The client as expert: Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

Counselling adults who were abused as children: Clients' perceptions of efficacy, client-counsellor communication, and dissatisfaction

Despite the amount of clinical material relating to adults who were abused as children, there is a dearth of research which has examined the effectiveness of counselling such clients. In order to examine the perceived efficacy of counselling with this client group, a total of 53 in-depth interviews were undertaken with a sample that included adults abused as children who had received counselling, counsellors working with this client group, and counselors-who-were-abused-as-children. The findings indicate that there are many similarities in what abused clients and the general client population judged to be helpful and unhelpful factors in counselling. However, certain aspects of the counsellor-client relationship appear to have specific impacts and meaning for an abused client group, especially when they have little prior knowledge or experience of counselling. Data are presented relating to clients' evaluations of counselling. These illustrate clinically relevant issues in relation to communication and experiences of dissatisfaction. One conclusion from the study is that in terms of their responses to counselling, it is simplistic for adults who were abused as children to be categorisied as a unitary group. Nevertheless, there are certain aspects of counselling with such clients which do merit particular attention if practitioners are to minimise the possibility of counselling being ineffective, unhelpful or, at worst, re-traumarising.     

The relationship between integrative and Islamic counselling

Integrative counselling is a valuable tool. However, it only considers the client within a social and natural framework. Islamic counselling on the other hand, utilizes the major tenets of integrative counselling, but adds to them an added dimension. This is the relationship between the client and his/her creator. In this paper I aim to draw out areas of commonality between integrative and Islamic counselling and highlight the main difference between these two therapeutic approaches.     

The context of counselling: A neglected dimension of trainings research and practice

The context of counselling includes such factors as the physical environment of the counselling room, the emotional climate of the counselling agency, the relationship between the agency and the community it serves, and the cultural beliefs and values which inform both counsellor and client. It is argued that these factors can make a difference to the relationship between counsellor and client, and the process and outcome of counselling. It is suggested that contextual issues have been largely ignored in counselling theory, research and practice, and that increased attention to context has the potential to contribute to the creation of more responsive and effective counselling services.     

A qualitative study of client experiences of working with novice counsellors

Aims: This paper reports on a qualitative analysis of written accounts by clients who participated in a counselling relationship with beginning-level trainees. The purpose of the study was to explore how clients experience the process of counselling with novice practitioners. Method: Consensual qualitative research was used for data analysis. Findings: Three general thematic categories were identified – client perceptions of self in counselling; client perceptions of the counsellor; and client perception of the counselling process. Conclusions: Overall, the findings suggest that these clients saw the interpersonal qualities and skills of the counsellor as major contributors to their experience. Implications: Clinical training of novices should start by developing the interpersonal and collaborative skills of trainees.     

Empathic interactional sequences and counsellor trainee effectiveness

Consecutive counsellor trainee and client statements from 12 audiotaped assessment interviews were coded to operationalize empathy as a sequential variable. For each two statement sequence the speaking order (counsellor to client, client to counsellor) was also coded, and the resultant matrix analyzed via loglinear statistical procedures for categorical data. For the speaking order client to counsellor, three empathy sequences (empathy enhancing, empathy diverging, empathy commencing) were found to be significantly related to counselling effectiveness. For the speaking order counsellor to client, only one sequence(empathy diverging) was found to be significantly related to counselling effectiveness. Implications for counsellor training and future research are discussed.     

Counselling with a profoundly deaf client and the impact of a therapist's dream: A case study

This case study explores the experience of one client participating in a project evaluating the use of dreams in short‐term counselling within the National Health Service. The client received 24 sessions of counselling and completed a post‐counselling semi‐structured questionnaire. This was followed by a semi‐structured interview, which confirmed the internal coherence within the participant's narrative and allowed a more detailed exploration of her experiences, supported by process notes. Supervision challenged the therapist's preconceptions and held her in her uncertainty until the work was aided by a dream that the therapist had of the client.     

Help-seeking behaviour and attitudes towards counselling: a qualitative study among Hong Kong Chinese university students

This study examined Hong Kong university students’ perception of general help-seeking and seeking of professional help. Thirty-two students, aged from 25 to 46 years were interviewed. A grounded theory approach was adopted. The results indicated four domains to categorise culture-influenced factors: attitudes towards speaking, relational concern, nature of the problem and assumptions about counselling. Hong Kong students are not reluctant to receive help but are reluctant to seek help from outsiders. Help is expected to be received from those within their social network. Passive coping strategies are normally adopted for finding relief and solving problems. These issues may greatly hinder people from consulting professional counsellors, or may limit the counselling process to something superficial and short term. The implications for counsellors are discussed.     

Supervision: A tale of the missing client

The profession of counselling is praised for its emphasis on the 'developmental' rather than 'policing' role of supervision. However, the profession is challenged on its presumption that supervision tells us anything about the client. For this to happen, the client must be admitted to the counselling room. Various means by which this can be achieved are explored and the resistance of the profession highlighted.     

