Counselling in general practice: Clients' perceptions of significant events and outcome

An investigation of clients' perceptions of the change process and outcome of counselling in primary care is presented. Significant events were identified by 51 clients post-session for a mean of 4.7 counselling sessions. Outcome was assessed by clients, through their perceptions of goal attainment and change in quality of life from pre-to post-counselling. Four-hundred-and-nine events were categorized by use of the Therapeutic Impact Content Analysis System (TICAS) and a content analysis system was created to categorize clients' goals. Results showed that ‘reassurance’, ‘problem solution ’, ‘insight’ and ‘involvement’ impacts were reported most frequently by clients. No category of significant events was related to change in quality of life. For 11 clients who set goals in the ‘expression’ category, more ‘reassurance’ and fewer ‘problem solution’ impacts were related to attainment of ‘expression’. Some suggestions are made for the lack of significant relationships with overall measures of outcome and it was suggested that more qualitative analysis of the process of outcome is needed.     

The Relevance of Systemic Thinking to Student Counselling

After outlining the predominant approaches which currently inform student counselling a case is made for adopting a developmental systemic paradigm, locating individual difficulties within the context of a family dilemma. The view is taken that family systems thinking and individual approaches can be complementary and that systemic work need not be restricted to formal family therapy and the technology this implies.     

Profiling a Profession: A Victorian Survey Assessing Lay Attitudes Toward and Knowledge of Counselling Psychologists

The current study employed a mixed‐methods approach to examine perceptions towards and knowledge of counselling psychologists, including perceived differences between counselling and clinical psychologists. One hundred and fourteen adult members of the Victorian general public participated in the study and completed a 65‐item questionnaire, the Counselling Psychology Status Survey. As predicted, results from quantitative analysis showed that counselling psychologists were reported to be highly needed, valued, and respected by the current sample of Victorian residents. Respondents also reported a high level of confidence in counselling psychologists to treat various mental illnesses. Thematic analysis of qualitative textual data derived from written responses to an open‐ended question revealed that compared with clinical psychologists, counselling psychologists were understood to be less qualified, less skilled, and to work with less severe or complex client presentations. Taken together, results from this study suggest that although counselling psychology appears to occupy a positive public image, the importance of public promotion and awareness‐raising of the specialist profession of counselling psychology, and the continuing need for public education into the nature of psychological services and the qualifications, skills, and competencies of practitioners of psychological service provision, particularly compared with clinical psychology, cannot be underestimated.     

Counselling and the schizophrenias

Schizophrenia is the collective name given to allied psychiatric disorders each of which has received a number of different professional interpretations. A primary counselling task is to help staff resolve conflicts over treatment, and give them support during their care of patients. Counselling patients and families, particularly through opportunities provided by self-help groups, is also discussed. The specialised work of genetic, psychoanalytical and behavioural counselling is considered, and stress is laid on the importance of counselling the adolescent schizophrenic for whom early help is vital to prevent deterioration. The article focuses on those areas where marriage guidance counsellors, social workers and probation officers are most likely to be consulted.     

Buddhism and Counselling

The relevance of the principles and practices of Buddhism to the field of counselling is discussed. Buddhist techniques have already been used by the helping professions in many settings (e.g. Japan, Sri Lanka). The extension of their use to a wider range of settings, and to a wider group of clients, is both feasible and desirable. In addition to the obvious relevance of Buddhist techniques to clients who have a Buddhist background, it is argued that they have a wider applicability. As Buddhism espouses the notion of a productive and healthy lay life, it offers ways not only of dealing with problems and difficulties, but also of improving psychological well-being in general. Examples are cited of relevant Buddhist techniques and their application. It is argued that, once systematically evaluated, many of these could profitably be incorporated into the repertoire of techniques used in present-day counselling and therapy.     

Understanding Clients' Perceptions of Stress

The association of individual behavioral and personality characteristics with the stress response provides a natural role for stress management and the development of coping responses within the counseling process. The incorporation of stress management within the counseling process requires a theoretical framework for examining clients' perceptions of their coping capabilities as they experience difficulty with stressful life events. In this article the author presents a framework based on learned helplessness, called systematic rationalization. Empirical support and applications of the framework for working with clients experiencing difficulties coping with stressful life events are discussed.     

Clients' response modes and session outcome

This study examined clients' response modes in one-session counseling interviews with two counselors and 32 volunteer college students as clients. Sessions which yielded clients' higher ratings of helpfulness and satisfaction were associated with low proportions of clients' recounting, which involves clients providing statements on factual information in a storytelling style and high proportions of clients' response modes, which indicate an exploration of feelings, thoughts, and behaviors, insight into problems, and a problem-solving attitude. Thereafter, clients' response modes were examined in conjunction with counselors' interventions in the previous speaking turn using a sequential analysis. This analysis indicated that the occurrences of clients' response modes were not random but rather seemed to be associated with antecedent interventions by a counselor.     

Clients' experience of bodywork psychotherapy

One-hundred and fifty ex-clients of 17 Energy Stream Psychotherapists were sent a questionnaire about their experience of their therapy. Sixty-eight clients completed the questionnaire. Of these 77% were highly satisfied or satisfied with their therapy. The frequency of use of some key Reichian psychotherapy techniques was explored. They were found to be used relatively frequently with at least 75% of the clients and rated as helpful by most clients. Also investigated were Rogers' core conditions, which were found not to be present as often as expected. The possible impact of transference on this is discussed. Some non-specific factors such as feeling listened to, or being given feedback, were generally found to be present and valued. Respondents also answered various qualitative questions about their experience of the therapy, including being asked to provide a metaphor for it. What emerges is a picture of an articulate, informed group of therapy consumers often with previous and subsequent experience of therapy. The questionnaire, which combines a mixture of quantitative and qualitative items, can be used with suitable modification to explore other clients' experience of bodywork psychotherapy.     

