Background and Purpose-There is inconclusive evidence of the effectiveness of the Stroke Family Support Organiser (FSO) service. We report the results from a randomized controlled trial of the service. Methods-Stroke patients admitted to hospital and their informal caregivers were randomly allocated to receive the FSO service (nϭ126) or standard care (nϭ124). Outcome assessments were undertaken 4 and 9 months after recruitment with the General Health Questionnaire 12, Carer Strain Index, Barthel Index, Extended Activities of Daily Living scale, and a specially designed questionnaire to determine knowledge of stroke and satisfaction with services. Results-There were no significant differences between groups in patients' mood and independence in personal or instrumental activities of daily living or caregivers' mood, strain, or independence. Patients in the intervention group were significantly more knowledgeable about whom to contact for stroke information, reducing the risk of stroke, practical help, community services, and emotional support. Patients in the intervention group were also significantly more satisfied with the stroke information received. Caregivers in the intervention group were significantly more knowledgeable about whom to contact for information on stroke, reducing the risk of stroke, community services, and emotional support. Caregivers in the intervention group were also significantly more satisfied with stroke information. Conclusions-The FSO service had no significant effect on mood, independence in activities of daily living, or reduction in caregiver strain, but it did increase knowledge of stroke and satisfaction with that knowledge. The results may not be representative of all FSO services, and the sample was small relative to the heterogeneity of the participants. However, results suggest that the policies and training procedures of FSOs need to be evaluated to ensure that a cost-effective service is being provided to stroke patients and their caregivers.

Rates of emotional problems were low given the highly disabled population studied. The HAD was relatively insensitive in comparison with the BAI and BDI. The GHQ-12 was sensitive and therefore recommended as a short screening measure. An alternative short screen, 'Emotional GNDS', was proposed.

British community norms (N = 376) for the Brief Symptom Inventory (Derogatis & Spencer, 1982) are presented. Means are significantly higher than previously published US norms for all symptom dimensions, and show variability according to age, sex and work status. The proportion of 'cases' in the sample is similar to other British estimates. It is recommended that culturally relevant norms should be established and used in future work with this instrument.

While psychotherapists discuss amongst themselves and in supervision the struggles they experience face-to-face with their patients, empirical study of therapists' experience of psychotherapy has been scant and there has been little investigation of therapists' difficulties. We require tools for such investigation and in this initial report we describe the development of a taxonomy of situations that psychotherapists experience as difficult and indicate lines of research to which the taxonomy might be applied. We also suggest that our procedure might serve as a model of collective self-study for other groups of practitioner-researchers. Using accounts of our own difficulties as therapists, we constructed a consensual set of experimental categories that could be applied to describe them. These were designated as Therapist (T)-Incompetent, T-Damaging, T-Puzzled, T-Threatened, T-Out of Rapport, T's Personal Issues, Painful Reality/T's Ethical Dilemma (a combined category), T-Stuck, and T-Thwarted. We then employed a fresh set of 30 accounts, which were also drawn from our own experience but had not contributed to the development of the taxonomy, to study the taxonomy's reliability. Each of us rated the presence and predominance of the categories for each of the 30 accounts. Both presence and predominance of all nine categories in the taxonomy could be reliably identified, with about three raters required to ensure good reliability for all categories; alphas (for our group of seven raters) were in the range 0.88-0.95 for presence-absence and 0.83-0.94 for predominance. We conclude that the taxonomy is a serviceable tool for further investigation. We also show that we are discriminable from one another as therapists in terms of the kinds of difficulty we reported, differences amongst us conforming to what we know of one another's therapeutic practice. We note implications for the diagnostic use of the taxonomy in training and supervision.