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Research Clinic Group (RCG)

Research Clinic Group (RCG).  

Developing evidence of Effectiveness for Humanistic and Integrative approaches to counselling and psychotherapy

Chair: Dr Biljana van Rijn

          Dr Joel Vos

          Maritina Peristeri

          Evi Chryssafidou

External Consultant: Prof William B. Stiles



Research Clinic group (RCG) focuses on treatment outcomes in routine practice for Humanistic and Integrative approaches to psychotherapy taught and practiced at Metanoia Institute,  based within the community research clinic, Metanoia Counselling and Psychotherapy Service (MCPS).

MCPS is a low cost  clinic providing up to a year of counselling and psychotherapy to the local population. The therapists are MI students undertaking practice placements during their study. The clinic offers placements to over 100 students per year and therapy to approximately 500 clients per year. MCPS is financially supported by Metanoia Institute, Ealing Borough Council (as part of the Talking Therapies Consortium), and client fees.

Routine Outcomes Monitoring  (ROM) is used a methodology appropriate to a naturalistic practice setting which actively involves psychotherapists and their clients, giving an opportunity for structured feedback (M.J. Lambert & Shimokawa, 2011; M. J. Lambert, Whipple, Smart, Vermeersch, & Nielsen, 2001).

The Research Clinic Group invites internal and external researchers to take part in joint projects and use the clinic data set to develop new research.


Current projects:

  • Routine Outcomes monitoring of trainee practice in Humanistic and Integrative approaches to counselling and psychotherapy (Transactional Analysis; Gestalt psychotherapy, Integrative Psychotherapy, Counselling psychology, Humanistic Counselling; Person Centred counselling.) Team: Vos,J.; Van Rijn,B., Peristeri,M.,Stiles, W.B.
  • Relational Depth Frequency Scale and Psychotherapy Outcomes, DeMalta,G, Vos, J. van Rijn,B., Cooper M.

One in four people in the UK lives with a mental health condition. Mental Health researchers are engaging with this issue by providing evidence to make psychotherapy more effective for those seeking help. This research study proposes to use psychological measures to evaluate if relational depth—defined as a significant encounter characterized by profound interconnectedness—is a predictor for therapeutic outcomes. The quality of the therapeutic relationship has, for decades, been associated with outcomes; and is at the core of counselling psychology practice. However, it is not clear what aspects of the therapeutic relationship are most closely related to therapeutic change. In recent years, there has been a growing interest in the phenomenon of in-depth therapeutic relating. Preliminary evidence has shown that experiencing relational depth in important moments of therapy is associated with improved outcomes. Moreover, this was found to be over and above the working alliance, which is the most common measure of the quality of the therapeutic relationship. These findings need further investigation such as including a larger sample, and using a more specialized measure of relational depth. In the present study, we aim to recruit 500 adult clients from a psychotherapy site. Data will be collected by Metanoia Institute to assess the respective contributions of two relational processes on therapy outcomes: Relational Depth Frequency and ARM-5. These will be measured for clients with validated measures every 4 sessions. Multilevel modelling will be applied to identify the extent to which these variables are predictors of outcomes. Therapy outcome will be assessed using change on measures of depression and anxiety. If it is found that relational depth predicts outcomes, over and above the ARM-5, findings from this study can support changes in training and practice for therapists, and assist in developing guidance for therapists and clients.


Previous projects:

  • Activity preferences in psychotherapy: what do patients want and how does this relate to outcomes and alliance? (2020) Cooper,M.;Van Rijn,B; Chryssafidou,E., Stiles,W.B

This study aimed to investigate (a) what clients’ within-treatment activity preferences were; (b) whether a match between preferences and psychotherapy approach predicted outcomes and alliance;(c) whether scores on preference dimensions, per se, predicted outcomes and alliance. Participants were 470 clients engaging in one of five approaches with trainee psychotherapists. We used the Cooper–Norcross Inventory of Preferences to identify clients’ within-treatment activity preferences; and multilevel modelling to examine the relationship between these preferences – and a match on these preferences – to outcomes and alliance. Clients had an overall preference for therapist directiveness and emotional intensity. We found no evidence of a preference matching effect. Clients who expressed a desire for focused challenge over warm support showed greater progress. Client preferences for focused challenge may be indicative of their readiness to change and indicate a positive prognosis. Further research should directly observe therapeutic practices and assess a range of client variables.


  • Development and evaluation of adherence questionnaires for gestalt psychotherapy, relational transactional analysis, and integrative psychotherapy: A preliminary investigation (2016), van Rijn,B, Wild,C.

This paper presented the preliminary development and description of adherence questionnaires in Gestalt Psychotherapy, Relational Transactional Analysis and Integrative Psychotherapy, and the first evaluation of their validity and reliability. The analysis was conducted with 450 questionnaires used between 2011 and 2013, at a research clinic. It suggested that the adherence questionnaires for each of the approaches had a good level of internal consistency (9< 0.7) and construct validity. Factor analysis results suggested that the key construct examined by these measures was the practitioner’s ability to work within their therapeutic framework. This would be expected in a questionnaire on adherence (factors account for over 55% variation in scores), i.e. “test-retest” reliability was not calculated due to difficulties in training the assessors, who were also the therapists’ clinical supervisors, and this test would be needed for further research into the consistency of the measures over time. Further testing and a refinement of the questionnaires would also be needed for different therapeutic environments and with different groups of therapists.

