To review the evidence on the efficacy of different types of existential therapies: a family of psychological interventions that draw on themes from existential philosophy to help clients address such issues in their lives as meaning and death anxiety. Relevant electronic databases, journals, and reference lists were searched for eligible studies. Effects on meaning, psychopathology (anxiety and depression), self-efficacy, and physical well-being were extracted from each publication or obtained directly from its authors. All types of existential therapy for adult samples were included. Weighted pooled mean effects were calculated and analyses performed assuming fixed-effects model. Twenty-one eligible randomized controlled trials of existential therapy were found, from which 15 studies with unique data were included, comprising a total of 1,792 participants. Meaning therapies (n = 6 studies) showed large effects on positive meaning in life immediately postintervention (d = 0.65) and at follow-up (d = 0.57), and had moderate effects on psychopathology (d = 0.47) and self-efficacy (d = 0.48) at postintervention; they did not have significant effects on self-reported physical well-being (n = 1 study). Supportive-expressive therapy (n = 5) had small effects at posttreatment and follow-up on psychopathology (d = 0.20, 0.18, respectively); effects on self-efficacy and self-reported physical well-being were not significant (n = 1 and n = 4, respectively). Experiential-existential (n = 2) and cognitive-existential therapies (n = 1) had no significant effects. Despite the small number and low quality of studies, some existential therapies appear beneficial for certain populations. We found particular support for structured interventions incorporating psychoeducation, exercises, and discussing meaning in life directly and positively with physically ill patients. It is important to study more precisely which existential intervention works the best for which individual client.

Background. Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.Method. Patients (n=1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. Therapists indicated which treatment approaches were used on an End of Therapy form. We compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these plus one additional approach (e.g. integrative, supportive, art), designated CBT+1, PCT+1 or PDT+1 respectively.Results. All six groups averaged marked improvement (pre–post effect size=1·36). Treatment approach and degree of purity (‘only’ vs. ‘+1’) each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores (respectively 1% and 0·5% as much as pre–post change). Distributions of change scores were largely overlapping.Conclusions. Results for these three treatment approaches as practised routinely across a range of NHS settings were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes. Caution is warranted because of limited treatment specification, non-random assignment, lack of a control group, missing data and other issues.

Historically, training, research and practice in counselling and psychotherapy have been dominated by unitary theoretical models. Although integrative and eclectic positions have been developed as alternatives, these have not been successful in generating research and have resulted in a further proliferation of competing models. In this paper we introduce a ‘pluralistic’ framework for counselling and psychotherapy and discuss the implications of this framework for research. The basic principle of this pluralistic framework is that psychological difficulties may have multiple causes and that there is unlikely to be one, ‘right’ therapeutic method that will be appropriate in all situations—different people are helped by different processes at different times. This pluralistic framework operates as a meta‐theory within which it is possible to utilise concepts, strategies and specific interventions from a range of therapeutic orientations. The framework is structured around three domains—goals, task and methods—by which therapeutic processes can be conceptualised, critically examined and empirically investigated. These domains, and the relationships between them, are outlined and the collaborative relationship at the heart of the pluralistic framework is discussed. The pluralistic framework provides a means for empirical research directly to inform practice and potential lines of empirical inquiry are outlined, along with findings from a recent study of counselling in schools.

Background: There is a need for a user‐friendly measure of change for use in school and youth counselling services which is easy for practitioners to administer and score, and which is appropriate for brief interventions. Aims: To develop such a measure and to present psychometric data on reliability, validity and sensitivity to change for the measure. Method: We employed a three‐stage approach: first, creating a pool of potential items; second, developing an 18‐item version; and third, refining to a final version comprising 10 items. We called the measure the Young Person's CORE (YP‐CORE). Results: The measure comprised eight negative and two positive items and included a single (negatively‐framed) risk‐to‐self item. Psychometric properties were all acceptable. Sensitivity to change was good and yielded an average improvement of 10 points on the YP‐CORE in a clinical group, broadly equivalent to changes in adult versions (e.g. Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM)). Conclusion: Initial validation work showed the measure to be well designed and sensitive to change. Analysis showed considerable variability as a function of age and gender suggesting the need for the collection of a large and diverse data set in order to produce gender and age‐specific norms.

The aim of this paper is to articulate a “pluralistic” understanding of what it means to be person-centered. This perspective places particular emphasis on an understanding of clients as unique, nonstandardizable “othernesses,” whose therapeutic wants and needs are likely to be highly heterogeneous and unknowable in advance. Based on this idiographic standpoint, it is argued that a person-centered understanding of therapeutic change necessitates an openness to, and appreciation of, the many different ways in which clients may benefit from therapy – including, but not limited to, established person-centered and experiential (PCE) practices. To translate such pluralistic principles into practice, it is suggested that therapists should specifically orientate their work toward clients' goals, and enhance their levels of dialogue and metacommunication with clients regarding the goals, tasks and methods of therapy. This pluralistic approach to person-centered therapy holds other perspectives and practices within the PCE community in high regard, as well as other non-PCE therapies; but it does challenge “dogmatic person-centeredness” and encourages PCE practitioners to be aware of the limits of their work. It also provides a coherent, “client-centered” framework through which PCE therapists can incorporate a wide body of practices, research findings and theories into their work.