Help 2

Recording therapy sessions: What do clients and therapists really think?

ELLIE BROWN*, NAOMI MOLLER, & CHRISTINE RAMSEY-WADE

Department of Counselling Psychology, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, UK

Abstract

Aims: Recording therapy sessions has become part of routine practice amongst trainee psychotherapists. To date most

research has focused on the benefits of recording sessions to support clinical supervision. There are few data about the

benefits or risks for clients. This study aimed to explore the views of clients who had had their therapy sessions recorded and

therapists who had recorded sessions. Design: Five clients and 25 therapists completed a qualitative survey, the results of

which were analysed using thematic analysis. Findings: All clients and several therapists reported that the recording devices

are soon forgotten. Both therapists and clients reported the benefits of recording as being purely for the therapist with none

identified for clients. Conclusions: It was observed that clients perhaps did not always understand how recordings were used,

suggesting the need for clearer practice guidance.

Keywords: recording; therapy; counselling; thematic analysis

Background

It is often accepted by students training in a variety

of therapies that they will need to audio or video

record a proportion of their therapy sessions as part

of their training course (e.g. Gothard & Bojuwoye,

1992). For example, in the UK the Improving Access

to Psychological Therapies (IAPT) programme has

trained 3700 new therapists over the past three years

(IAPT, 2013) and a core element of its training and

assessment is the submission of recorded therapy

sessions.

The IAPT curriculum and commissioning guide-

lines (March 2011, p. 11) state, ‘each therapy session

should be video- or audio-taped. Three audio/

videotapes of clinical sessions with each patient

should be submitted for formal examination’. Deter-

mining trainee competence is important in ensuring

that therapists are able to practice safely. Organisa-

tions such as the British Association of Counsellors

and Psychotherapists (BACP) and the British Asso-

ciation of Behavioural and Cognitive Psychothera-

pies (BABCP) that accredit training programmes

also require that recording sessions be used to deter-

mine trainee competences. Despite this requirement

for large numbers of trainees to frequently provide

‘in-vitro’ examples of their work, there is little

research or theoretical writing on the impact it may

have on trainees as well as their clients.

Authors that have written about recording therapy

sessions have argued from alternative perspectives,

with some advocating the practice, stating it helps

practitioners develop their clinical skills (see for

example, Abbas, 2004; Aveline, 1992), whilst others

have reasoned against the practice stating that it is

a barrier to the therapeutic relationship (see for

example, Brown, 1990; Gelso, 1973, 1974; Huhra,

Yamokoski-Maynhart, & Prieto, 2008; Lamb &

Mahl, 1956; Roberts & Renzaglia, 1965; Van Atta,

1969).

Much of the recording therapy literature pub-

lished to date has focused on the experience of the

trainee therapist. Of particular focus has been how

recording sessions can influence the therapeutic

process or the trainee’s experience of supervision

(e.g. Aveline, 1992; Ellis, 2010; Haggerty & Hilsenrot,

2011). Aveline (1992) suggested that resistance to

recording sessions originates from trainee therapists’

own feelings of anxiety and vulnerability because of

how the recordings can be used to evaluate and

review their clinical practice. Haggerty and Hilsenrot

(2011) reported findings of a systematic review

*Corresponding author. Email: [email protected]

Counselling and Psychotherapy Research, 2013

Vol. 13, No. 4, 254�262, http://dx.doi.org/10.1080/14733145.2013.768286

# 2013 British Association for Counselling and Psychotherapy

of the literature around the use of videotapes in

psychotherapy supervision. They suggest the use of

video recording in therapy sessions provides more

effective supervision for trainee therapists. They also

question relying on a therapist’s memory to vividly

recall a therapy session, emphasising that videoing

sessions allows supervisor and therapist to observe

non-verbal behaviour, facilitating better reflection of

the therapeutic process. Similar conclusions were

noted by Levenson and Strupp (1999) from two

large surveys of the views of practitioners and

training course directors from which they suggested

that American training programmes in brief psycho-

dynamic therapy should use videotapes for super-

vision and training. From their observations they

argued that they had experienced few negative

effects from its use and agreed with Aveline (1992)

