Career development of counsellors

Unlike nursing or social work, counselling is not yet a statutory profession and there is no obvious career progression route. To explore the ways in which graduates of a counselling programme use their training a questionnaire was sent to 143 counselling students who had completed a minimum of Diploma level training. The questionnaires were analysed using both quantitative and qualitative methods. The key findings are that students embark on counselling training for both professional and personal development. The majority find some paid work. Many are engaged in unpaid counselling work, either solely or as well as paid work. Counsellor training is seen as providing good preparation for work but inadequate preparation for the job market. Some recommendations are made for training courses.     

Spiritual emergency and counselling: An exploratory study

Growing up in a multicultural community in England brought me into close personal contact with the beliefs and perceptions about healing held by people of many different cultures. In many cases, no strong boundary was seen between physical, psychological and spiritual aspects of an illness, and experiences of hearing voices or seeing visions were accepted as normal everyday occurrences. During my training as a counsellor, I came into contact with the work of Stanislav Grof on the concept of spiritual emergency, which, together with the work of African and European authors who were exploring transpersonal aspects of psychology, provided a theoretical framework for researching how counsellors respond to clients wishing to explore experiences of spiritual crisis. This paper describes an exploratory study into the phenomenon of spiritual emergency within counselling. Questionnaires were distributed by post to people known to have been in counselling relationships, and interviews were conducted with three informants reporting different types of spiritual experience. All respondents who completed questionnaires reported having at least one of the ‘non‐ordinary’ experiences classified by Stanislav Grof as characteristics of a ‘spiritual emergency’. Several participants felt unable to explore this experience with their counsellors, some for fear of being labelled as mentally ill, while others found their counsellors helpful and sympathetic. Differences in dealing with spiritual phenomena were apparent between European and non‐European participants. These findings are discussed in relation to theory and practice.     

A follow‐up study of the long‐term effects of counselling in a primary care counselling psychology service

Despite much recent work examining the short‐term effect of counselling in primary healthcare settings, to date relatively little research has examined the effectiveness of such treatment programmes over the longer term. In this study, 58 participants underwent brief, time‐limited integrative counselling sessions, with symptoms being measured using the CORE‐OM immediately before, immediately after, and 30 months after counselling. It was found that in addition to participants reporting significantly lower levels of psychological distress immediately post‐counselling, a further significant improvement at 30‐month follow‐up was also apparent, indicating that the benefit from counselling was maintained. In addition to this reduction in symptoms post‐counselling, a significant reduction in GP visits was also detected in the 12 months following counselling when compared with the 12 months prior to counselling, indicating a lower reliance on the primary healthcare team after counselling.     

Internationalizing counselling: A Southeast Asian perspective

To learn about our Southeast Asian colleagues’ views on internationalizing counselling psychology to Asian cultures, we interviewed eight counselling psychologists who had received their doctoral training in the United States. Four of the participants were currently practicing and teaching in their native countries and four in the United States. Using the basic principles of Grounded Theory [Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. Chicago, IL: Aldine.], we derived two themes from the data: (1) major assumptions in US counselling psychology that may limit its transferability to Southeast Asian cultures and (2) practices in learning, training, and cultural adjusting for future development and internationalization of counselling psychology. The participants emphasized the need for indigenization and knowledge sharing in the efforts to internationalize counselling psychology.     

Problem-solving training to help workers increase positive affect,job satisfaction,and life satisfaction

The purpose of this study was to determine the effectiveness of brief problem-solving training for improving adjustment in individuals who have low control over their work environment. The 118 participants were flight attendants who were randomly assigned to an intervention or control group. The results indicated that when compared to the control group, those who received the problem-solving skills training reported at postintervention more problem-solving skills, more problem-solving self-efficacy, greater positive affect, higher job satisfaction, and higher life satisfaction. To assess whether improvements were due to experimenter demand, participants completed a measure of openness, which the intervention was not expected to affect. No difference in groups occurred for openness. The results provide evidence that problem-solving training can help improve adjustment in individuals working in low-control environments.     

Generalised anxiety: A controlled treatment study

The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition, non-directive counselling, or a combination of relaxation and brief cognitive therapy. Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment, but there were relatively few differencs between anxiety management and non-directive counselling, either at post-treatment or at 6 months follow-up. Those differences which were found could plausibly be explained in terms of the demand characteristics of training in relaxation or cognitive therapy. It was concluded that anxiety management is clearly better than a non-treatment control condition, but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated.     

