WHAT FACTORS INFLUENCE A CLIENT’S CHOICE OF COUNSELLOR OR PSYCHOTHERAPIST IN A PRIVATE PRACTICE SETTING? JULIE MAY DCouns & Psych 2018 Abstract This study considered how a client chooses a psychotherapist/counsellor working in private practice. It emerged from a desire to know whether clients made informed choices, which factors influenced their selection and the extent to which they were aware of the regulatory status of the profession. 22 participants including ten psychotherapist/counsellors, ten clients and two other professionals were interviewed using semi-structured interviews. This qualitative study was underpinned by pragmatism, and data was analysed using thematic analysis. The findings suggested that the primary selection factor was third-party recommendation, and where this option was either absent or undesired, selection was made based on internet searching using location, experience of the presenting issues and the perceived ability to relate to the client. Clients assessed these factors using the photograph and rhetoric on the therapist’s website or directory entry, as well as during the first face-to-face meeting, largely relying upon unconscious projection and ‘gut instinct’. Factors of limited importance in the selection process included qualifications, professional standing and modality. There was an assumption that the profession was already statutorily regulated and that these factors would be obligatorily in situ, before a therapist could practise privately. The findings suggested little awareness that the responsibility to validate a therapist’s professional standing or credibility rests, with the client. A lack of information for both clients and recommenders was highlighted, together with an increased risk for exploitation affecting private practice clients, because of unprotected titles and an absence of minimum education standards for the profession. Recommendations from the research included an increase in public education, urgent debate within the profession of the issues highlighted and support for statutory regulation. 1 Contents Abstract ..................................................................................................................... 1 List of Tables ............................................................................................................ 8 List of Figures .......................................................................................................... 9 Acknowledgements ................................................................................................ 10 Author’s Declaration .............................................................................................. 11 Chapter 1 – Introduction ........................................................................................ 12 1.1 Summary of Chapters ................................................................................. 12 1.2 Contextualising the Researcher .................................................................. 13 1.3 Contextualising the Research Within Statutory Regulation ......................... 15 1.4 Timely Research ......................................................................................... 16 Chapter 2 – Context and Background .................................................................. 17 2.1 Historical Context to Regulation of Counselling and Psychotherapy ........... 17 2.2 Quantifying the Risks .................................................................................. 23 2.3 Role of Supervision ..................................................................................... 28 2.4 Regulation of Other Healthcare Professions ............................................... 31 2.5 Mental Health Inequalities ........................................................................... 33 2.6 Regulation of Counselling and Psychotherapy in other Countries ............... 34 2.7 Sociology of the Professions ....................................................................... 35 2.8 The Private Practice Paradigm .................................................................... 37 2 2.9 Service User Consultation ........................................................................... 41 2.10 Why Do Therapists Choose Private Practice? ............................................ 42 2.11 Issues Related to Training .......................................................................... 44 2.12 Aims of the Study ........................................................................................ 47 Chapter 3 – Literature Review ............................................................................... 48 3.1 Decision Theories ....................................................................................... 48 3.2 Prospect Theory .......................................................................................... 48 3.3 Rational-Emotional Theory .......................................................................... 50 3.4 Theory of Irrationality .................................................................................. 50 3.5 Social Functionalist Theory ......................................................................... 51 3.6 Health Belief Model ..................................................................................... 51 3.7 Theory of Planned Behaviour ...................................................................... 52 3.8 Existing Studies Exploring Client Choice of Therapist ................................. 52 3.9 Sociodemographic Variables....................................................................... 55 3.9.1 Gender.................................................................................................. 55 3.9.2 Sexual Orientation ................................................................................ 55 3.9.3 Age ....................................................................................................... 56 3.9.4 Ethnicity ................................................................................................ 56 3.9.5 Religion ................................................................................................. 56 3.10 Client and Therapist Attributes .................................................................... 57 3.11 Theoretical Orientation ................................................................................ 60 3.12 Existing Models ........................................................................................... 61 3 Chapter 4 – Methodology ...................................................................................... 64 4.1 Role of the Researcher ............................................................................... 64 4.2 Pragmatism ................................................................................................. 65 4.3 Ethical Requirements .................................................................................. 70 4.4 Client Participant Recruitment ..................................................................... 70 4.5 Therapist Participant Recruitment ............................................................... 71 4.6 Professional Body Spokesperson Recruitment ........................................... 72 4.7 Inclusion/Exclusion Criteria ......................................................................... 73 4.8 Data Collection Methods ............................................................................. 74 4.9 Data Collection Process .............................................................................. 77 4.10 Data Collection Location ............................................................................. 78 4.11 Data Storage/Confidentiality........................................................................ 79 4.12 Consent ....................................................................................................... 80 4.13 Analysis ....................................................................................................... 82 4.14 Risks to Researcher and to Participants ..................................................... 84 4.15 Validity and Reliability ................................................................................. 86 4.16 Benefits to Participants ............................................................................... 88 4.17 Pre-Pilot Study ............................................................................................ 88 4.18 Pilot Study ................................................................................................... 90 Chapter 5 – Findings .............................................................................................. 91 Main Theme - Third Party Recommendation ....................................................... 91 4 Main Theme - Location .......................................................................................... 92 Main theme - Therapist Previous Experience ...................................................... 92 Main Theme - Ability to Relate to Me .................................................................... 92 5.1 Main Theme – Third Party Recommendation .............................................. 92 5.1.1 Sub-Theme - GP ......................................................................................... 94 5.1.2 Sub-Theme - Other Professional ................................................................. 94 5.1.3 Sub-Theme – Friend