that resistance tended to lie in therapists who either

consciously or unconsciously feared having their

work scrutinised. Gossman and Miller (2012) inter-

viewed 13 trainee counsellors about the recording of

therapy sessions. Despite doubts expressed over the

ability to be ‘completely present’ when their therapy

sessions were recorded, almost all participants felt

that the practice helped them to develop their

clinical skills and that perceived benefits outweighed

drawbacks to the practice. Ellis’ (2010) clinical

summary of research and supervisory experiences

posited that it is a myth that recording therapy

sessions is overwhelming and anxiety producing for

therapists and counter-therapeutic for clients, stating

that when clients know that the purpose of recording

sessions is to train therapists and improve the quality

of their therapy, they are generally happy to consent.

Research into the client’s experience of having

sessions recorded is dated. Most studies were

undertaken between 1950 and 1980 (Brown, 1990;

Friedman, Yamamoto, Wolkon, & David, 1978;

Gelso, 1973, 1974; Lamb & Mahl, 1956; Roberts

& Renzaglia, 1965; Van Atta, 1969; Zinberg, 1985).

These authors all concluded that recording therapy

sessions could have a negative effect on the client,

therapist and the therapeutic relationship. For ex-

ample, Roberts and Renzaglia’s (1965) study of eight

participants found that clients made more favourable

self-reference (talking positively about themselves)

when they knew they were being recorded and more

unfavourable references when not recorded. They

concluded that as self-references are quite relevant

aspects of the therapeutic situation, the different

recording conditions did affect the therapeutic

process. These findings were achieved by comparing

recordings from covertly and overtly recorded

sessions. It is noteworthy that this methodological

approach would be impossible to defend ethically

today, where all research participants are required to

give informed consent. This, amongst other metho-

dological constraints may explain in part why

relatively little research into this area has been

undertaken in the intervening decades.

A study by Shepherd, Salkovskis, and Morris

(2009) investigated the impact recording had on

31 clients receiving cognitive behavioural-therapy

(CBT) at a centre specialising in anxiety disorders.

Recording was integrated into the structure of

therapy, with clients being provided with a copy of

their session each week for them to listen to after-

wards. Clients were asked how they felt about having

their sessions recorded and being issued a copy for

their use each week. The most frequent advantage

reported by clients was that recordings acted as a

good memory aid of what went on during the

session. The authors reported that their results

were consistent with research in physical health

settings such as oncology, where patients generally

report positive attitudes towards recordings of

appointments and being able to listen back to them

(McHugh et al., 1995; Ong et al., 2000; Van der

Meulen, Jansen, Van Dulmen, Bensing, & van

Weert, 2008). It is hard to generalise from Shepherd

et al.’s study however, as client involvement with

recording both in and out of sessions is not routine

practice in most mental health services. Generally,

recordings are only listened to by the therapist

outside of sessions and it is unusual for clients to

be given a copy of recordings. It might also be argued

that the processes involved in psychological therapy

are very different to those in physical care, although

further exploration of this assumption would be

informative.

The focus of current literature has been on the

benefits to a therapist’s training and supervision.

It is hard therefore to draw strong conclusions

about the impact that recording therapy sessions

has on the therapeutic process as well as clients’

willingness to fully engage in therapy. Arguments

are frequently made in the literature that it is trainees’

anxiety about being recorded and ‘found-out’ which

drives the negative ideas around recording clients.

There has been little on-going reflection about the

impact recording may be having on clients. This

study aimed to gain an up-to-date insight into how

clients and therapist feel about recording therapy

session.

