Exploring Counselling

Nature gave us one tongue and two ears so we could hear twice as much as we speak.
EPICTETUS (GREEK PHILOSOPHER)

This broad-ranging first chapter covers considerable ground on the multifaceted topic of counselling. It opens by defining counselling, illustrating the differences between counselling and other forms of helping, and examines whether a distinction can be made between counselling and psychotherapy. It then addresses the extensive range of counselling approaches currently practised, and outlines five widely used approaches: psychodynamic counselling, personcentred counselling, cognitive behavioural therapy (CBT), eclectic counselling and integrative counselling. Next, it draws attention to transference and counter-transference (a psychoanalytic concept) and clarifies that psychodynamic counselling is different to psychoanalysis. The issue of confidentiality is then discussed, followed by a review of future climate changes in the profession, and the potential impact of these. The broad work areas where counsellors are employed, a debate on the opportunities of fulltime paid employment for counsellors, what motivates people to seek counselling, barriers to seeking counselling and the elements required to counsel effectively draw the chapter to a close.

Defining counselling

Counselling, often described as ‘talking therapy’, is a process aimed at providing clients with the time and space to explore their problems, understand their problems, and resolve, or come to terms with their problems, in a confidential setting. The Royal College of Psychiatrists (2006) defines counselling simply as ‘a type of psychotherapy which helps people address and resolve their problems and work through their feelings’. They describe a counsellor (2006) as ‘someone who uses ‘‘counselling’’ to solve people’s problems or plan for the future’ and who ‘may work with individual patients, in pairs or groups’. Dictionary definitions usually define counselling as giving advice or guidance. Figure 1.1 distinguishes between advice giving, guidance and counselling.

Figure 1.1. Distinguishing between advice giving, guidance and counselling.

To lay the foundations for building a trusting relationship, counsellors:

- provide a safe and supportive setting, free from intrusions and distractions;
- respect client confidentiality;
- respect the client’s principles, ethnicity, and coping resources;
- refrain from being judgmental;
- avoid stereotyping or labelling;
- shelve personal prejudices;
- maintain impartiality, integrity, and reliability.

If you judge people, you have no time to love them.
Mother Teresa of Calcutta

Through the counselling process clients are helped to:

- adapt to situations that cannot be changed (e.g., terminal illness, death of a loved one);
- consider aspects of their lives they want to change;
- view their situation from a different perspective;
- create positive changes;
- develop coping strategies;
- develop their full potential;
- find their own solutions to their problems;
- gain insight into their thoughts, feelings and behaviour;
- grow and develop;
- let go of painful secrets;
- make informed decisions;
- manage life transitions and crises;
- resolve personal and interpersonal conflicts;
- set and achieve goals;
- take control over their lives.

For counselling to prove an empowering experience, the client must be self-motivated and committed to change. Coerced into participating to satisfy someone else’s needs is likely to be met with resistance, or a reluctance to cooperate.

Clarifying why counselling is not advice giving

*Giving advice frequently means telling people what they should do or ought to do. This conflicts with the true meaning of counselling. Certainly, counsellors help clients look at what is possible, but they avoid telling clients what they should do. That would be the counsellor taking control rather than the client gaining control.

The counsellor who answers the question ‘What would you advise me to do?’ with ‘What ideas have you had?’ is helping the client to recognise that they have a part to play in seeking an answer. They help the client take responsibility for finding a solution that feels right for them.

Advice may be appropriate in crises, for example, at times when clients’ thoughts are clearly confused or they feel overwhelmed following a traumatic event. At such times the counsellor will exercise greater caution than when clients are fully responsive and responsible. Advice offered and accepted when in crisis, and then acted upon, could prove to be, if not ‘bad advice’, not totally apt to meet the client’s needs. When people are in a state of shock or under stress they are vulnerable. For all those reasons, counsellors are wary about responding to a request for advice.

Not offering advice can sometimes prove difficult for even the most seasoned counsellors. For example, if a client is suffering from tension the counsellor may suggest relaxation techniques to help reduce stress levels. Even though the given ‘advice’ might be offered with the client’s best interests at heart, the choice should always remain with the client as to whether it is pursued.