Counselling implications of anxiety and depression in AIDS and HIV infection: A pilot study

Anxiety and depression are two major psychological reactions to HIV infection. The recognition and treatment of these are of fundamental importance as they may alleviate the suffering for those with a potentially terminal illness, may increase coping and may improve the quality of their life. Furthermore, many of the physical symptoms associated with anxiety mirror AIDS symptoms. For prompt care it is important that those with HIV/AIDS, and those caring for them, recognize the role of anxiety to minimize unnecessary symptoms and recognize those which could respond to medical intervention. In this study a group of front line AIDS/HIV workers were given an in-depth training course on anxiety and depression. Evaluation of the course revealed a high number of patients suffering from anxiety (80.1%) and depression (31%). The evaluation revealed gains in counselling proficiency, knowledge and symptom recognition. Some of the entrenched myths, particularly surrounding suicide, were not resolved. These findings are discussed in the light of the difficulties of training non-mental health workers in the use of counselling skills.     

The Role of the Black Church in HIV Prevention: Exploring Barriers and Best Practices

Black people have the highest rate of HIV/AIDS infection in the USA, and they are less likely to access quality physical and mental healthcare. To address these disparities as outlined in the National HIV/AIDS Strategy, there is a need for culturally congruent, innovative approaches to HIV/AIDS prevention. The first multi‐denominational national study of Black faith leaders was conducted utilizing focus groups that were held in 11 US cities. The 265 participants were faith leaders who reported involvement in such prevention practices as sponsoring HIV/AIDS workshops, integrating HIV/AIDS messaging in the worship service, hosting HIV/AIDS screenings, distributing written materials about HIV/AIDS through the bulletin or flyers, pastoral counselling, advocating for policies that provide quality healthcare to the community and disseminating HIV/AIDS prevention messages through new media such as the Church website. These findings, including attention to barriers to engagement, provide insight into innovative practices that can be integrated into faith‐based HIV/AIDS prevention programming. Copyright © 2016 John Wiley & Sons, Ltd.     

Demand characteristics and self-report measures of imaginary audience sensitivity: implications for interpreting age differences in adolescent egocentrism.

Self-consciousness during early adolescence has been explained as an outcome of adolescent egocentrism, in which adolescents create an imaginary audience (IA) of attentive, critical peers. The possibility that such self-consciousness might result from contact with peers who are more attentive and critical than those encountered during childhood or adulthood has not been considered. Study 1 tested whether young adults, who are not theoretically susceptible to IA, could be made to receive high scores on IA and self-consciousness measures by having them complete a procedure in 1 of 3 laboratory conditions-a critical audience, a noncritical audience, or no audience. However, participants in the critical-audience condition received significantly lower IA and self-consciousness scores than participants in the no-audience condition did. Study 2 tested whether the directions given to Study 1 participants might have been responsible for the unexpected findings. Results indicated that participants instructed to give mature-sounding responses received lower IA/self-consciousness scores than did those asked to report their honest opinions. Together, the results of Studies 1 and 2 indicated that survey measures of IA are subject to demand characteristics and highlighted the need to interpret with caution age differences in IA as traditionally assessed.     

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups – frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months post-intervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.     

Ripples in the pond: A qualitative study of graduates' perceptions of the impact of counselling training upon their work within the core professions

A small-scale qualitative study was conducted in order to examine the value of counselling training when incorporated into a person's established professional role. Questionnaires were sent to graduates from an MA/diploma in counselling course in order to identify those who had continued working within their core profession. This was followed by in-depth exploration of the issues through a focus group and interviews. Twelve respondents, from a variety of work settings, took part in this second stage. Results indicated that counselling training had impacted on all aspects of their work role and that there can be a benefit of such training in the workplace. Participants developed a tripartite understanding with regard to the self, clients and the organization, and change was experienced in each of these three dimensions. A larger-scale study, among graduates from a number of courses and also among employers, is indicated.     

