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



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.

Presentation at the 19th BACP Research Conference, May 2013

19th Annual BACP Research Conference, 10 & 11 May 2013;
Conference title ‘Synergy in counselling & psychotherapy research’

Presenter: Dr Biljana van Rijn and other author: Ciara Wild

ABSTRACT: Research Clinic: Routine Outcome Evaluation of Humanistic and Integrative Therapy

Keywords (give 5): research clinic, Humanistic and Integrative psychotherapy/counselling; routine outcome evaluation


The research was a naturalistic, non randomised, evaluation of Transactional Analysis (TA) and Gestalt psychotherapies, Integrative Counselling Psychology and Person Centred counselling within a community based service. Routine outcome evaluation used standardised measures to assess treatment outcomes and 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. The presentation will offer a reflection on how a choice of therapist and a length of therapy impacted on outcomes.

To evaluate the outcomes of humanistic and integrative psychotherapies (Transactional Analysis, Gestalt, Integrative Counselling Psychology) and Person Centred counselling in routine practice by:

  • Evaluating whether these therapies achieved a  significant reduction in scores on  standardises measures
  • Comparing the effectiveness of different theoretical orientations


The project was a naturalistic, non-randomised, evaluation of routine outcomes of Transactional Analysis and Gestalt psychotherapies, Integrative Counselling Psychology and Gestalt and Person Centred counselling. Differences between the approaches have not been evaluated due to the sample size.

Therapy was evaluated using sessional standardised measures  (GAD7;PHQ9;Core 10), pre and post measures (BDI-II;CORE 34). Adherence to the theoretical model was evaluated using Adherence questionnaires.


67 herapists and 321 clients took part in the evaluation. There was a high percentage of completed data sets (over 90% for sessional measures). The outcomes show that:

  • Clients who continued in therapy after the assessment period, achieved a significant improvement and large effect size on sessional measures for depression, anxiety and general outcomes measured by CORE 10.
  • There were no differences in effectiveness between theoretical orientations

Additional Analysis:

  • Analysis of the high level of attrition and requests to change therapists during the assessment period. It showed that once the clients changed therapists they achieved the same levels of change as those who made a good working relationship with their initial therapist.
  • Length of therapy. The number of sessions varied between individual clients, but was not directly related to the outcomes.

Research Limitations relevant to naturalistic research:

  • No randomisation
  • No control group
  • Limited monitoring of  therapist techniques in sessions
  • Evaluation of therapies in routine practice, rather than efficacy.


  • Humanistic (Transactional Analysis; Gestalt Psychotherapy; Person Centred Counselling) and Integrative therapies achieved a significant improvement in anxiety, depression and general wellbeing in routine practice, within a community setting.
  • There was no difference in effectiveness between these approaches
  • Length of therapy varied but a number of sessions was not directly linked to outcomes
  • A large proportion of clients stop therapy prematurely within a community setting. Offering a different therapist to those clients enabled them to engage in therapy and gain from it.


2nd EATA TA Research Conference

Details about this conference can be found at:
Upcomming conferences:

Paper presentation: Research Clinic, Development, Outcomes and Challenges

The paper will present a year (2010-2011) in the research clinic at Metanoia Institute. This was a naturalistic evaluative study using quantitative, standardised methods of evaluation within a low cost training clinic. Outcomes of evaluation of TA psychotherapy, alongside Integrative Counselling Psychology, Gestalt psychotherapy and Person Centred counselling will be presented and discussed. The presentation will end with recommendations for future research and learning about the development of research clinics.
About the Presenter(s)
Biljana van Rijn is a Head of Clinical and Research Services at Metanoia Institute in London, where she has developed a research clinic and conducts practice based evaluative research projects. She teaches on the MSc programme in Transactional Analysis Psychotherapy and the Doctorate in Counselling Psychology at Metanoia Institute and offers research supervision. Biljana also works as a psychotherapist and supervisor in private practice in West Sussex.
Outcomes for delegates:
Knowledge about current research on effectiveness of Transactional Analysis Psychotherapy.
Understanding of the gains and challenges of evaluation in practice settings.

Research and relational psychotherapy

At the Bilbao conference 2011 a new book about Relational Transactional Analysis was presented by the editors Heather Fowlie and Charlotte Sills. My contribution Research and relational psychotherapy forms a chapter in part III : The implications for professional practice.

Excerpt from Introduction and basic principles:

“Research is not often associated with relational psychotherapy. the gap between psychotherapy research and practice separates the two disciplines and has consequences for both. Although psychotherapists use clinical supervision to reflect on their practice, research methodologies contain strategies which can also deepen insight and develop practice. Overt evaluation of practice is also increasingly important as a way of evidencing effectiveness. Relational methodologies in psychotherapy research and the relevance of quantitive findings have a potential to bridge the research/practice gap and develop both clinical practice and its mainstream credibility.
The aim of this chapter is to show that all research has the potential to be relational and useful for clinical practice. I will give a broad overview of research methodologies, their principles and design, and invite reflection on how they can be used in relational practice.”

Chapter Reference

Van Rijn, B. (2011) Research and relational psychotherapy in: Fowlie, H. and Sills, C. (Eds.)(2011)Relational Transactional Analysis, Principles in Practice. (pp.305-312) London: Karnac .

Book Review

Through different voices and styles of contributions, including papers, edited talks and panel discussion, this collection explores and applies the principles of relational transactional analysis. It sets them in social, cultural and political contexts, and considers a number of important implications of this particular ‘relational turn’ in psychotherapy. The book advances relational transactional analyses and, in doing so, reflects the creativity and vibrancy of contemporary TA. The editors have skilfully brought together different generations of TA practitioners in an accessible and stimulating volume. I commend the editors and highly recommend the book.
Dr Keith Tudor, author of a number of books and co-author of the article ‘Co-creative transactional analysis’ in the Transactional Analysis Journal. He is Associate Professor, Auckland University of Technology, Auckland, Aotearoa, New Zealand

Book Reference

Fowlie, H. and Sills, C. (Eds.)(2011) Relational Transactional Analysis, Principles in Practice. London: Karnac .
ISBN 978-1-85575-762-2