice. Pure phenomenological research seeks essentially to describe rather than explain, and to start from a perspective free from hypotheses or preconceptions (Husserl 1970). However humanist and feminist researchers refute the possibility of starting without preconceptions or bias, and we should be more congruent with how interpretations and meanings have been placed on the findings. In order to do this the visibility of the researcher within the frame of the research must be acknowledged as someone who has subjective or bias views rather than a detached observer. (Plummer, 1986)
This project was time limited, and one of the benefits of this approach is that analysis commences as soon as the first data is collected. It was challenging finding person-centred therapists who had worked with clients suffering from schizophrenia and anxiety, however we managed to secure five respondents who met the criteria for our research. We interviewed them in person using semi-structured interviews with a digital recording device. We confirmed that the interviewees would remain anonymous throughout the research process, referring to them only by their initials. Each respondent was asked to sign a copy of our research consent form (see appendix A) before the interview commenced if they were happy with the terms given. We explained what the research was for, the questions they would be asked, how we would be using the data and where it would be presented.
We understand that one of the main purposes of research is to give us greater access and knowledge in the field of psychotherapy and we hope to find greater value and understanding in this field.
Interviewer and interviewee are in a relationship with a common cultural context which can skew the findings.
Results and Findings
All our interviews seem to show that the Person Centred Approach is helpful when working with clients with paranoid schizophrenia and anxiety, and it appeared that a relationship was able to be formed and clients appeared to make changes, but the challenges faced were one of achieving relational depth, and concern around the relationship ending with the belief that there is a lack of further support after therapy.
Interview findings from CB
CB says that she doesn’t think she will ever get to any great relational depth with the client as she has done or experiences with other clients she sees.
‘I wouldn’t say I enter her world in quite the same way as I do with my other clients. My other clients, erm, there is a depth of relationship there. Right, a depth of relationship, whether ever we will get to that, errm to the possibility of relationship depth, which we will learn about soon, I really don’t know’ CB
CB also described how difficult it can be working with clients who have schizophrenia due to the irrational nature of it, in establishing psychological contact. She also mentioned that it is hard to move someone forward because in their frame of reference they tend to rationalize things that are totally irrational.
‘It’s a challenge in having contact but it’s a bigger challenge in trying to move someone along or you know, be effective as a counsellor’ CB
However she goes on to describe how she absolutely stays with what the client is bringing despite it being irrational, because she recognises that this is what the client absolutely believes and it would appear that this may be affective in sustaining the client with lesser levels of anxiety perhaps.
‘She has these particular things that she experiences, and I say that she experiences, because she truly does.’ CB
But CB is aware that these experiences she is imagining to be happening are due to the paranoia and so uses Socratic questioning at times
‘I mean sometimes it is quite directive, in that I will ask her Socratic questions’ CB Brown
CB says she needs to be a bit more directive to help her client understand that she can be rational and make better choices but always stays with what the client is bringing and this is effective in the way the client comes to see in moments that she is being irrational.
Almost from the onset CB was very clear that establishing her clinical intention was imperative for working with this particular client and it was to help her reduce her anxiety and paranoia. In order to do this she has to be a bit more directive, but still remains person centred, always staying with the client’s experiencing, but challenging it by offering her the scenarios she is describing with a rational view as a possibility, so that the client can choose her own way.
‘My clinical intention from onset was to – well maybe not from onset – but through her own experience was to help her reduce the anxiety to help her reduce the paranoia, to help her understand that actually she can make choices – she doesn’t have to create these scenarios that cause her a great deal of distress just to be able to say fuck it I’m not going to work today’ CB Brown
By working this way CB seems able to decipher that what her client actually wants and what her organismic experience truly is at times, is not to go to work. Instead though she creates illnesses as reasons why she can’t work because she can’t admit that she simply doesn’t want to work, and then convinces herself the illnesses are real. In moments she is able to recognise for her-self what her organismic experience is. For example, when her mother wanted to get her a new bedroom she became upset because she felt that her mother was controlling her, however throughout a session of extending empathy and exploring the client’s feelings further in the situation, she came to see that this was her mother’s way of showing her love and decided it was ok to let her help her which in turn released her from some anxiety and paranoia about the situation.
‘She wanted the mother to leave her alone and gradually over the session by looking at it the client came to the conclusion that it was her mother’s way of showing her love and she ended up allowing the bedroom to be done and she went away very happy so very often with these client’s its helping them negotiate the anxiety firstly before anything’ CB
Despite that she does use a little more directive and intentional questioning CB is adamant that she always remains in the client’s world and stays with what the client is telling her in full belief that what the client says she is absolutely experiencing.
