Valerie Owen-Pugh

Exploring the clinical experiences of novice counsellors working with LGBT clients: Implications for training

Aim: This study was designed to explore the clinical experiences of novice counsellors working with LGBT clients. Method: Sixteen counsellors participated in semi-structured interviews. As an elicitation technique, they were asked to recall critical incidents in relation to LGBT clients. Findings: The interview transcripts were subjected to a thematic analysis. Identified meaning units fell into three superordinate categories, namely, Engaging with Learning, Finding Strategies that Work, and Entering the Clients World. A core category of Confronting Homophobia and Heterosexism was also identified. Conclusions: Participants felt unprepared by their training but had gained valuable learning from the challenges they had faced. Recommendations: Initial counsellor training should include an emphasis on contemporary, inclusive theory and allow trainees opportunities for facilitated, challenging exploration of sexuality issues.

Client discourses on the process of seeking same-sex couple counselling

How same-sex couples manage the process of seeking help for their relationships is an under-researched area. Twelve semi-structured interviews were conducted with 16 people who had engaged in same-sex couple counselling, and were analysed using discourse analysis. The ways in which the couples positioned themselves as part of a ‘minority group’, or part of a generic group of couples struggling with relationship issues, impacted on how they discussed seeking help. We conclude that counsellors and psychotherapists need to be aware of the ways in which couples construct their relationships, and mindful of the tricky navigations around similarity to, and difference from, different-sex relationships. The impact of this on couples seeking therapeutic help is considered.

Preventing boundary violations in clinical practice

In this book, Gutheil and Brodsky offer a comprehensive discussion of boundary violations in clinical practice, with the accent on how to prevent them. The book is offered both as an educational resource and a handy reference book for psychiatrists, psychologists, counsellors, social workers and other professionals with responsibility for promoting ethical clinical practice in mental health settings. Both authors are eminent American psychiatrists with a specialist interest in psychiatric law and clinical ethics. The book is divided into three main sections. Part I, ‘Foundations’, seeks to establish relevant practice principles relating to the establishment and maintenance of clinical boundaries. Part II, ‘Explorations’, applies these principles to different forms of boundary crossing. Chapters in this second section discuss a wide range of potential boundary violations, for example those associated with the giving of money and gifts, self-disclosure, communication and out-of-office contact, clothing and physical contact and sexual relationships. These discussions are detailed, comprehensive and illustrated with numerous case examples, ranging from relatively harmless (or, in some cases, even potentially therapeutic) boundary crossings to dangerously exploitative boundary violations. Here, the authors’ intention is to consider the potential benefit and harm accruing to patients, and to remind readers of appropriate ethical practice principles. Part III, ‘Implications’, covers a range of issues related to boundary violation that readers might want or need to know more about. For example, this section includes in-depth discussions of: the potential for causing harm to patients; therapist and patient vulnerability to boundary crossing; relevant academic debates; the therapist’s legal obligations to patients; and ways in which boundary violations can be prevented. A key strength of this book is its emphasis on context. The authors’ message is that there are no simple answers to the question of what constitutes a boundary crossing or violation. Rather, they tell us, what would constitute a boundary crossing in one context may be approved clinical practice in a second, while being a violation in a third. For example, a therapist who goes for a drive with a patient, or accompanies a patient to a restaurant or supermarket, would be crossing a professional boundary if he or she is working psychodynamically but not if he or she is a cognitive-behavioural therapist engaged in a contracted graded exposure treatment. Similarly, a male therapist helping a female patient on with a coat, or referring to a client by his or her first name, would constitute a boundary crossing in British Journal of Guidance & Counselling, Vol. 38, No. 1, February 2010, 131 139

Bereavement Counselling in Uganda and Northern Ireland: A Comparison

ABSTRACT Therapeutic interventions for bereavement in Northern Ireland and in the Sub-Saharan African country of Uganda are compared. Semi-structured interviews were conducted with Ugandan (n = 18) and Northern Irish (n = 20) therapists. These were thematically analysed. The findings focused on: the counselling context, the characteristics of counsellors, the characteristics of clients and counselling practices. Whilst there were many similarities in practice, core differences arose from the demands of these regions’ predominately collectivist or individualist settings. Findings suggest that counselling interventions require adjustment to reflect cultural practices where there is less emphasis on an individualised ego, and where bereavement responses must concur with social norms.

Therapeutic interventions for bereavement: learning from Ugandan therapists

This article contributes to the development of indigenous knowledge around therapeutic interventions for bereavement in non-western settings. Interventions are explored through 18 qualitative interviews with indigenous therapists in the Sub-Saharan African country of Uganda. Aspects of the therapeutic process are examined along with clients’ presenting problem and the ways in which clients make sense of their loss and express their grief. Ugandan therapists identified contradictions between their indigenous practices and western assumptions embedded in bereavement counselling theory and practice. These indigenous accounts indicate ways in which existing therapeutic approaches might best be modified for use in non-western and pluralistic societies.

Iraqi refugee men’s experiences of psychotherapy: clinical implications and the proposal of a pluralistic model

ABSTRACT The psychotherapy experiences of a sample of Iraqi refugee men, in later stages of exile, were explored with the aim of shedding some light on how this client group can experience therapy. Ten adult male Iraqi refugees – who had lived in Sweden for at least five years and had been psychotherapy clients at some point during that time – were recruited for this study. Using individual semi-structured interviews (in Arabic), three main areas were explored with each participant: (1) reasons for seeking psychotherapy; (2) perceptions of the psychotherapy professional; and (3) experiences of the psychotherapy process and outcome. The interviews were then translated into English, transcribed, and then analysed using Interpretative Phenomenological Analysis (IPA). Most participants/clients described exile-related stressors as their main reason for seeking psychotherapy, but some described distress due to a combination of pre-migration trauma and post-migration stress. They also found some aspects of therapy to be positive (mainly verbalising ones thoughts and feelings, and feeling less marginalised) and some negative (mainly experiencing racist or culturally insensitive treatment by therapists, and experiencing a lack of competence and transparency in therapists). The findings were explored in terms of clinical implications and a pluralistic model was proposed to address the identified needs.