The needs of clients coming to counselling following an experience of second harm: A Q Methodology study

Abstract

Introduction Successive reports identified that psychological harm (second harm) can be caused to patients by poor responses of healthcare providers to initial errors or neglect. Aim To explore the needs of clients coming to counselling following experience of second harm. Method A Q methodology study involving ten participants UK wide was undertaken. Participants sorted 42 statements online constructed from a concourse comprising sources on experiences of second harm. Concourse sources focused on the deficits of interpersonal relationships, therefore statements focused on what participants needed from interpersonal relationships with counsellors moving towards recovery. Data analysis Factor Analysis via PQMethod was undertaken on the Q sort data. The interview data was used to elucidate the nuances of the Factors as viewpoints. Findings Two Factors were extracted from the Q sort data that demonstrated the viewpoints of participants: Viewpoint 1 – Needs that are both past and present focused: being understood. Viewpoint 2 – Needs that are both present and recovery focused: making me well. From these two viewpoints 11 perceived needs were identified. Nine were identified as generic needs within the counselling relationship; however, two were identified as specific to those attending counselling for second harm. Counselling needs specific to second harm were; the need for participants to not be blamed for what happened and, the need to have the counsellor understand the impact of the harm and the complaints and litigation system including issues of control, power, and autonomy. Conclusion Findings of this study revealed people who seek counselling following experiences of second harm have specific needs beyond those expected from a general counselling relationship. Furthermore this study was able to define second harm for the first time and offers this to the research and practice community in the hope it will advance the field by helping counsellors to understand the concept, nature, and impact of second harm in addition to the expected skill set for any counsellor supporting those who have experienced second harm. Further research is required to evaluate the impact of educating counsellors in second harm and further testing of the definition of second harm.