He that gives good advice, builds with one hand; he that gives good counsel and example, builds with both; but he that gives good admonition and bad example, builds with one hand and pulls down with the other.
Francis Bacon, Sr.
English lawyer and philosopher (1561–1626)

Examining why counselling is not persuasion

Counselling is not about persuading, prevailing upon, overcoming the client’s resistances, wearing the client down or ‘bringing the client to their senses’. Persuasion is in direct conflict with at least one principle of counselling – selfdirection – the client’s right to choose for themselves their course of action. If the counsellor were to persuade the client to go a certain way, make a certain choice, there could be a very real danger of the whole affair backfiring in the counsellor’s face and resulting in further damage to the client’s self-esteem.

This concept of self-direction, based on personal freedom, is the touchstone of the non-directive approach to counselling but is present in most others. The basis of the principle is that:

- any pressure which is brought to bear on the client will increase conflict and so impede exploration.

Exploring why counselling is not exercising undue influence

Some people believe that successful counsellors are those who are able to suggest solutions to clients’ problems in such a way that the clients feel they are their own. This is commonly called ‘manipulation’, a behaviour from which most counsellors would recoil. However, situations are seldom clear cut. There is a fine line between legitimate influence and manipulation.

Manipulation always carries with it some benefit to the manipulator. Influence is generally unconscious. In any case, suggesting solutions is not part of effective counselling. There is a difference between exploring alternatives and suggesting solutions and manipulation. Manipulation invariably leaves the person on the receiving end feeling uncomfortable, used and angry.

The dividing line between manipulation and seeking ways and means to resolve a problem may not always be easily seen, but the deciding factor must be who benefits? Is it you, or is it the other person?

(*Adapted from Stewart, W. and Martin, A. (1999) Going For Counselling. Used with permission of the authors.)

Counselling skills versus counselling per se

Counselling skills are used by a range of professionals and volunteer helpers. Examples of counselling skills in practice include the doctor who listens attentively to his patient without interrupting before prescribing, the psychiatrist who pays thoughtful attention to the symptoms being described by a patient before making a diagnosis, the priest who helps an anonymous parishioner accept God’s grace and forgiveness from behind the curtain of the confessional box, or the lifecoach who allows time and space for a client to explore any roadblocks that are hindering achieving a desired goal.

The dividing line between using counselling skills and counselling per se is often blurred. Managers, nurses, social workers and other health practitioners may apply counselling techniques to help their clients, patients or employees, and may have undertaken a counselling skills training course. In effect, they use counselling skills as a part of their role, but counselling is not their main career or how they earn a living.

Counselling, in contrast, is a distinct occupation which requires extensive training, supervised practice to reflect on one’s own performance and maintain high standards of professionalism, keeping abreast of changes in the field, and an ongoing commitment to personal growth and professional development. It entails a sound understanding of theories of human development and counselling theory and its applications to practice. Furthermore, it is a mandatory requirement of many counselling training courses for trainees to undertake personal therapy, the aim of which is to address personal issues that arise through their counselling work, to foster personal growth, and to experience what it feels like to be in the client role.

Counselling is a contractual agreement – client and counsellor have agreed to work together. The client may have attended an initial assessment interview to determine if counselling is appropriate and counsellor and client may have negotiated a time-limited contract (typically between six and twelve sessions) or an open-ended contract (no set limit on number of sessions). (See Chapter 4 for an example of a counselling contract and further discussion on the topic.)

Counsellor and psychotherapist: is there a difference?

The terms ‘counsellor’ and ‘psychotherapist’ are often used interchangeably and, just as distinguishing between using counselling skills and counselling per se is not straightforward, so it is with attempting to differentiate between counselling and psychotherapy. Some would argue that there is no difference, or that the disparity in minimal. In contrast, others would advocate that a distinction can be made on the basis that psychotherapy is more in-depth and longer term and that psychotherapists receive more extensive training than a counsellor.