‘What’s so special about HIV and AIDS?5: Stresses and strains for clients and counsellors

The issues of supervision relating to counselling people who have been diagnosed as having HIV and AIDS are discussed. Against the background of the stigmatisation of this group of clients by society, the impact of these issues upon the client and the counsellor is addressed. Using a case-history as illustration, the conflicts and losses arising at different stages are explored. These have important implications for the need for supervision to facilitate the changes necessary in coping with clients' and counsellors' feelings regarding a terminal illness, death and dying, and the containment of anxiety. The process within supervision of enabling the counsellor to deal with their countertrans-ference, hopelessness and sense of loss is examined. Through this, the counsellor is enabled to allow a balanced view to be reached within the therapeutic relationship.     

Addressing ‘Dreaded issues’: A Description of a unique counselling intervention with patients with AIDS/HIV

The authors describe an approach to counselling patients with AIDS/HIV in which the patients main anxieties can be addressed. A definition of ‘AIDS Counselling’ and ‘Dreaded issues’ is offered. The choice of method is derived from experience with over 1,000 patients. A therapeutic strategy is used in which hypothetical and future-orientated questions asked by the counsellor can help to sidestep denial and resistance with patients. Clinical case examples are described in order to illustrate the approach. Some of the advantages as well as the limitations of the approach, for patients and staff, are considered.     

AIDS Counselling: Clinical Application and Development of Services

The reasons for the provision of AIDS counselling services, and the ways in which they have developed, are described. The role of the counsellor both in medicine, and in the field of AIDS/HIV infection, is outlined. The psychosocial difficulties accompanying this illness are reviewed. Stress is placed on the need to consider not only the client, but also their sexual partners, family, friends, colleagues and even other members of the health-care team. Further investigations need to be carried out to clarify where AIDS counselling services fit with other medical and paramedical services.     

Addressing disparities: The impact of a lesbian,gay, bisexual,and transgender graduate counselling course

Background: Lesbian, gay, bisexual and transgender (LGBT) individuals experience serious mental health disparities and treatment inequities. Counsellor education has been identified as both a contributing factor to these problems as well as an ameliorating mechanism to address these inequalities. Aim: The purpose of the current study was to evaluate the impact of an LGBT‐affirmative counselling course. Method: A total of 23 students enrolled in a graduate LGBT counselling course were administered the Sexual Orientation Counselor Competency Scale (SOCCS, Bidell, 2005) and the Lesbian, Gay, and Bisexual Affirmative Counseling Self‐Efficacy Inventory (LGB‐CSI, Dillon & Worthington, 2003) pre‐ and post‐course. In addition, a comparison group of 23 matched counselling students was obtained from an existing data source in order to make further assessments of the course's effectiveness. Those in the comparison group were not enrolled in the LGBT course, but were administered the SOCCS at analogous time intervals. Results: After completing the LGBT course, enrolled students demonstrated significant improvements regarding their sexual orientation counsellor competency and self‐efficacy. In addition, these students showed significant gains in SOCCS scores versus those in the comparison group. Implications: Results from this study show the positive effect a full‐credit LGBT psychotherapy course can have on graduate counselling students' sexual orientation counsellor competency and self‐efficacy. The findings also indicate that such a course can significantly impact counselling skills, a facet of LGBT cultural competency found to be the most attenuated. Findings are discussed in conjunction with LGBT‐affirmative counsellor training and clinical practice.     

The evolution of counselling

The history of counselling in the USA is presented in terms of four developmental stages: infancy, early childhood, late childhood, and adolescence. It is suggested that client-centred counselling may be an inadequate model as counselling moves into adulthood. The emphasis on relationship is necessary but not sufficient. A more active approach is needed in which the counsellor is prepared to use a wider variety of techniques, to take actions about clients' problems rather than just talk about them, and to devote more attention to a training and support role in relation to a wide variety of community agencies.     

A study of Muslim Asian women's experiences of counselling and the necessity for a racially similar counsellor

A survey of four Muslim Asian women of varying ages was carried out, for whom the author had previously acted as a counsellor. The survey was designed to explore the extent to which client and counsellor racial similarity affected the therapeutic alliance, as the counsellor/author was of a similar race to all four clients. It was the author's belief that racial similarity in itself would not procure positive counselling outcomes, and hence this study attempted to explore the clients' perceptions of qualities extrinsic to race, including interpersonal skills, styles and approach to counselling of the counsellor, in order to duduce whether in fact these factors were more singnificant to the outcomes than race. The majority of clients did not feel racial similarity was an essential quality, although one client expressed cultural awareness as being a preferable quality. This has suggested that it is not essential for client and counsellor to be racially similar in order to achieve successul counselling outcomes.     

Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

Experiencing gay affirmative therapy: An exploration of clients' views of what is helpful

Gay affirmative therapy is a counselling approach that emphasises an affirming, non‐pathologising approach to therapeutic work with lesbian, gay and bisexual clients. In this study, lesbian and gay clients who had experienced counselling that they defined as affirming identified what they perceived to have been helpful. Questionnaires and interviews were used to collect the views of a sample of lesbian, gay and bisexual informants. The material gathered was analysed using a grounded theory approach, which generated six main categories: communicating a non‐pathologising perspective on homosexuality; the counselling relationship; the counselling space; what the counsellor brought to the relationship; humanity; and the counsellor adopting a holistic approach. Some of these identified affirming elements are unique to gay affirmative therapy and cannot be attributed to other factors. The possible significance of the findings for practitioners is discussed.     