Organizational factors and mental health in community volunteers. The role of exposure,preparation, training,tasks assigned,and support

During disasters, aid organizations often respond using the resources of local volunteer members from the affected population who are not only inexperienced, but who additionally take on some of the more psychologically and physically difficult tasks in order to provide support for their community. Although not much empirical evidence exists to justify the claim, it is thought that preparation, training, and organizational support limit (or reduce) a volunteer's risk of developing later psychopathology. In this study, we examined the effects of preparation, training, and organizational support and assigned tasks on the mental health of 506 Indonesian Red Cross volunteers who participated in the response to a massive earthquake in Yogyakarta, Indonesia, in 2006. Controlling for exposure level, the volunteers were assessed for post-traumatic stress disorder (PTSD), anxiety, depression, and subjective health complaints (SHCs) 6, 12, and 18 months post-disaster. Results showed high levels of PTSD and SHCs up to 18 months post-disaster, while anxiety and depression levels remained in the normal range. Higher levels of exposure as well as certain tasks (e.g., provision of psychosocial support to beneficiaries, handling administration, or handing out food aid) made the volunteers more vulnerable. Sense of safety, expressed general need for support at 6 months, and a lack of perceived support from team leaders and the organization were also related to greater psychopathology at 18 months. The results highlight the importance of studying organizational factors. By incorporating these results into future volunteer management programs the negative effects of disaster work on volunteers can be ameliorated.     

Purchase task sensitivity to drug and nondrug reinforcers in opioid-agonist treatment patients

The behavioral economics of substance abuse has been increasingly recognized as a method of determining the value of abused substances for individuals who use those substances. It has been hypothesized that such analyses could serve as a clinical tool and that demand functions can be targeted predictors for the level of intervention necessary. This study evaluated the sensitivity of a demand task in 2 patient groups in a medication assisted treatment program (methadone maintenance), those who had used opioids in the last 2 months and those who had not used opioids in at least 18 months. Demand for 7 drugs and a control was assessed using hypothetical purchase tasks. Participants maintaining long-term abstinence had significantly higher α (sensitivity to price) and lower Q₀ (intensity of demand) for heroin than participants who had recently used opioids. Further research is necessary to illustrate if treatment is responsible for this reduction in demand. If so, demand analyses may provide clinical utility as an aid for treatment planning or as a target for treatment.     

Psychological trauma associated with AIDS and HIV infection in women

The growing numbers of women faced with HIV infection and AIDS has specific counselling implications. This paper analyses the psychological needs of all women patients seen by the psychology department (n = 33) over the past 12 months. The mean age was 32.3 years. Psychological crisis was high. Four women reported rapes (three accounting for their HIV infection). Two women had suicide attempts (one on two occasions), Death experiences were notable, including multiple bereavement. Conjidentiality was problematic for many of the women. Problems were reported around pre- and post-test counselling which was absent for three women, and often surrounded the diagnosis of a loved one (child, husband or partner). Most women were first seen as in-patients (when disease progression was extensive) or when their partners or children were in-patients. Despite offers of out-patients follow-up, only four HIV + ve women attended, three of which were irregular. A group of ten women were only seen indirectly when provision of care wasgiven to their children. A consistent group were seen with worries about HIV (either due to sexual contact with a known HZV+ ve or at risk individual) or to unfounded concerns often reflecting underlying psychological problems. This paper explores the counselling challenges of AIDS and HIV for women.     

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS‐related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over‐sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV‐related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.     

Psychological distress and quality of life of people living with HIV/AIDS in a Nigerian teaching hospital

Presence of psychological distress and poor quality of life (QoL) may affect the outcome of HIV/AIDS. One hundred and seventeen consecutive and consenting participants were interviewed using a Socio-demographic questionnaire, Kessler Psychological Distress Scale (K10) and World Health Organization Quality of Life-HIV Bref. Fifty-six (47.9%) participants scored 20 and above on K10 Scale. QoL was significantly higher in married participants, those who perceived their state of health as being good, asymptomatic participants and those who scored well–mild on K10. The older age group scored higher on QoL Scale than the younger age group in the physical health domain while the married participants scored higher in the domains of physical health, psychological health, environment and spiritual/religion. The participants who perceived their state of health as being good scored higher than those who perceived their health as poor in all domains. There is a high level of psychological distress and poor QoL in people living with HIV/AIDS.     