Recording therapy sessions 255

Method

Design

A qualitative survey was chosen over more traditional

interviews due to this study being an initial pilot. This

allowed for a larger and potentially broader sample of

views to be obtained (Clarke, Ellis, Peel, & Riggs,

2010). This method was also felt to be the least

intrusive way of gathering data from a vulnerable

clinical population. Additionally it typically allows for

data collection to occur on a larger scale, particularly

in comparison to conducting interviews, which con-

sume considerable time and resources. There were two

versions of the survey, paper and electronic, questions

were identical in both. This allowed for fast collection

of data from a potentially broad participant population

(Harding & Peel, 2007). An additional reason for

using data collection via surveys was its long and

substantive history within research, as explained in

Czaja and Blair (2005) and Groves et al. (2009).

Data collection

Participants were invited to complete the survey that

included basic demographic information (age, gen-

der, ethnicity) and for clients, a question to check

whether they had received an adequate explanation

about why their session was being recorded. To

avoid bias in data collection, questions remained

broad and open-ended. This was instead of using

questions originating from quotes from the research

literature (e.g. ‘‘‘some people have said that record-

ing therapy sessions gets in the way of the therapeu-

tic relationship’’ What do you think about this?’),

which could have been perceived as leading. Parti-

cipants were asked to respond to the following open-

ended questions in as much detail as possible:

(1) Overall, what was your experience of having

your therapy sessions recorded/recording ther-

apy sessions?

(2) What may be the advantages of recording

therapy sessions? Can you think of any specific

examples?

(3) What may be the disadvantages of recording

therapy sessions? Can you think of any specific

examples?

(4) Have you experienced the recording being

used in your therapy/in the therapy sessions

you have provided? If so, how? [This question

was included to gather information on activ-

ities such as those in Shepherd et al. (2009).]

Study participants

Two participant groups were invited to take part in

the study:

(1) Clients who had had at least one therapy

sessions recorded,

(2) Any practising psychological therapist who

had experience of recording their clients.

Clients. Recruitment was undertaken in three

services in the South West of England where

therapists recorded therapy sessions. Within the

services a variety of therapeutic approaches were

used. These services were: a charitable drug and

alcohol agency; a University counselling service; and

an NHS-run IAPT service. Therapists in these

services who were currently recording client sessions

were asked to approach any clients who had been

recorded to consider completing the survey. It may

have been preferable to write directly to clients to

invite them to take part, but this was not possible

because of data protection issues, i.e. personally

identifiable data can only be accessed by members of

the treating clinical team.

Therapists. A snowballing (chain referral sampling)

technique was used to identify potential therapist

participants, i.e. through contacts who know thera-

pists that may have been interested in taking part

(Biernacki & Waldorf, 1981). Adverts were also

placed with the British Psychology Society (BPS)

website and email service to gain a wider sample of

therapists who have experienced recording sessions.

Thirty-one participants were recruited, five (16%)

clients, 26 (84%) therapists. Thirty clients were

approached to complete the questionnaire with a

return rate of five. Table I shows the demographic

characteristics of client participants. The mean age

of clients was 47, they all defined themselves as

British and all felt they had had the reason for having

their sessions recorded adequately explained to

them.

Table II shows the demographic data for therapist

participants. Fairly typical of this professional group,

participants were predominantly female, white

British but with an average age of 35 (range 25�58

years), which is slightly younger than may be

anticipated. The most common type of therapy

provided was CBT (n �12) followed by integrative

counselling (n �11).

256 E. Brown et al.

Data analysis

The qualitative approach adopted was thematic

analysis. This predominantly ‘essentialist’ method

reports experiences, meanings and the reality de-

scribed by participants but also allows the researchers

to ‘unpick or unravel the surface of ‘‘reality’’’ (Braun

& Clarke, 2006, p. 81). It involves an integrative,

interpretative process between the data and the

researcher in order to ‘code’ the data. Thematic

analysis involves the careful reading of all the data,

looking to identify meaningful units of text that are

relevant to the area being researched and assigning

these ‘codes’. Analysis then moves to the broader

level of ‘themes’, whereby codes are combined to

form an overarching theme. Braun and Clarke argue

that equal attention should be paid to each item of

data when generating codes and themes. Each of the

two data sets (clients and therapists) were analysed

independently of each other.