‘I think it would be really detrimental to this client, for me to say to her, I don’t believe these things are in you, because then where is the empathy? I don’t have to believe these things are in her, but what I do have to do is believe, that she believes, and in that way right, it’s very person centred because that’s the clients experience’ CB
It would appear that after years of seeing CB she trusts and feels at ease and is doing well seeing as she hasn’t had a relapse back into hospital during this time. It could also be said that by using the PCA approach the client feels heard by Chris and that this works well therapeutically for the client to maintain herself because she trusts the relationship and herself within it. CB also maintains that she will be congruent about what she perceives to be true in her experience and that this also seems to support the client as she doesn’t ever take away still from what the client states as true for her.
I said in my experience – you’re always going to have this anxiety that you can hold onto and it always creates havoc – I said my intention in this is trying to help you get well – she said yes I know Chris you’re the only one – CB
Interview finding from DN.
As a group we asked DN to participate in our Research, to which he accepted. We asked him because of his experience, which is of working in the NHS with mental health clients, he also has a background of working with the specific client group our question is aimed at, namely; Paranoid Schizophrenics.
DN was asked the same questions as all our interviewees. Here are the results and findings from his interview. To start DN expressed he has years of experience of working with Paranoid Schizophrenics- this has been long term work that he expressed as often being challenging and ‘risky’ to work with. Which is outlined below.
Working with people who have this particular diagnosis is risky according to DN, he gave us an example of why he felt this was. Often he found that showing or extending empathy was greeted by the client with paranoia as a belief that he could then read their mind. This could heighten the paranoia and he believed that the client’s diagnoses blocked their ability to full accept empathy without questioning it. If empathy is greeted with suspicion the boundaries for this relationship then become unsafe, paranoia could be exhibited verbally or non-verbally. Manifestations of paranoid could be seen by DN in the non-verbal sense, in the form of stopping mid-sentence, teeth grinding or sitting in silence.
Trust, as highlighted by DN is understood to be paramount to the successful or to the measurable positive outcomes for some he worked with. According to DN (and in his experience) building a trusting relationship, by which he could see that the extension of the core conditions permitted clients to open up about their experiences of what it is like to be Paranoid Schizophrenic. Was part of the therapeutic alliance, this took time because of the previous mistrust of the professional. But once it was present, according to DN that is when significant changes were made in the client’s life.
There were then some aspects of the client’s life that they wanted help with. DN’s client who wanted all the cans gone from his house, removing the cans from his home, was like (from what DN described) a physical burden being lifted from the client. Through the work done with this particular client group in DN’s experience, there was and is capacity for a change in some parts of behaviour, when working within the Person Centred Approach. What we can concluded from this is that it is long term work.
Interview findings with LA
LA worked with her client when she was still in training as a Person Centred counsellor and when she first met her client she failed to recognise from the assessment that her client was on medication that might be supporting her with Paranoid Schizophrenia. Her client was describing how her ex-partner was trying to make her out to be mad to get custody of the children. LA was initially concerned for her client’s safety after she had described her fears that her partner was entering her flat at night while she was asleep. LA took this to supervision where her supervisor recognised the medication and her behaviour as being symptomatic of PS.
For LA, the first challenge was her own inexperience of working with a client suffering from PS but she agreed that she felt she could continue to work with this client extending the core conditions, where she could “just give her the benefit of being congruent and giving her UPR so that she felt valued.” (L.A, 2016). LA was congruent with her client asking her what her medical condition was and she confirmed it was PS.
LA established the clients need for “somewhere to go to have someone to talk to, to offload, share her fears and for general support.” LA found the work challenging as life for her client appeared to be chaotic with two young children and committing to weekly meetings was difficult. In total they only met 14 times over a much longer period but this was all that her client seemed to be able to do.
Another challenge for LA was staying with her client’s own reality. Sometimes if her client was particularly stressed (possibly because she wasn’t taking her medication properly) and she would talk about her ex-partner entering her apartment, by offering the Person Centred Approach and accepting this was her reality, they explored safety issues around that. “We talked about what she could do to make her and the children feel safer, she got onto the landlord to change the locks, but then she believed that her landlord had given a copy to her ex-partner.’ LA found this “really difficult to work with and really sad, like just to see how much she struggled and she would go through phases of isolating herself from friends because she worried that they were telling her partner.”
However in extending the PCA, LA did see a positive change in her client, for example in the early days she would turn up with sloppy tracksuits but around session 6 her client smartened up her appearance, choosing to wear a wig, make up and a dress and then continued to take care of her appearance. LA said “something in the value of our relationship touched her.”
LA said her client was further enabled to ask for help from her, wanting LA to attend a SENCO appointment, having someone with her, just for support. Her client also felt able to share her experiences of horrific ritual tribal abuse and cried a lot in her sessions.
