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The Align Study – A Summary of the Impact

The Align Study – A Summary of the Impact

School-Based Counselling is one of the most prevalent provisions for mental health problems for young people in the UK and worldwide with around 70,000-90,000 young people accessing it every year in the UK. However, despite the extensive use of this intervention in schools, only a relatively small body of reliable supporting evidence exists and so the Align Study outputs represent an important addition.

The Align study offered a manualised form of individual humanistic counselling, within a school context using a two-arm, individually randomised trial.

The following outcomes were observed in young people who received School Based Humanistic Counselling (SBHC) as part of the Align Trial:

1)Significantly greater reduction in psychological distress at post-test ,

2) Significantly greater reduction in emotional symptoms at mid-therapy, post-test, 3 months follow-up, and 6 months follow-up;

3) Significantly greater reduction in total difficulties score at post-test and 3 months follow-up

4) Significantly greater improvement in self-esteem at post-test. (Ref 1)

In addition to this contribution to research on the effectiveness of School-Based Humanistic Counselling (SBHC), the Align Study was the first trial of this treatment to include an economic analysis. The findings for Align suggested that in the short-term, counselling compared to school-based pastoral care, primary and hospital care, and community-based services, had the greatest impact on within-school costs, reducing the amount of time/costs form teachers and pastoral care staff spent with these pupils. ( Ref 2).

Align was also the first trial to include a 6 month follow up of participants in both arms and to take place within Inner London schools with a diverse population.

Align has also contributed to the ability to assess longitudinal data from the large body of school-based counselling practice which has no comparative group of participants, randomly allocated to a non-intervention condition, against which to evaluate the magnitude of change. The data from the Align study was used as the largest of four pilot RCTs of school-based counselling to benchmark the changes in psychological distress that can be expected for young people who are referred in to school-based counselling in the UK, but who do not receive this intervention. (Ref 3)

The ALIGN trial has also been used as, ‘best available’ evidence of the effectiveness of humanistic counselling within an educational setting by the Early Intervention Framework Technical Working Group formed by NHS Education for Scotland (NES) to develop a resource (the Early Intervention Framework for Children and Young People’s Mental Health and Well-being) to allow comparison of the effectiveness of, and supporting evidence for, different kinds of prevention and early intervention approaches. This project arose in response to Action 3 of the Scottish Government’s Mental Health Strategy (2017-2027) to “commission the development of a Matrix of evidence-based interventions to improve the mental health and wellbeing of young people”. The impact of this was that SBHC as an intervention was accepted into the Matrix. The benefits of this are that children and young people throughout Scotland may have access to this model of school-based counselling, most likely through local authority service provision. The Matrix informs best practice in mental health services at policy level as well as in ground level service provision to children and young people within their communities by providing expert guidance to stakeholders who may not themselves have a good understanding of the most effective interventions but now have a resource to help them invest in programmes to support mental health in children at an early age and stage. https://earlyinterventionframework.nhs.scot/self-assessment/?programmeId=3143

Align formed a significant part of a pooled analysis of data across the four available UK pilot studies of School-Based Humanistic Counselling that led to a successful submission to the Economic and Social Research Council (ESRC) to fund the first full powered Effectiveness and Cost- Effectiveness Trial of Humanistic School- Based Counselling in UK schools, ETHOS  (reference:4)


The ETHOS Study of School-Based Humanistic Counselling

The ETHOS RCT (Cooper et al., 2021) included 329 young people aged 13-16 years with at least moderate levels of emotional symptoms. Participants were recruited from eighteen state funded secondary schools in London, ten located in the deprived areas, with an average of 32% of participants receiving free school meals. Compared to participants who did not receive the SBHC, the following outcomes were observed:

Outcomes Achieved

Child Outcomes

  • Significantly reduced psychological distress at 12 weeks and 24 weeks post-baseline
  • Significantly improved goal attainment and self-esteem at 6 weeks, 12 week, and 24 weeks post-baseline
  • Significantly improved mental wellbeing at 12 weeks post-baseline
  • Significantly reduced psychological difficulties at 12 weeks post-baseline



1.Pearce, P., Sewell, S., Cooper, M., Osman, S., Fugard., A.J.B., & Pybis, J. (2017) Psychology and Psychotherapy: Theory, Research and Practice, 90,138-155 https://pubmed.ncbi.nlm.nih.gov/27470500/

2.Beecham, J. & Pearce, P. (2018) Cost-effectiveness of school-based humanistic counselling for psychological distress in young people: pilot randomised controlled trial. British Journal of Guidance & Counselling, 47:4, 460-471, DOI: 10.1080/03069885.2018.1552777

3. Cooper, M., Fugard, A., J. B., Pybis, J., McArthur, K. & Pearce, P. (2015) Estimating effectiveness of school-based counselling: Using data from controlled trials to predict improvement over non-intervention change. Counselling & Psychotherapy Research, 15(4), pp 262-273 http://onlinelibrary.wiley.com/doi/10.1002/capr.12017/full

4. Rose Stafford, M., Cooper, M., Barkham, M., Beecham, J., Bower, P., Cromarty, K., Fugard, A., Jackson, C., Pearce, P., Ryder, R. & Street, C. (2018). Effectiveness and cost-effectiveness of humanistic counselling in schools for young people with emotional distress (ETHOS): Study protocol for a randomised controlled trial. Trials. 19 (1). https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2538-2

5. Cooper, M., Stafford, M. R., Saxon, D., Beecham, J., Bonin, E.-M., Barkham, M., Bower, P., Cromarty, K., Duncan, C., Pearce, P., Rameswari, T., & Ryan, G. (2021) Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS): a randomised controlled trial. Lancet Child and Adolescent Health. https://doi.org/10.1016/S2352-4642(20)30363-1