  • Pluralistic therapy for depression: Acceptability, outcomes and helpful aspects in a multisite study Cooper, M., Wild, C., Van Rijn, B., Ward, T., McLeod, J., Cassar, S., . . . Sreenath, S. (2015).

The aim of this study was to assess the outcomes, acceptability and helpful aspects of a pluralistic therapeutic intervention for depression. The study adopted a multisite, non-randomised, pre-/post-intervention design. Participants experiencing moderate or more severe levels of depression (as assessed by a score of 10 or greater on the Patient Health Questionnaire depression scale, PHQ-9) were offered up to 24 weeks of pluralistic therapy for depression. This is a collaborative integrative practice oriented around shared decision making on the goals and methods of therapy. Of the 42 participants assessed, 39 (92.9 per cent) completed two or more sessions. Participants were predominantly female (N=28, 71.8 per cent) and white (N=30, 76.9per cent), with a mean age of 30.9. The principal outcome indicator was improvement and recovery on the PHQ-9 and Generalised Anxiety Disorder 7-item (GAD-7) scale. Of the completer sample, 71.8 per cent of clients (N=28) showed reliable improvement and 43.6 per cent (N=17) showed reliable recovery. Effect sizes (Cohen’s d) from baseline to endpoint were 1.83 for the PHQ-9 and 1.16 for the GAD-7. On average, the clients found the PfD sessions helpful and valued the

flexibility and collaborative approach of their therapists. Clients felt that change had been brought about by their own active engagement in therapy and through the therapists relational qualities, as well as their use of techniques. Conclusions: Initial indications suggest that pluralistic therapy for depression has acceptable outcomes, retention rates, and user satisfaction. Refinement and further testing of the approach is recommended


  • Challenges to Developing Routine Outcomes Evaluation in Different Practice Settings and Cultures: A Naturalistic Enquiry in Spain and the UK. (2013) van Rijn,B.; Wild,C.

A naturalistic sessional evaluation of routine outcomes of psychotherapy from a range of theoretical orientations including transactional analysis, using standardised measures for depression, anxiety, general distress and working alliance, was conducted across completed therapy interventions by 113 therapists with 263 clients within an academic institution in the UK and across stages of therapy by 10 therapists with 26 clients in three independent clinics in Spain. Outcomes in both countries demonstrated clinical gains but it was found that such evaluation methodology was more easily applied within a training institute than in private practice; it also appeared to better fit the UK professional climate of evaluation. Suggestions are made concerning the introduction of such research in future.

  • Humanistic and integrative therapies for anxiety and depression. Practice based evaluation of Transactional Analysis, Gestalt and Integrative psychotherapies and Person-Centred counselling (2013) Van Rijn, B. ,& Wild,C.


The research described in this article involved a naturalistic, nonrandomized evaluation of transactional analysis and gestalt psychotherapies, integrative counselling psychology, and person-centred counselling within MCPS. Routine outcome evaluation used standardized measures to assess treatment outcomes and the working alliance. Adherence to the model was evaluated in clinical supervision. The outcomes showed that clients who engaged in treatment made statistically significant improvements and that transactional analysis and gestalt psychotherapies, integrative counselling psychology, and person-centred counselling can be used effectively in treatment of anxiety and depression within a community setting. Clients had a choice about the duration of therapy and used different numbers of sessions within the framework of the service. They were also able to change therapists.

Both choices had clinical implications in terms of attrition and outcomes and require further research.


  • Evaluating the Outcomes of Transactional Analysis and Integrative Counselling Psychology within UK Primary Care Settings  (2011) Biljana van Rijn, Ciara Wild, Patricia Moran


The paper reported on a naturalistic study within MCPS and counselling within the NHS primary care, aiming to replicate the IAPT method of monitoring routine outcomes. Standard outcome measures were used in line with the IAPT model (GAD-7, PHQ-9), supplemented with measurement of the working alliance (WAI Horvath 1986) and an additional measures BDI-II (Beck, 1996), CORE-10 and 34) and adherence to the therapeutic model using newly designed questionnaires. Results indicated that severity of problems was reduced using either approach, comparative to IAPT outcomes; that initial severity was predictive of outcome; and that working alliance increased as therapy progressed but was not directly related to outcomes. Adherence was high for both approaches. Several areas for enhancements to future research are suggested.




