What is counselling?

  • An interpersonal relationship between someone actively seeking help and someone willing to give help who is capable or trained too help in a setting that permits help to be given and received.
  • Different to a standard doctor-patient relationshipàà counselling relationship is more intimate and mirrors what a relationship is in real life
  • It is a collaborative process and requires active participation
  • Counselling usually involves 1-15 sessions– process over time
  • Counselling is creative- an art not a science
  • Consists of a repertoire of skills
  • Using yourself (the therapist) as the tool
  • Its about a connection with the individual

 

Is counselling effective?

  • The average treated person is better off than 80% of those without the benefit of treatment
  • For most problems psychological therapy is more effective than alternative treatments like psychoactive medications.

 

Limitations

  • The drop out rate is high- about 47%
  • It takes time- not a quick fix
  • It requires commitment, insight, time and trust.
  • Some people perceive talking about emotions as weak- element of stigma.

 

Does training matter?

  • Evidence indicates the level of education and training one gets doesn’t necessarily correlate with how good of a counsellor you are.
  • There is a great different within professions rather than between.

 

History

  • Since the 60s the number of treatment has grown from 60 to 400+

 

Different approaches

  • Psychodynamic o Psychoanalytic therapy: based largely on insight, unconscious motivation, and reconstruction of the personality
    • Adlerian therapy: focuses on meaning, goals, purposeful behaviour, conscious action, belonging and social interest. Accounts for present behaviour by studying childhood experiences but it does not focus on unconscious dynamics.
  • Experiential and relationship-oriented therapies o The Existential approach: stresses a concern for what it means to be fully human. This approach is not a unified school of therapy with a clear theory and a set of techniques. o The Person-Centred approach: rooted in humanistic philosophy, places emphasis on the basic attitudes of the therapist. Maintains that the quality of the client-therapist relationship is the prime determinant of the outcomes of the therapeutic process. Clients have the capacity for self-direction without active intervention by the therapist.
    • Gestalt therapy: Offers a range of experiments to help clients gain awareness of what they are experiencing in the present. Gestalt therapists take an active role, yet they follow the leads provided by clients.
    • These approaches emphasize emotion as a rout to bringing about change– they can be considered emotion-focused therapies.
  • Cognitive behavioural approaches o Reality therapy: focuses on clients’ current behaviour and stresses developing clear plans for new behaviours
    • Behaviour therapy: emphasizes on doing and on taking steps to make concrete changes
    • Rational emotive behaviour therapy and cognitive therapy: highlight the necessity of learning how to challenge inaccurate beliefs and automatic thoughts that lead to behavioural problems.
    • These approaches are used to help people to modify their inaccurate and selfdefeating assumptions and to develop new patterns of acting
  • Systems and postmodern perspectives o Feminist therapy: contributed an awareness of how environmental and social conditions contribution to the problems of women and men and how gender-role socialization leads to a lack of gender equality.
    • Family therapy: not possible to understand the individual apart from the context of the system.
    • Postmodern approaches: include social constructionism, solution-focused brief therapy and narrative therapy.
    • These focus on how people produce their own lives in the context of systems, interactions, social conditioning and discourse.

 

The factors of effective therapy

  • The therapeutic relationship o Shared understanding of the problem o Feeling understood o Trust, compassion, connection, rapport etc.
  • The intervention- techniques used (15%)
  • Client expectations of therapy
  • Extra-therapeutic factors- things we cannot define- something in a patients life changes outside of therapy, which helps them get better (40%)

 

Micro-skills

  • Micro-skills are observable actions of therapists that appear to effect positive change in the session in which active listening involves both receive and sender
  • Psychologists that are effective apply these skills – Core skills:
    • Attending skills- nodding, leaning in, eye contact o Listening skills- summarizing o Confronting- gently bringing out about awareness o Focusing- themes and keep on track
    • Reflection of meaning – explore deeper understanding

 

Attributes of effective practitioners

  • One study by Ricks (1974) followed adults who had been treated as childrenàà he found a major difference in outcomes depended on who their therapist was.
  • Experience:
    • Paul Clement found that it didn’t matter how much experience he had his outcomes didn’t improve
    • Why don’t psychologists improve with experience?
    • § Automaticity- do not connect with the client
    • § Lack of authenticity
    • § Focus on not making mistakes- taking the path of least resistance
    • § Over confidence- the more confident you are the lower your outcomesàà Dunning-Kruger Effect
  • Psychological health doesn’t seem to be related to being an effective therapist.
  • Effective counsellors… o Have a willingness to become a more therapeutic person o Have a strong identity, sense of self, who they are
    • Respect and appreciate themselves
    • Open to change o Authentic, sincere and honest o Have a sense of humour o Make mistakes and are willing to admit them o Able to be in the present
    • Appreciate the influence of culture-incredibly important o Have a sincere interest in the welfare of others o Have effective interpersonal skills o Become deeply involving in their work and derive meaning from it  o Are passionate
    • Are able to maintain health boundaries

 

Effective counsellors in multicultural settings

  • Competencies in multicultural counselling involve three areas: beliefs and attitudes, knowledge and skills.
    • Beliefs and attitudes:
    • § Ensure that their personal biases, values or problems will not interfere with people of different cultures.
    • § They are aware of their positive and negative emotional reactions towards people from different cultures.
    • § Seeks to understand the world from the vantage point of their clients.
    • § They accept and value cultural diversity.
    • § Realizing that traditional theories and/or techniques may not be appropriate for all clients. o Knowledge
    • § Study the historical background, traditions and values of the client and are open to learning from him/her
    • § They are aware of the institutional barriers that prevent minorities from using mental health services.

o Skills

  • § They use methods and strategies that are consistent with the life experiences and cultural values of their client.
  • § They modify and adapt their interventions to accommodate cultural differences.

 

Personal therapy for therapists

  • Personal therapy can contribute to therapists professional work in three ways:
    • Therapist experiences the work of more experienced therapist and learns experientially what is helpful or not helpful
    • Enhance their interpersonal skills
    • Enhance their ability to deal with ongoing stresses associated with clinical work – Therapists learn what it is like to be a client
  • They can prevent their potential future countertransference from harming clients.

 

The role of values

  • Every psychologist their own values and this will influence how they will act in therapy
  • It is not the therapists function to persuade clients to share the same values
  • We aim to be objective, but we can get caught up in our own world view
  • Client’s responsibility to develop goals

 

Issues faced by beginning therapist

 

  • Dealing with demands from clients
  • Dealing with clients who lack commitment
  • Tolerating ambiguity
  • Countertransference
  • Developing a sense of humour
  • Sharing responsibility with your client
  • Declining to give advice
  • Defining your role as counsellor
  • Learning to use techniques appropriately
  • Developing own counselling style
  • Maintaining your vitality as a person and a professional
  • Dealing with anxieties
  • Understanding silence
  • Being oneself and self-disclosing – Avoiding perfectionism
  • Being honest with your limitations
  • Tolerating ambiguity