The role of risk perception and efficacy cognitions in the prediction of HIV-related preventive behavior and condom use

The salience of the Protection Motivation Theory to HIV preventive behavior was investigated in a sample of 468 heterosexual men 20-45 years of age recruited in Germany and at vacation spots in Spain. This theory conceptualizes self-protective behaviors as a function of the severity of the threat, perceived personal vulnerability to this threat, the availability of coping responses, and the effectiveness of these responses. Cognitive variables measured included perceived severity of the threat of AIDS, sexual self-efficacy expectancy, self-efficacy expectations in terms of sexual communication skills, response efficacy, and attitude toward condom use. On a scale of 1 (low) to 6 (high), perceived severity of the AIDS threat averaged 5.3, individual susceptibility ratings averaged 3.5, and susceptibility of peers had a mean of 4.9. Although 33% of respondents had made behavioral changes in response to the AIDS epidemic, only 15% always used condoms while 12% used them occasionally. Self-efficacy expectancy with regard to assertiveness and use of preventive measures emerged as the most significant predictor of HIV-related behaviors. The causal analyses indicated that high communicative self-efficacy expectancy is associated with high-risk sexual behaviors, while self-efficacy expectancy regarding assertiveness and the use of preventive measures promotes risk reduction. These associations were strongest in men over 26 years of age, singles, and tourists. These findings suggest a need for interventions for couples such as assertiveness training and guidance on communicating about sex and AIDS. Also demonstrated was the need for AIDS education programs to identify where participants are in terms of perceiving the threat of and coping with the AIDS epidemic and promote conditions that will help people advance to the next stage.     

A profile of counsellors working in non-statutory alcohol services

There are 39 voluntary sector alcohol agencies in the UK who meet minimum standards of counselling set out by the national organization Alcohol Concern through their Volunteer Alcohol Counsellors Training Scheme (VACTS). This paper reports on a study to create a profile of volunteer counsellors who work in VACTS-recognized agencies. Fifeen agencies agreed to take part in the study, and 141 counsellors completed and returned a mailed survey questionnaire, to elicit information about demographic characteristics, current and previous counselling training, reasons for undertaking the VACTS training and level of experience within agencies. The results suggest that this cohort of counsellors tend to conform to the volunteer stereotype of the middle-aged middle-class woman. Many counsellors utilize their experience within agencies to develop counselling skills, often in connection with further counselling courses, or to consider a change in career direction. Some counsellors wish to use personal experience of alcohol problems to help others undergoing similar difficulties. In contrast to those in the generic volunteer field, counsellors appear to retain long-term involvement with their agencies. The study concludes that alcohol services in the UK rely greatly upon a group of committed and competent volunteers to deliver individual counselling to problem users of alcohol.     

The advantages and disadvantages of a brief intervention strategy in a community counseling service

Abstract

The Isis Centre, a long-established NHS open-access counselling facility in Oxford, experienced excessive demand for service. This placed strain on the capacity to deliver, and an unacceptably long waiting list resulted. A brief intervention strategy limited to four counselling sessions was shown to reduce the waiting time. This outcome study tests the hypothesis that the strategy was sufficiently clinically effective to warrant its continuing availability to those who wished to be seen more quickly, rather than waiting for an open-ended contract. Counsellors assessed outcome on clinical parameters and clients were retrospectively asked their views on the acceptability of the method and its usefulness.

There was a high level of correlation between clients' and counsellors' assessment. One-quarter of the study group had an experience classified as ‘useful and sufficient’. However, half felt the experience ‘useful but insufficient’, although this group also thought the intervention provided more than temporary relief. For one quarter, the experience was not helpful, but for some of these it prevented a long, unnecessary time on the waiting list.

While a brief intervention appears to be an effective strategy in delivering a counselling service, further work is necessary to target those most likely to benefit and those for whom a longer-term option should be sought from the start.     

Assessment feedback counselling and individual differences: An exploratory study

The demand for assessment feedback counselling, and individual differences in feedback seeking, were investigated in a group of fifty managers who had been through a psychometric assessment procedure. Results suggest that there is a substantial demand for such feedback counselling and that those who seek it are, in some respects, more intellectually able and more interpersonally positive than those who do not. Some advice is offered on the handling of assessment feedback counselling sessions.