Counselling for sight loss: using hermeneutic single case efficacy design methods to explore outcome and common factors

Background: Sight loss can lead to depression, suicidal thoughts, social isolation and loneliness. Although there is growing recognition of the need to provide emotional support for people with sight loss, little is known about effective counselling interventions for this client group.
Aims: The aim of this study was to contribute to an understanding of the nature of counselling for sight loss by carrying out a Hermeneutic Single Case Efficacy Design (HSCED) study in which the client was a 70-year-old woman who had experienced sudden and irreversible post-operative sight loss.
Method: The client received six sessions of counselling from a sight-impaired counsellor, working within a pluralistic framework informed by a common factors perspective. The client completed outcome and process measures at each session, and was interviewed at the end of therapy and at follow-up. All counselling sessions were recorded and transcribed. These data formed a rich case record, which was analysed by an inquiry team, using an HSCED procedure. Ethical approval was obtained from the University Research Ethics Committee to conduct this study, and the client engaged in an informed consent process at the beginning and end of her therapy.
Results: Results indicated that the client reported considerable benefit from the counselling she had received. The most important aspects of the therapy process were: feeling understood; being able to express emotions around the loss of sight; finding a new identity; identifying strategies for coping with fear, loss, dependency and other people's perceptions; exploring the possibility of a future without sight; making sense of things, and finding ways to become more socially connected. These themes are discussed in relation to the development of a model of counselling for sight loss based on a common factors approach.
Implications: The findings of this study suggest that systematic case study research and a common factors perspective have the potential to deepen our understanding of issues presented by specific client groups.