The nature and effectiveness of therapies provided in counselling centres at the Princess Nourah Bint Abdulrahman University

  • Afnan Ahmed R Alhimaidi

Student thesis: Doctoral Thesis


Interest in counselling and guidance in Saudi Arabia has grown in recent years. Evidence about how it is delivered and by whom, as well as its effectiveness, is limited. What does psychotherapy/counselling look like in practical terms in Saudi Arabia? How have western mental health approaches and procedures fared in an Arabic/Islamic cultural milieu? What has been assimilated and what has been accommodated or adapted? In this research I aimed to explore the nature and effectiveness of the counselling services provided at Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. This dissertation presents two studies using complementary research methods, carried out within a pluralist, broadly critical-realistic framework. The first study was a constructivist/descriptive qualitative counselling service research study, which aimed to map the nature of the therapists' perceptions of the counselling services, asking three broad questions: First, what kinds of services do therapists see themselves as providing to their clients? This included kinds of 'therapies', 'techniques',and 'measures'. Second, what kinds of professional experiences have therapists report, including 'years of experience', 'personal development' and 'improvement in providing counselling'? Third, what kinds of practice difficulties and challenges do therapists perceive, including 'in-session challenges' and 'external difficulties'? The study sample consisted of thirteen (out of a total of sixteen) female therapists at the counselling centre in Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. A semi-structured interview was developed and piloted in order to collect the study data, which was then analysed from the viewpoints of both a version of grounded theory and Braun & Clarke's thematic analysis. The findings showed that therapists used different kinds of predominantly western forms of psychotherapy, both positivist-realist (e.g. CBT) and humanistic-phenomenological (Person-centred Therapy) as well as mostly positivist-realist therapeutic techniques (e.g.they most commonly used homework, behavioural therapy, and behavioural activation) and assessments/measures (e.g. the Beck Depression Inventory and Beck Anxiety Inventory).;Furthermore, therapists generally reported that they had improved in their performance and were interested in developing their skills and providing better services, although some complained of limited opportunities to do so. Finally, therapists indicated that they faced both external difficulties (e.g. lack of privacy and conflict with co-workers) and in-session challenges with their clients (e.g. lack of client commitment to counselling and client silence) that affected their performance and work satisfaction. The second study was a quantitative client practice-based outcome study, using what can be described as both a mental health services research design and a practice-based therapy effectiveness study of the outcomes of counselling practiced at Princess Nourah bint Abdulrahman University. It aimed to document amount of client-reported personality change in the counselling centre at the Princess Nourah bint Abdulrahman University over the course of therapy. To do this, I used a western psychotherapy outcome measure that had been developed to assess -in a non-pathologising manner- the outcome of humanist, phenomenological approaches to psychotherapy.;This assessment measure, the Strathclyde Inventory (developed by Elliott, Rodgers, Freire, & Stephen, 2016), was chosen to avoid cultural sensitivities that might have been activated by more commonly-used pathology distress measures such as the CORE-OM. Therefore, an Arabic translation of the Strathclyde Inventory was prepared, using standard practices including parallel and back translation. The result was the 20-item Arabic translation (the SI-20-A) that measures two factors based on Carl Rogers' theory of the fully functioning person, namely Congruence/Experiential Fluidity and Incongruence/Experiential Constriction, as these concepts were considered in Islam and Arab culture. The outcome measure was administered to the clients by their therapists at the beginning, the middle, and then at the end of a course of therapy. Data from thirty eight clients was used and analysed using descriptive, inferential statistical analyses (a repeated measure ANOVA) within a critical realist perspective; in addition, reliable and clinical significant changes were calculated to provide multiple ways of documenting reported client change or lack of it using the SI-20-A. The study results showed that there were medium to large differences between the three time points (pre-, mid- and post-tests) and that these were extremely unlikely to be due to chance (p < .001). Additionally, the study found that about 44% of the clients at the end of the therapy appeared to have made clinically significant and reliable changes, 50% of the clients showed no change in reported personality functioning, and one of the clients showed deterioration on this measure. However, cultural differences between Western and Saudi Arabia may have affected the study findings, a possibility that I explore in the Discussion chapter of this dissertation.;Overall, the research findings provide a multi-faceted view of counselling centre services within a Saudi university and their effectiveness, with possible benefits for these services, for the therapists, and for the university's students: The main potential benefit to the Counselling Centre is encouragement to continue to provide help and support to therapists who sometime struggle to deal with client's issues, and to consider the importance of supporting quality counselling services. The therapists involved could benefit from the knowledge that the services they provide are generally effective with many clients. And the university students could benefit from knowing what kind of services that counselling centre offers and the quality and effectiveness of these services. Beyond Princess Nourah bint Abdulrahman University, this dissertation contributes to knowledge about the counselling and psychotherapy field in Saudi Arabia by documenting the nature of university-based counselling services provided and quantifying client outcomes in the university counselling centre; these include the counselling services provided, therapists' their practice difficulties, and substantial amount of client pre-post change over the course of therapy. This dissertation may encourage counselling and guidance in education settings to set up a clear and fixed roles and requirements which would help therapists and counsellors to be more careful with client confidentiality and privacy, and, in addition, to provide a better work environment to carry out counselling sessions. Furthermore, it highlighted the usefulness of evaluating the performance of the counselling services. Further research is recommended in the field of counselling in higher education institutions in Saudi Arabia to replicate these findings and to provide a better understanding of counselling services at Saudi universities and their effectiveness.
Date of Award10 Jun 2019
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SupervisorRobert Elliott (Supervisor) & Marc Obonsawin (Supervisor)

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