Ethics

The study was approved as a service evaluation by

the University of the West of England Ethics

Committee and by the mental health services

participating in the project. Consolidated criteria

for reporting qualitative research (COREQ) stan-

dards for reporting qualitative studies were com-

plied with throughout (Tong, Sainsbury, & Craig,

2007).

Reflexivity

As a qualitative researcher I am conscious of my own

perspective on recording of therapy sessions. When

analysing data I have been mindful of this, consider-

ing the effect that my own beliefs and values can have

on the interpretations that I derive from the data. As

part of my therapy training I am required to record

therapy sessions. My own views about the topic are

mixed, both seeing the necessity of the activity but

also at times feeling anxious when having to ask

clients if they consent to being recorded as it can feel

a personal thing to ask for my own benefit. I feel my

own ambivalence toward recording helped me re-

main open to interpreting the data in this study.

Results

The overall aim of this study was to explore client

and therapist views of recording therapy sessions and

the main themes are outlined in Table III.

Thematic analysis

Clients. Four themes came through from the

client data. These were ‘Recording devices are soon

forgotten’, ‘It’s good for my therapist’, ‘It may be an

issue for some people’ and ‘Is there a lack of

understanding about recording?’

Table I. Client demographics.

Characteristic Client 1 Client 2 Client 3 Client 4 Client 5

Age (years) 44 53 53 39 59

Gender M M M F F

Client defined ethnicity British British British British British

Type of therapy Person-centred Unsure Unsure Unsure CBT

Service receiving therapy in Drug & alcohol Drug & alcohol Drug & alcohol NHS NHS

Recording explained Y Y Y Y Y

Happy with explanation Y Y Y Y Y

Table II. Therapist demographics.

Characteristic N �26

Age (mean, SD) 35 (8.6)

Female (n,%) 24 (92)

British ethnicity (n,%) 25 (96)

Providing CBT therapy (n,%) 12 (46)

Providing therapy in NHS service (n,%) 16 (62)

Table III. Main themes from analysis.

Main Themes

Clients Recording devices are soon forgotten

It’s good for my therapist

It may be an issue for some people

Is there a lack of understanding about recording?

Therapists Recording is beneficial to me

We never really know how it impacts our clients or us

Refusal is surprisingly infrequent

My feelings about recording sessions change during

the process

Technology failures get in the way

Recording therapy sessions 257

Client theme 1: Recording devices are soon forgotten:

Clients frequently reported that although they were

potentially aware of the recording device at the start

of their therapy, this was soon forgotten. A number

of reasons for this were mentioned, including their

presenting problems taking priority and being used

to being recorded.

I think that knowing that you are under pressure

with problems, I didn’t really take any notice (P5).

[Being recorded was] no different from my per-

spective, I’m used to it. (P2)

Client theme 2: It’s good for my therapist: Positively,

all clients that participated recognised the benefits

recording sessions holds for therapists. Clients seemed

to see therapy as an active process that extended

beyond the therapy session. There was also an appre-

ciation that a lot can happen in a session and having

the chance to review what was said can be helpful.

The therapist can . . . isolate certain themes which

he or she can work upon. (P1)

[It’s an] aid for reflection and personal develop-

ment [for my therapist]. (P4)

Client theme 3: It may be an issue for some people:

Clients recognised that not everyone will feel com-

fortable having therapy sessions recorded. It was

suggested that it could lead to sessions feeling

unnatural. Despite this, participants were clear that

that was not the case for them.

Somebody could be worried about what they’re

saying and therefore not open up completely. (P4)

Some individuals may find them intrusive and so

be unable to communicate in a natural relaxed

manner. (P1)

Client theme 4: Is there a lack of understanding about

recording?: There was a sense from the data that some

clients didn’t fully grasp why sessions were recorded

and what the recordings was used for, perhaps

because of the information their therapist has given

them. They felt that the recordings were used

beyond supervision and professional development.