Recent research output:


Vos, J., Chryssafidou, E., van Rijn, B., & Stiles, W. B. (2021). Outcomes of beginning trainee therapists in an outpatient community clinic [https://doi.org/10.1002/capr.12466]. Counselling and Psychotherapy Research, n/a(n/a). https://doi.org/https://doi.org/10.1002/capr.12466

Cooper, M., van Rijn, B., Chryssafidou, E., & Stiles, W. B. (2021). Activity preferences in psychotherapy: what do patients want and how does this relate to outcomes and alliance? Counselling Psychology Quarterly, 1-24. https://doi.org/10.1080/09515070.2021.1877620

Van Rijn, B. (2016). The role of routine outcomes evaluation in developing reflexivity in clinical practice. The Psychotherapist, Spring 2016(62), 34-36.

Van Rijn, B., & Wild, C. (2016). Development and evaluation of adherence questionnaires for gestalt psychotherapy, relational transactional analysis, and integrative psychotherapy: A preliminary investigation. International Journal of Psychotherapy, 20(1), 7-18.

Van Rijn, B., & Wild, C. (2016). Comparison of transactional analysis group and individual psychotherapy in the treatment of depression and anxiety: routine outcomes evaluation in community clinics. Transactional Analysis Journal, 46(1), 63-74. doi: 10.1177/0362153715615115

Cooper, M., Wild, C., Van Rijn, B., Ward, T., McLeod, J., Cassar, S., . . . Sreenath, S. (2015). Pluralistic therapy for depression: Acceptability, outcomes and helpful aspects in a multisite study. Counselling Psychology Review, 30(1), 6-20.van Rijn, B., Wild, C., & Dumitru, A. (2014).

Van Rijn,B., Wild,C. (2014) Challenges to developing routine outcomes evaluation in different practice settings and cultures: A naturalistic enquiry in spain and the UK. International Journal of Transactional Analysis Research, 5(2), 28-34. Retrieved from http://www.ijtar.org/article/view/13800/9077

Van Rijn, B., & Wild, C. (2013,Autumn). Evaluation of Transactional Analysis psychotherapy groups in primary care within an IAPT site Transactional Analyst, 3(4).

Van Rijn, B. ,& Wild,C. (2013). Humanistic and integrative therapies for anxiety and depression. Practice based evaluation of Transactional Analysis, Gestalt and Integrative psychotherapies and Person Centred counselling. Transactional Analysis Journal, 1543(2),150-163.

Van Rijn, B. (2012). Evaluation in psychotherapy: An Opportunity and a Challenge.    The Script, 42(4), 1-3,www.itaaworld.org

Van Rijn, B., Wild, C., Moran, P. (2011) Evaluating the outcomes of Transactional Analysis and integrative counselling psychology within UK primary care settings, International Journal of Transactional Analysis Research,2/2, 34-44

Van Rijn, B., Wild, C.,Fowlie,H., Sills,C. van Beekum,S. (2011), Impact of Transactional Analysis psychotherapy training on self awareness and ability for contact, International Journal of Transactional Analysis Research,2/1,16-24Van Rijn, B.,Wild,C. (2010) Research clinic approach to the evaluation of integrative and humanistic psychotherapies, The British Journal of Psychotherapy Integration,7/2,49-56

Van Rijn, B (2010) Research clinic at Metanoia Instituite,Therapy Today,July 2010 21/6,50

Recent Conference papers:

2018                European Transactional Analysis Research and Development Conference, July 2018 London

Chryssafidou, E., Van Rijn, B., Routine Outcomes Evaluation at Metanoia Counselling and Psychotherapy service (MCPS)

2016                SPR 47th Annual International meeting, Jerusalem, Israel

van Rijn, B., Wild, C. Evaluation of Transactional Analysis psychotherapy in the treatment of depression, anxiety and clinical levels of general distress. Routine Outcomes Evaluation within a community clinic

Panel: The Effectiveness of Transactional Analysis Psychotherapy for Depression and Anxiety: Findings from Practice-Based Research

2015                European Transactional Analysis Research and Development Conference

Van Rijn, B. (2015). How do we demonstrate the effectiveness of TA psychotherapy practice in research. Exploration of an adherence questionnaire in Relational Transactional Analysis. Paper presented at the EATA Conference 2015.1st EATA Development and Research Conference, Rome,Italy. www.cleup.it

2015                UKCP Research Conference,London

Comparison of Transactional Analysis Group and Individual Psychotherapies in the treatment of Depression and Anxiety. Outcomes in community clinics

2014                ProReal Ltd. Conference ‘Avatars in Mental Health’

Van Rijn,B. paper ‘Evaluation of Pro- Real based therapy within a prison setting’

2014                Society for Psychotherapy Research Conference.                                                    The outcomes of pluralistic therapy for depression

Biljana van Rijn, Mick Cooper, John McLeod, Tony Ward, Simon Cassar

                        Client-identified helpful factors in pluralistic therapy for depression

                        Pavlina Antoniou, Mick Cooper, John McLeod, Biljana van Rijn, Tony                     Ward, Simon Cassar

The development of an auditing tool for assessing adherence to pluralistic practice

John McLeod, Biljana van Rijn, Tony Ward, Mick Cooper, Simon CassarSymposium