Boot night shelter

This article is an outline of the author's work as a volunteer counsellor, and describes some of the methods used and insights obtained in dealing with the special problems of counselling in non-institutionalised and unstructured settings. The general background of this type of counselling and the counselling methods used are illustrated with reference to a case study; there is also an overall evaluation of the contribution that this kind of counselling offers in contrast to more formal and institutionalised counselling methods.     

Individual-Centred Cognitive Counselling for Study Problems

An argument is developed for basing study counselling more closely on relevant principles of the cognitive psychology of studying. This can and should take into account the inter-relationships between study processes and the student's emotional state, and offer help with both in an integrated way. Finally, the advantages of an individual-centred approach are emphasised. A good grounding in relevant cognitive principles enables the counsellor to apply these to the problems of the individual student, rather than merely to offer standard advice on studying.     

Executive Career Counselling

Executive career counselling is relatively new. Some of its implications are examined and a three-tiered approach by organisations is advocated. Executives are verbally fluent, and this highlights the importance of the 'opening paragraph' of words they use in counselling. Neuro-linguistic programming offers a useful set of tools to the executive career counsellor. Left-handedness, probably overlooked in most types of counselling, is briefly considered. However, counselling is not only about problems, but also offers executives a welcome chance to review their lives and careers.     

Marriage guidance counselling: I. What clients think will help

Thirty-one first-time attenders for marriage guidance counselling were given a non-schedule standardised interview and a client questionnaire. The main aim was to identify the counselling and counsellor characteristics which clients considered would be most helpful in dealing with their problems. Traditional counselling skills such as the ability to be warm, supportive, understanding and a good listener were seen to be important by most clients. However, the vast majority of clients indicated that it would be helpful to receive the counsellor's opinion about their marriage, their personal problems and marriage in general: this is incompatible with a non-directive approach to counselling. Whilst clients may not know best how they should be helped, counsellors who fail to address their preconceptions risk mutual disappointment and premature termination of counselling.     

Client perspectives on counselling: Before,during and after

This four‐year study investigated the under‐researched area of first‐time users’ perceptions of counselling and how these evolved over time. Research participants were drawn from six settings within university counselling services, the voluntary sector and primary care. Using an interpretive hermeneutic framework based on thematic analysis, 30 interviews were carried out. Results revealed that before counselling, participants were uncertain about the nature of counselling and what to expect, described stigma associated with peer influence and varying levels of confusion about specialist language. During counselling, participants experienced some level of positive change. At the same time, divergences of counsellor and client perception highlighted theoretical issues concerning counsellor approach and the exploration of emotions. Post‐counselling interviews revealed further positive change, and practical issues with implications for counsellor training and practice in terms of client assessment, preparation for counselling and the influence of cultural assumptions on theory and practice.     

The concept of culture in the contexts and practices of professional counselling: A constructivist perspective

In this paper we first describe two approaches to the concept of culture as they relate to counselling: the first approach emphasizes the organizational culture of the institution where the counsellor works; the second - the multicultural approach - calls for the recognition of the variety of ethnic cultural backgrounds of those involved in the counselling situation. Then, we present recent developments in the understanding of culture within constructivist perspectives. Last, we suggest a new orientation for counselling training, that of the professional counsellor as a cultural agent, one attentive to context and practices in all their complexities.     

Psychological Test Interpretation: Integrative or Disintegrate?

The need for constructive debate by psychologists about the interpretation of psychological tests is noted. This paper is a critique of Crites' integrative test interpretation approach which eschews a specific test-interpretation session in favour of feeding in such data as are perceived appropriate by the counsellor during subsequent counselling. Five problem areas are noted: hidden knowledge; counsellor as guru; clients' rights and responsibilities; using any information in counselling; and little supportive evidence. It is concluded that the 'integrative' approach fails to live up to its laudable intentions. To promote the debate about psychological test interpretation, seven general principles are outlined to further the development of more useful approaches to the use of tests in counselling.     

Psychological distance,stated values and values in use: An approach to considering interactions for counselling within organizations

The work of Argyris (Reasoning, Learning and Action: Individual and Organisational: San Francisco Jossey-Bass, 1982) demonstrated the gaps that we tend tio have between our stated values and those that we actually use in practice. That of Micholt (Transactional Analysis Journal, 22, 228–233, 1992) illustrated the concept of psychological distance as applied tio facilitating groups in an organizational setting. These are both important works which can be very useful in conceptualizing the organizational context of counselling and also the client's problem situation. By combining these two approaches, it is possible to demonstrate a more detailed picture of the psychological distance and some of the potential problems inherent in interactions among three (or more) parties. For counselling, the combined approach emphasizes the importance of the counsellor remaining aware that the client's story is likely to reveal their stated values and that only by gaining a values-in-action perspective (i. e. behaviour) about the client's life can the counsellor adequately assess the client's situation. The examples given in this paper relate to counselling in an organisational context, but the approach may be applied tio facilitation, geneal management or consltancy.     

The emerging narrative approach to counselling and psychotherapy

An important recent development within counselling and psychotherapy has been the emergence of narrative perspectives on theory and practice. The task of the counsellor is viewed as that of assisting the client to 're-author' parts of their life-story. The origins of this approach within psychology and social science are discussed, and the central elements of a narrative approach to counselling and psychotherapy are identified. A brief case-study illustrates some of these themes.     

Towards networking in counselling: a follow-up study of Finnish school counselling

A follow-up study (1990-1997) and in-depth interviews on school counselling practices and problems in Finland showed that in the last 10 years the work of the school counsellor has extended and become more diversified. This article analyses this change in school counselling in terms of the problems and core tasks of counselling and the new challenges faced by Finnish counsellors, such as dismantling the traditional gender divisions in working life and counselling for immigrants. In addition, the article examines how school counsellors have attempted to solve the problems related to their work, for example, by establishing counselling networks inside and outside the school.