[An advantage is] to further the trains of thought

within the organisation. (P3)

If you ever returned for therapy sessions [the

therapist] will be able to find out whether it is a

repeated problem [by listening to old tapes]. (P5)

Therapists. Data gathered from therapists gener-

ated 31 codes that were then collapsed into five

main themes using Braun and Clark’s (2006) six

stages of thematic analysis. These were ‘Recording is

beneficial to me’, ‘We never really know how it

impacts our clients or us’, ‘Refusal is surprisingly

infrequent’, ‘My feelings about recording sessions

change during the process’ and ‘Technology failures

get in the way’.

Therapist theme 1: Recording is beneficial to me:

Therapists reported several benefits to recording

therapy sessions, that were nearly all related to

themselves, not their clients. Benefits included noti-

cing things that were missed in the session:

I found it particularly helpful to review a whole/

part of a session. (P1)

You can reflect on things you may miss in the

moment. (P8)

Taping was also reported to be a useful learning tool

for professional development. Participants fre-

quently said that the use of recordings in supervision

helped them reflect on their work with clients.

You can listen back over your sessions to see what

you can improve on or what went well. (P2)

Listening [back] can enable therapists to reflect on

what was going on during specific parts of therapy

sessions. (P21)

Trainee therapists specifically highlighted the need

to have recordings to successfully complete assign-

ments as part of their programme of study and

achieve qualification.

It’s useful for assignments e.g. process reports . . .

it’s useful for CBT, if assessing CTS-R [cognitive

therapy scale revised] etc. (P5)

The aim of recording was to provide the recorder,

alongside a process report, to my training course.

(P19)

Therapist theme 2: We never really know how it

impacts our clients or us: Concern about how taping

258 E. Brown et al.

affects the therapeutic process was raised by partici-

pants. This worry reflects the lack of research on the

impact of recording sessions on clients. An idea that

frequently came through in this theme was the sense

that recording sessions made it feel that there was ‘a

third person in the room’:

Sometimes clients say things . . .and I really don’t

think they’re saying it for me, but for those who

may listen to the tape. As if there is another

audience to this confidential space (P5);

A client once said that the tape machine was a

third person in the room. (P24)

As this final quote may demonstrate, therapists

questioned whether recording sessions changed

how clients presented in sessions, potentially holding

back things they might have said.

Perhaps they would feel uncomfortable and less

likely to disclose. (P20)

Clients can find themselves holding back and not

talking as openly as they might usually talk. (P11)

Therapists also questioned whether recording

had a negative impact on the therapeutic rela-

tionship and made suggestions as to why this

might be:

Some clients felt paranoid and suspicious which

could damage the therapeutic relationship. (P21)

The therapeutic relationship can be strained due

to both parties being overly self-conscious. (P11)

Despite these possibilities, therapists rarely cited

examples of this happening and seemed more likely

to suggest that although this was a possibility, it had

not happened to them.

If clients are self-conscious it may affect the

relationship, don’t think this has happened to my

clients. (P13)

Therapist theme 3: Refusal is surprisingly infrequent:

Therapists were quick to report that they had rarely

had clients refuse to be recorded, which on reflection

surprised them.

I have been amazed how willing my clients are to

be recorded. (P3)

I haven’t experienced any clients refusing to be

recorded as yet. (P15)

Some therapists expressed concern over whether

this was because clients are too compliant and

find it hard to say no. Although this concern

was expressed, there were no suggestions made to

overcome this.

Some clients may not want to be recorded and

agree out of a sense of obligation. (P12)

Clients may not feel comfortable or able to refuse

consent to have sessions recorded. (P7)

Therapist theme 4: My feelings about recording

sessions change during the process: Therapists fre-

quently reported how recording clients made them

feel. Most apparent was the sense of anxiety that

initially existed, especially around having to ask

during the first session. Therapists reflected that

after this initial feeling of awkwardness it soon began

to feel more natural to an extent that they often

forgot the session was being recorded.