A qualitative content analysis of ChatGPT's client simulation role-play for practising counselling skills

Role-play is often used as a pedagogical technique by counsellor educators to help counsellors-in-training (CITs) learn and practise counselling skills. This study used qualitative content analysis to assess the effectiveness of Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI) chatbot, in simulating client role-play to facilitate practising counselling skills. The author used 10 case vignettes to conduct a simulated role-play where ChatGPT was asked to simulate the client and author as counsellor. The results indicated that ChatGPT demonstrated authenticity, consistency, appropriate emotional expression, cultural sensitivity, empathy and self-awareness while portraying the client. However, at times, ChatGPT's responses to the counsellor's questions appeared overly idealised, lacking the authenticity typically observed in real clients. Furthermore, ChatGPT, as a simulated client, lacked non-verbal cues, limiting the overall experience of counselling skill practice. Recommendations for CITs and future research are discussed.     

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.     

Replacing client-centred counselling with culture-centred counselling

Models of psychotherapies and counselling do not develop in a social vacuum. They arise out of and rest on several fundamental assumptions-social, linguistic and cultural-most which are understood and shared by the client group and the therapists andor counsellors. The extent to which there is a congruence of shared assumptions facilitates the process of counselling and/or therapy. It does not, however, guarantee its successful outcome. This paper examines the fundamental assumptions underlying client-centred counselling and argues that there is at present a lack of correspondence between the assumptions of the counsellors and those of their client groups-even within their own culture. But among the client groups comprising the ethnic minorities originating from the Indian subcontinent, there is a wide chasm. The clients do not understand or share the fundamental assumptions of their counsellors. As a result, client-centred counselling is irrelevant and does not serve the needs of the clients groups comprising the ethnic minorities. It is in urgent need of a paradigm shaft. It is argued that client-centred therapy needs to be replaced by culture-centred counselling, in which counsellors can be trained. The paper presents the main features of a model of counselling that is applicable not only to the white indigenous population in Britain but to the above ethnic minorities living in Britain.     

Positive living with anxiety: A morita perspective of human agency

Morita therapy, a Japanese cognitive behavioural approach, is applied to a Western context. This paper intends to focus on one of the Morita key concepts, namely the positive acceptance of social anxiety, and its underlying meaning of human agency that can be interpreted in daily life and counselling situations. Some similarities and differences between Morita philosophy of human anxiety and Western therapeutic conceptions of anxiety feelings are highlighted in order to clarify Morita principles as they are incorporated into counselling process in Western society. Suggestions for counselling, with special focus on counsellor attitude, client cognitive behavioural transformation, and client existential meaning making, are provided.     

Exploring counsellor perceptions of the impact of counselling supervision on clients

This qualitative study explores counsellors’ experiences and perceptions of how counselling supervision impacts upon their clients. Data collection combined open‐ended questionnaires (n = 13) and semi‐structured interviews (n = 6). The findings indicate that supervision impacts client work both helpfully and unhelpfully. Areas that emerged as having the most direct impact on client work were the counselling relationship dynamics and self‐awareness, professional development, emotional support, clients not discussed in supervision and the quality of the supervisory relationship. Congruence and confidence were the most direct link between supervision and client work.     

The Use of Modelling in Career Counselling: A Case-Study

Through the presentation of a case-study, two issues are addressed: the application of modelling to career counselling and the generalisation of counselling effects. The case-history is presented of a client who was failing in nursing. Modelling was used to reduce the fear and to enable the client to implement her career plan. Particular attention is focused on the initiation of modelling, the use of a modelling hierarchy, the self-efficacy mechanism, the use of mental rehearsal, and the implications of reciprocal determinism for counselling. It is concluded that modelling may be an effective technique for career-development problems. Further, modelling may enable the effective transfer and generalisation of coping strategies.     

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.     

The Evaluation of Student Counselling: A Review of the Literature 1962-86

A critical review of studies examining the efficacy of student counselling is presented, together with suggestions for how the design of such research might be improved. Complementary investigations of client and employer attitudes towards and expectations of student counselling services are also described. The need to evaluate student counselling in the face of economic cutbacks is discussed.     

Action: a bridge between vocational and mental health counselling*

A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.     

The experiences of counselling for persons with ME

A number of studies have evaluated counselling interventions for people with myalgic encephalitis, but few report client perceptions in any detail. This study seeks to explore client perceptions using a qualitative methodology. A sample of 25 individuals with myalgic encephalitis were interviewed about their experiences in counselling. The interviews were transcribed and subjected to thematic analysis using grounded theory principles. The analysis showed that people with myalgic encephalitis endure significant changes to their lives, often involving great loss and trauma. After seeking help through counselling, participants had experienced a wide variety of approaches and there were positive and negative perceptions of each. Other perceptions related to therapist characteristics and the way in which interventions were carried out. Recommendations for practitioners are given.