“It was just literally just being with her in the room and giving her that space to offload and share what had happened to her.” LA
LA was very boundaried with time and endings but did refer her on for further support. Her client declined saying “she’d like working with me, she had found it useful.”
LA did find working with this client challenging, “I felt quite deskilled a lot of the time, because the content was so big, yes of course, diversity issues that were beyond my comprehension.” But also, “just valuing her, was wonderful for her. I could see what a difference that made for her.”
Findings from GJ interview
It appeared from the interview that there were two opposing feelings/beliefs around the use of the Person Centred Approach (PCA) when working with clients who may present with symptoms of Paranoid Schizophrenia and anxiety. The interviewer felt that, in his experience, that the PCA approach when offered, clients ‘respond really well to the conditions’ and ‘offers a real intimacy, a real relationship’ and an ‘umbilical chord…and therefore want to do the work.’
It was the interviewers experience and belief that it was this connection and relationship that created an environment that could not be sustained long term outside of the therapeutic relationship. The question for the interviewer was one of whether this was ethical for the counsellor to create this relationship in the first place knowing that with this particular client group external resources/support can be limited, if existent at all.
There was a concern from the interviewer that there could be a danger or a risk when the ending of the relationship occurred and the termination of the therapeutic relationship with a belief that the client will be left with nothing and as a result was the PCA an appropriate therapy to use.
It was felt that due to the nature of the condition of Paranoid Schizophrenia and, in the interviewer’s experience, that people with this condition can ‘lead lives that are difficult, quite isolated and quite lonely’ that their lives ‘do not have many people in it’, people that would ordinarily ‘help that person assimilate any new information and new ways of being’ GJ
So it appeared that on one hand that the PCA was helpful in establishing a working relationship that could be utilised by the client, where an intimacy could be achieved in the space between the counsellor and the client it was also believed, in the interviewers experience, that it was when this relationship ended that there was a fear that the client could be more vulnerable and potentially dangerous.
The interviewer felt that if this was a possibility then how ethical would it be to ‘open up’ clients with Paranoid Schizophrenia and expose them to conditions that cannot be fulfilled by other mental health practioners outside of the counsellor/client relationship.
Findings from interviewers B and DL
From the brief experience interviewer DL had with their client she felt, in her experience, that having used the PCA allowed the client to ‘trust me to disclose’ and to express her ‘thoughts and feelings whereby she hadn't previously’ and also that PCA ‘builds that relationship’ and that ‘congruence and acceptance is perhaps what the client felt in the session’ and this enabled her to ‘feel safe’
Interviewer DL felt that due to her inexperience as a therapist she may have found it too difficult to work with this client and acknowledged the possibility of not knowing where her limitations are as a counsellor and this being a potential reason for not being able to work with clients with Paranoid Schizophrenia.
In the findings for interviewer B they felt that in their experience the criteria that is set out for providing counselling and a therapeutic relationship should be that ‘they can engage in a meaningful way with meaningful being that they can ‘hear your interventions, they can reflect on them, and they can respond.’
The interviewer referred to respond as being able to be in an ‘…interactive way, so that might be to reject it, or to accept it, or to acknowledge that they understand what you are saying…’
In the interviewers experience of working with clients with Paranoid Schizophrenia they felt that the clients were able to interact and respond to interventions and make use of the interventions and not only that were able to reject or accept or acknowledge that they didn't know in relations to any interventions by the counsellor. Especially in regards to the severity of the clients
symptoms and previous rejections from other services due to severity and this was also prevalent in the interviewers experience of clients with anxiety.
Discussion and Hypothesis
Our research findings suggest that the PCA is helpful when working with clients diagnosed with Schizophrenia and Anxiety. From the data collected from health practitioners in diverse settings, we can hypothesize that the PCA creates an environment that supports the client’s organismic experiencing. Although it is not clear that in all cases clients experienced long lasting change or relief from their symptoms, all respondents agreed that for the duration of the therapeutic alliance, the nature of the relationship in the PCA was pivotal in helping clients with this symptomatology to maintain their sense of self.
“…it allowed, I guess, a good therapeutic relationship, in the sense that the client was able to trust me in order to explore their experience of their world and their life, so I was, with this one particular client, able to say what their experience of being schizophrenic?” DN
There were however some significant limitations to our research. The respondent sample size was small, primarily because clients with these perceived severe mental health diagnoses are not normally referred to our respondent group. There was also a dearth of available in-depth research available, again possibly because the context has traditionally been skewed towards the clinical study and medical treatment of schizophrenia, and possibly viewed as being outside the remit of therapeutic counselling. Our research further suggests that there is scope for research into better integration of statutory mental health teams and other health practitioners, to better manage what seems often to be a challenging transition between services.