It was initially very anxiety provoking, as though a

tutor was sitting in the room criticising. I gradually

got used to it. (P24)

I quickly forgot the recorder was in the room. (P7)

I was anxious about doing so but once I had

recorded one or two this lessened and I forgot

about the recording device being present. (P9)

I have found that over time recording sessions

becomes more natural. (P14)

Therapist theme 5: Technology failures get in the way:

The final theme captures the expression that occa-

sionally the technology being used to record inter-

feres with the therapy session which seems to have a

significant impact on the therapy.

I have had sessions where the dictaphone has

beeped and stopped working . . . It’s as if a silent

person has suddenly interrupted and made their

presence known when otherwise it would have

gone unnoticed. (P5)

The battery has run out and the machine

squealed. (P24)

Recording therapy sessions 259

Discussion

The aim of this study was to explore the views of

clients and therapists about the recording of therapy

sessions. The findings from the study fall broadly

into two areas: benefits and ethics.

Benefits of recording sessions

Generally, clients were amenable to having therapy

sessions recorded and recognised benefits, particu-

larly for their therapist. This is consistent with the

work of Ellis (2010) who felt that when clients know

why recording was occurring they were happy to

consent. The observation by Roberts and Renzaglia’s

(1965) and Gelso (1973) that taping was a barrier to

effective therapeutic working was not reported by

participants in this study. For clinicians that record

sessions, it may be reassuring to know that clients

who agree to being recorded are generally happy to

do so and that recording instruments are quickly

forgotten. The sample for this study was clients who

had agreed to be recorded and who were compliant

with the request to complete a questionnaire. It is

perhaps therefore not surprising that their views

were by and large positive. That so few clients who

were asked agreed to participate may cast a shadow

over the generalisability of these observations. It

would be informative to survey clients who had

refused to be recorded and to get their perspective as

to why this was. This could be carried out using a

similar methodology to the present study with

therapists asking clients for their consent to be

contacted by researchers to complete a survey or

interview.

In this study, participants did not identify any

benefits to themselves of having sessions recorded.

This seems to be a largely consistent observation

with the only research that has demonstrated client

benefit being Shepherd et al. (2009). In their study it

was the practice of giving copies of recordings that

was being tested. As this practice was not reported as

occurring by any of this study’s participants, it is

probably not surprising they did not identify any

benefit to themselves.

A further theme suggested that clients acknowl-

edge that recording sessions holds benefits for their

therapist and it is for this reason they are happy to

consent. This implies that procedures for explaining

why therapists are proposing to record therapy

sessions need to be articulated more clearly. Indeed,

is there a sense that it is not ethically sound to offer

an intervention (session recording) when there is no

reported benefit from clients of participating in this?

Turning to the therapist participants, they also

acknowledged the benefits of recording to their

professional development, which was consistent

with both what the clients said and previous research

(Haggerty & Hilsenrot, 2011; Levenson & Strupp,

1999). Again it was only therapists who had pre-

viously recorded clients who were eligible to take

part in the study so there was no sense from

therapists who have not recorded clients about their

views on this.

It was positive to find that many of the themes

presented in this study paralleled those found by

Gossman and Miller (2012). Themes in their

investigation included ‘a third person in the room’,

‘moving from extreme nervousness to a more relaxed

style’, ‘aiding development of counselling practice’

and ‘the relationship between counsellor and client’

(p. 28). There is considerable overlap between these

themes and the ones currently presented, adding

support for the generalisability, or ‘trustworthiness’

of the findings in the study.

Ethics of recording sessions

The finding that clients might not understand

exactly why they are being recorded and what the

recordings are used for, was troubling. Indeed, this

finding suggests that some clients are agreeing to an

intervention (audio recording) without an adequate

understanding enabling them to give informed con-

sent. This is surely not ethical practice. On reflec-

tion, it would have been helpful to obtain copies of

the information sheets given to clients by participat-

ing therapists as this may have provided some insight

into what information clients have been given about

recording sessions.

