Publication in Counselling and Psychotherapy Research

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Our article is published as part of a Special Section: Therapists and Knowledge. Guest Editors: Sofie Bager‐Charleson, Alistair Mcbeath & Simon Du Plock

Digital images as meaning bridges: Case study of assimilation using avatar software in counselling with a 14‐year‐old boy

First published: 24 May 2019



According to the assimilation model, psychotherapeutic progress involves building semiotic meaning bridges between disconnected parts of the person. Previous research has focused on verbal meaning bridges; this case study investigated whether and how digital imagery might serve as well.


This was a qualitative theory‐building case study.


The client was a 14‐year‐old boy with autism spectrum disorder seen in school counselling for 60 sessions. Assimilation analysis was applied to screen recordings and accompanying voice recording nine sessions, drawn from an early part of his treatment, during which he participated in an evaluation of video game‐like software designed for therapy and coaching.


The client created avatars representing aspects of himself and significant others, and scenes representing his problems and coping. The imagery and meanings evolved across this segment of treatment, providing a channel of interpersonal and intra‐personal communication.


Observations showed how digital imagery can serve as meaning bridges between client and counsellor, and between internal parts of the client.

Publication in British Journal of Guidance & Counselling

Published by Routledge

Avatar-based counselling for psychological distress in secondary school pupils: pilot evaluation

Mick Cooper, Biljana van Rijn and Evi Chryssafidou

This study is a pilot evaluation of a new avatar-based therapeutic tool,
ProReal, with psychologically distressed young people within a school
setting. In total, 54 young people, aged 12–18 years old, participated in
face-to-face avatar-based counselling. Young people used the software to
represent themselves and others, their problems and emotions. The
primary outcome measure was the Young Person’s CORE (YP-CORE). The
avatar-based counselling intervention was feasible to implement and
acceptable to clients, with 90% rating the help that they received as
good, and less than 20% dropout. The intervention was associated with
small to medium reductions in psychological distress, psychological
difficulties and conduct problems. These improvements, however, were
significant for male clients only. Outcomes were greater for counsellors
who spent more time in training and using the ProReal software.

Computer-assisted therapy;
avatar-based therapy;
adolescents; treatment



Sage Handbook of Counselling and Psychotherapy

The SAGE Handbook of Counselling and Psychotherapy
Fourth Edition, edited by Colin Feltham – Emeritus Professor of Counselling & Psychotherapy, Sheffield Hallam University; Terry Hanley – University of Manchester, UK; and Laura Anne Winter – University of Manchester, UK.

“At over 600 pages and with more than 100 contributions, this Fourth Edition brings together the essentials of counselling and psychotherapy theory, research, skills and practice. Including new content on assessment, theory, applications and settings, and with new chapter overviews and summaries, this continues to be the most comprehensive and accessible guide to the field for trainees or experienced practitioners.”

You can find my contribution in Part 3: Therapeutic Skills and Clinical Practice, Chapter 3.3 Assessment.

See Sage Publishing for more details and a preview.


SPR Conference 2017 in Oxford

Society for Psychotherapy Research
UK & European Chapters
4th joint conference
20 – 22 September 2017
Examination Schools, Oxford
“Psychotherapy practice and research: Finding the common ground”

I am taking part in a structured discussion ‘The SPRISTAD Study of Psychotherapist Development in Training – Experiences and challenges of data collection in different countries and its impact on research activity’ on Wednesday the 20th

On the 21st I am presenting a paper in a panel:
‘New directions in assimilation research: Theory-building case studies on the therapist’s activities in setbacks, assimilating the experience of dementia, and using digital images as meaning bridges’
The title of the paper is ‘Digital images as therapeutic meaning bridges. Case Study research into the use of avatar-based software by adolescents in school counselling’, van Rijn, B., Falconer C., Chryssafidou. E., Stiles, W.B.

Two new Publications

Psychotherapy 2.0: Where Psychotherapy and Technology Meet

Psychotherapy 2.0: Where Psychotherapy and Technology Meet

Editor : Philippa Weitz

I wrote a commentary in chapter eight of this very timely book.

Synopsis from the Karnac website:

The digital age is both exciting and challenging for psychotherapy, opening the door to clients groups previously not able to access psychological help, whilst also providing the challenges caused by social media and internet abuse and how these impact on the consulting room.

Psychotherapy 2.0 blows open the consulting room doors and shows successful pathways for attracting new clients to gain access to psychological help, as well as demonstrating that despite initial scepticism, working online as a psychotherapist or counsellor can be as effective as ‘face2face’ work: the therapeutic relationship may be different but it remains the centrally important feature for successful psychotherapy. It follows therefore that all psychotherapists and counsellors need to be fully informed about the impact of the digital age on their clinical practice. Psychotherapy 2.0 covers the key issues for psychotherapists and counsellors who are, or are thinking of, working online, include thinking about psychotherapy in the digital age, the requirements to modify training both for working online and also the digital issues as they arise within the face2face consulting room.

This book is intended as a first volume in this fast changing field, with further volumes intended to concentrate on existing and emerging research, as well the diverse ways in which online work is already being developed and implemented worldwide. It is possibly the greatest moment of change for psychotherapy since Freud: there is no going back, and just as we cannot put toothpaste back in the tube, psychotherapy practice is changed for ever with the advent of the digital age.


Van Rijn, B. (2014). Establishing an Online Practice. Chapter Eight Commentary. Psychotherapy 2.0: Where Psychotherapy and Technology Meet  Ed. P. Weitz. London, Karnac Books: 186-187.


Challenges to Developing Routine Outcomes Evaluation in Different Practice Settings and Cultures: A Naturalistic Enquiry in Spain and the UK


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.


van Rijn, B., Wild, C., & Dumitru, A. (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