Counselling the dead!

The paper discusses the author's meeting and a counselling encounter in Varanasi (formerly known as Banaras) with a former High Court Judge, who has renounced the material world, excised all his attachments, abandoned his wife, his children, his grandchildren and a luxurious and prestigious life-style, and taken on the mantle of a sanyasi in search of enlightenment and nirvana. He has left his hometown and for the past two to three years has been living on the banks of the river Ganges in Varanasi, the holiest of holy cities in India, leading the life of a mendicant, living off the charity of the hordes of pilgrims who come to Varanasi all around the year.     

Counselling and the social construction of self

The specific and Comparatively narrow nature of selfhood which counselling suggests is examined. It is argued that the discourse of counselling is directly and powerfully related to the social construction of self. The social consequences of two central notions of this constructed self—authenticity and autonomy—are debated. It is proposed that, far from being necessarily socially desirable, the propagation of these notions within selfhood may have some derogative consequences to social relations, within communities and within society. It is suggested that counsellors need to develop much more awareness of the sociological perspective of their profession before enthusiastically propagating the authentic, autonomous self.     

Counselling and Sex Therapy

Qualified counsellors do not necessarily feel competent to work with their clients' sexual issues. It is argued that the principles underlying good sex are the same as those which underlie good counselling practice. It is also suggested that sex therapy in the form of a behavioural exercise programme - whilst valuable in many cases - is not necessarily the only way of working with sexual issues, and that other therapeutic approaches merit attention.     

Counselling and primary prevention

Counsellors/therapists have much to contribute to preventionists concerning the social causes of individual distress. Such insights will lead to efforts to change society to reduce the environmental stresses, including racism, sexism, ageism and homophobia that lead to emotional problems in members of groups at risk. Political efforts by conservatives stress the medical model argument that all mental disorders are diseases or dejects of the brain and/or genes, thereby making social changes unnecessary. An alliance between counsellors and preventionists is necessary to oppose this personal defect position. The struggle for a more just and equalitarian society goes on. We must work together in this struggle.     

Counselling and Pain Relief

Health-care staff (e.g. doctors, nurses, physiotherapists, occupational therapists) frequently have to care for patients who suffer from conditions which cause crippling pain. Pain relief is part of such treatment. This article suggests how counselling, as a skill which every health care worker could acquire and use, may reduce the level of pain by helping the sufferer cope more effectively with it. Four principles of pain relief are considered: the therapeutic relationship; other sensory input; rest and relaxation; and the use of imagery. The discussion on pain relief centres on rest and relaxation and the use of imagery, based mainly on the work of Jung and Assagioli's model of psychosynthesis. Patients are encouraged to continue practising these pain-relieving techniques when counselling has ended. By so doing, they will acquire positive ways to escape from the world of nightmare in which sufferers from chronic pain are often held prisoners. An account is included of how a sufferer from trigeminal neuralgia benefited from one session in which imagery was used.     

Counselling and academic achievement

The possible relationship between emotional difficulty and under-achievement and wastage is examined. Psychometric data is presented from a recent longitudinal study on university students which suggests that psychological and academic difficulty may be different presentations of similar core problems. Particular attention is paid to the interaction between the individual and the institution, and clinical illustrations are provided. It is concluded that psychotherapy and counselling may be the appropriate response to a proportion of students in academic difficulty.     

Counselling and primary prevention

Counsellors and counselling services are frequently involved in primary prevention work. Increasingly these services are required to help immediately after major disasters, an implicit assumption being made that normal social support networks will be unable to cope. A review of the literature suggests extensive participation of counsellors in primary prevention activities despite difficulties in definition, training and funding, and evidence that some interventions may be ineffective or harmful. It is suggested that counsellors providing primary prevention services should be aware of the complex practice and philosophy issues surrounding such efforts, and should be rigorous in assessing the real effects of primary prevention activity.     

Family Relationships and Counselling

During the last ten years, family therapy has developed a number of distinctive schools of work. Four such schools—structural, strategic, the Milan school, and psychoanalysis - are described, and their importance to British workers is examined. Comments are offered on a variety of issues likely to face those engaged in family therapy in the coming decade.     

Therapist Judgments of Clients' Sex-role Problems

Thirty therapists belonging to the Michigan Society of Consulting Psychologists rated the bipolar adjectives of the Sex-Role Stereotypes Questionnaire as to which pole was a problem for their average male and female clients. Female clients were viewed as too feminine on both socially desirable and socially undesirable adjectives. The problems of male clients were not viewed in sex stereotypic ways on the specific stereotypes. Asked directly, therapists reported that sex-role expectations create problems for both male and female clients. The findings contradict the hypothesis that therapists see the problems of women in therapy as nonconformity to the feminine stereotype.     

Clients' ratings of counselor multicultural competency

Differences in perceptions between Euro American and ethnic minority respondents were examined to compare the role of counselor multicultural competency in multicultural versus traditional counseling. Results showed a strong positive correlation between clients' ratings of counselors' multicultural competencies and clients' ratings of counselors' general competency and empathy. However, when comparisons were made between Euro American and ethnic minority clients' on satisfaction, counselor multicultural competency explained a large and significant amount of variance for the ethnic minority sample only, above and beyond counselor general competency and empathy. Results are discussed in the context of relevant literature and suggestions for future research.