It may be possible that the clients who took part in

this study were those that tend to passively consent

to whatever they are asked to do by a therapist. This

was echoed by one of the themes raised by therapists

who worry that clients are possibly too compliant.

Previous studies in this area have not suggested

that this may be the case (Ellis, 2010). This raises a

question for therapy and supervision. Is it an atypical

group of clients who consent to have their sessions

recorded and therefore how representative of the

trainees’ work are their recordings? Some support for

this perspective was reported by Van Atta (1969)

who found that over a quarter of clients would reject

260 E. Brown et al.

counselling altogether if they were required to

be recorded.

One theme that did emerge from the data that

has not been previously reported was that of their

surprise at how infrequently clients declined to have

sessions recorded. This observation contrasts with

that of Van Atta (1969) who argued that resistance to

having sessions recorded was common. It may be

that in the decades since this study was done

attitudes towards having sessions recorded have

changed as technology has become a part of every-

day life. Gossman and Miller’s study perhaps lends

some support to this argument as they reported that

more intrusive video recording distracts therapists

and possibly clients as well. Even if clients have

become more used to having technology present in

the session, the theme of ‘technology failures get in

the way’ in this current study suggests that therapists

worry that equipment failures could impact on the

therapeutic relationship.

Returning to the issue of infrequent refusal, data

were not collected on whether therapists were work-

ing with clients with common mental disorders (for

example anxiety and depression) or within secondary

services with clients with severe mental illness. It can

therefore only be speculated as to whether the client

population influences willingness to be recorded. For

example, it may be hypothesised that clients with

schizophrenia would be less likely to agree to having

their therapy sessions recorded.

Limitations

In addition to problems with bias (non-response

bias and sampling bias), recruitment of clients was

problematic due to issues of confidentiality. As a

researcher independent of the services where clients

had accessed therapy, the author was unaware of

client identifiable data. Potential clients were there-

fore contacted via their therapists, who enquired as

to their willingness to participate, and paper copies

of the questionnaire were provided for them to

return either to their therapist or in a self-addressed

envelope.

Even despite these difficulties, recruitment of

clients was disappointingly low. This was possibly

due to busy practicing therapists who were unable to

adequately promote involvement in the study to their

clients. An important consideration is how to

increase recruitment in the future, perhaps with the

researchers being more actively involved in the client

recruitment process, for example having more

frequent, direct contact with therapists in the ser-

vices recruitment was being conducted. Necessary

ethical consideration would need to be given to

ensure strict client confidentially is maintained.

Due to the methodology used to recruit therapists,

it was not possible to know how many potential

participants were unable to or unwilling to take part.

Whilst this approach was effective in generating a

sample, it could be criticised for introducing a

systematic bias; contacts are likely to refer therapists

who are willing to discuss this issue, negating those

who may be extremely resistant to recording clients

for potentially a variety of reasons.

Recommendations

Despite these limitations, this study has generated

important new data in a narrow field of research.

Perhaps the most practical implication of this

research is the need for psychotherapy training

programmes to better ensure clients are providing

informed consent to have their sessions recorded as

part of their therapist’s training. Expanding this

study into a larger piece of work with a greater

number of clients taking part is the next step to

gaining a greater understanding of how clients really

feel about having their therapy sessions recorded.

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Biographies

Ellie Brown is a trainee counselling psychologist

and senior research associate at the University of the

West of England, Bristol. She has published articles

in the areas of medication adherence and mental

health crisis services. She is currently working on a

National Institute for Health Research (NIHR)

programme grant investigating mental health crisis

teams in England

Naomi Moller is associate head of department in

the Department of Psychology at the University of

the West of England, Bristol. Trained as a counselling

psychologist, she publishes and teaches in the area of

counselling and psychotherapy.

Christine E. Ramsey-Wade is a senior lecturer

in counselling psychology at the University of the

West of England, Bristol and a chartered and HPC-

registered counselling psychologist at The Priory

Hospital Bristol. Her main clinical and research

interests are mindfulness and creative writing for

therapeutic purposes.

262 E. Brown et al.

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