“…I have a number of clients who quite quickly form a connection with me and seem to really attach, and really appreciate the warmth in the relationship, you know the kind of, the more humane face, as opposed to maybe other mental health professionals that they’ve worked with. But, the problem is, the attachment, that if someone really attaches, um, and they have very few people in their lives, or they have a very complex mental health kind of network around them supporting them, when the work ends, I think it’s quite dangerous.” GJ
Our research indicates that the PCA may have significant impact over the longer term Health Related Quality of Life of this client group. However, further long term study and investigation is necessary to evaluate this hypothesis, as well as to determine if and how our conclusions can be extrapolated.
Our research findings explore broad and varying information and experience exploring the effectiveness of the PCA when working with people who have paranoid schizophrenia. Due to the fact that the PCA is not commonly established as an effective approach for working with clients who suffer with paranoid s schizophrenia, we struggled to find therapists who could only speak of working with clients in the PCA way. We also struggled to access a lot of information in this area of study. However, we were able to find enough therapists and information to conduct our research and gathered a thorough qualitative research project exploring the helpfulness of the PCA approach when working with this clientele and a worthy basis for further research in this area of enquiry.
We found that each therapist struggled to clarify how the PCA approach was clearly helpful outside the therapeutic alliance. For long term results beyond the PCA therapy we couldn’t establish that it is effective. However, we read information from varying sources online and from books, and found in our interviews many examples of how the extension of the core conditions within the PCA therapeutic relationship did prove helpful.
We read information about how people with paranoid schizophrenia are treated in different countries and cultures across the world and how a more person centred approach proved affective. We also learnt from research done in the ‘hearing voices’ community that the more common and established approaches therapy had been challenged by addressing the issue with a more person centred approach also, and that results had been effective.
All therapists we interviewed expressed that the therapeutic relationship (developed through the extension of the core conditions) provided their client’s with a sense of safety and security within themselves and their experience. This meant that each client was able to develop a stronger sense of self, and maintain a more consistent sense of self, despite the often conflicting nature of their minds. Each therapist described moments of breakthrough for clients who became closer to their sense of self and so cultivated more control in their lives in different ways, as a result of the PCA relationship. It appears that the PCA allows people with paranoid schizophrenia to accept themselves more as they are and develop a more peaceful and settled existence.
It appeared from our findings that overall, the PCA was helpful in working with clients who have paranoid schizophrenia in helping to develop and maintain a stronger sense of self. However, beyond the PCA relationship it was unclear as to how effective the PCA was for the long term.
Recommendations for further research
We have considered the following areas for further investigation into the helpfullness of the PCA with clients suffering from anxiety and schizophrenia, these being:
We recommend further investigation into the helpfulness of PCA with this client group, through securing larger and more representative respondent participation.
Further research into the experience of clients suffering from schizophrenia working with PCA counsellors
- Banerjee, A. (2012). Cross-Cultural Variance of Schizophrenia in Symptoms, Diagnosis and Treatment. Washington DC: Georgetown University.
- Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.
- Husserl, E (1970) trans D Carr Logical investigations.New York: Humanities Press
- Longdon, E. (2013) The voices in my head, video recording 2013, TED, viewed 05 November 2016, https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head
- Moustakas, C. (1994) Phenomenological research methods.CA: Sage
- Plummer, K (1983) Documents of Life: an introduction to the problems and literature of a humanistic method. London: Unwin Hyman
- Roger, C. (1980)A Way of Being. New York: Houghton Mifflin Co
Is the PCA a helpful therapy when working with clients who experience anxiety and paranoid schizophrenia?
We will be conducting a semi structured taped interview with you in relation to our research subject above. This will involve discussion about your client work and so you may need to bear in mind the anonymity and confidentiality of your clients when answering our questions.
The material from our interview will be analysed and used as research evidence in the documentation required for our Higher Professional Diploma course and hopefully for a BACP Research Conference submission, which, if successful, will involve a public presentation of our findings. Pseudonyms will be used to ensure you anonymity.
The questions we will ask you will include:
- Are you a PCA Practitioner?
- Have you worked with clients diagnosed with paranoid schizophrenia and anxiety?
- What is your experience working with people suffering from paranoid schizophrenia and anxiety?
- Can you describe the challenges working with this client group?
- Can you tell us of your experience extending the PCA working with this client group?
I consent to be a participant in this research and for the interview material to be used as set out in this consent form.
Print name of participant:
Signature of participant:
Thank you for your time and participation.
The LC&CTA Paranoid Schizophrenic and Anxiety Research Group 2016