This methodology paper presents how the application of grounded theory (GT) allowed the incorporation of additional data sources from what began as a systematic literature review (SLR) aimed at developing a counselling skills competencies framework for non‐career counsellors who provide counselling in a variety of care settings. This involved inclusion of purposive research material from experts with a wide range of relevant experience and critical input compensating for the limitations of the systematic review. GT provided the necessary analytic steps, and the paper discusses how the application of the constant comparative analysis procedure assured in‐depth analysis of the data from the systematic review, empirical data suggested by expert participants, researcher reflexivity, and critique and feedback from independent experts. Overall, this mixed‐methods approach enabled an expansion of relevant data and led to the construction of a framework for counselling skills organised into five key categories. A core group of practitioners and academics (CG) engaged in open and axial coding, holding in mind the goals of the project. Critical assessment and scrutiny through dialogue and reflection achieved saturation and agreement of the final framework. This meticulous process was inclusive of the views of experts in the field of counselling and led to an integrated framework of counselling skills for individuals in various care settings (nursing homes, NHS and social care services, charitable community projects, etc.). The paper shows that grounded theory allowed expansion of the data field and demonstrates how this approach added rigour and reliability to the developing framework.
The recently revised NICE guidelines on treatment and management of borderline personality disorder (BPD) (NICE, 2018) presents new evidence on psychological therapies being effective treatments for patients diagnosed with BPD. This article will describe some of the challenges we face as clinicians working with complex co-morbid presentations in a healthcare setting. It will briefly discuss the different modalities as suggested by NICE guidelines and expand on the implications of this guidance in relation to service development and constant restructuring, often acted out as an organisational procedure to avoid the harsh reality of limited resources within the NHS. The impact of this on patient care, organisational dynamics, the need for joined-up thinking, and contextual formulations will be discussed using case scenarios. Clinical examples will be used to highlight that pseudo hallucinations, core thoughts, self-to-self dialogues, which trigger "state shifts", can be understood and formulated using dialogic sequence analysis (Leiman, 1998) and concepts from cognitive analytic therapy (CAT). This article will offer some pointers as to how we as clinicians can build resilience, survive the powerful projections and countertransference reactions, recognise the importance of self-care, supervision, and personal therapy in order to be effective, minimise harm, and develop compassion for our patients.
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