Towards a social model approach to counselling disabled clients

The social model of disability has emerged over the past 30 years in Britain to challenge the dominant individual, particularly medical and tragedy, models. This social model is borne from the experiences of disabled people and essentially defines disability as the discrimination faced by people with impairments. This paper explores the possible conflicts between some counselling approaches that can individualise and personalise problems and disability as a political issue. Drawing on research with counsellors and disabled clients, we illustrate the social construction of disability as an individualised problem within the counselling process. Considering the implications for counselling practice, we argue for an approach to counselling which recognises the social model of disability as the basis for social change.     

Explorations of the effectiveness of a voluntary sector psychodynamic counselling service

This paper reports two studies of individual psychodynamic counselling provided by a voluntary sector service. The first study examines evidence of the effectiveness of counselling, as evaluated by the General Health Questionnaire and Personal Opinion Survey. Measures of the process of counselling indicated the improvements that clients attributed to counselling, the changes that occurred during it, and the factors that were most beneficial, as well as the approaches used by counsellors. The second study, using the CORE Outcome Measure and ratings of problem severity, found counselling to be equally effective with disadvantaged and non‐disadvantaged clients, as defined by British Department of Health criteria, but these clients differed somewhat in their perceptions of helpful aspects of counselling. Both studies also indicated predictors of positive outcome of counselling. The studies are used to illustrate some of the methodological issues around research in this area.     

Attitudes of clinical psychologists towards clients with personality disorders

Previous studies have found that a variety of mental health professionals hold negative attitudes towards clients diagnosed with a personality disorder. These negative attitudes may lead to clients receiving a lower quality of service. Specialist training has been found to improve attitudes towards personality disorders but no empirical studies in Australia have examined this among clinical psychologists. In this study, the attitudes of 81 clinical psychologists towards clients with personality disorders were examined. We were specifically interested in investigating the relationship between recency of specialist training and clinician's attitudes as well as the influence of percentage of personality disorder clients on the clinician's caseload. Results demonstrated that both recency of specialist training and percentage of clients seen were associated with more positive attitudes; however, a higher caseload of clients with personality disorders was the most important predictor of positive attitudes. The implication is that recent participation in specialist training for personality disorders appears to be valuable in improving clinician's attitudes but that more positive attitudes are associated with seeing a greater number of individuals with personality disorders.     

The social utility of disability and rehabilitation

This article suggests that a disabled class is useful to society in maintaining certain social arrangements. Consequently, the rehabilitation counselor may unwittingly play unexpected roles that facilitate the social utility of the disabled. As totem, he wards off the evil associated with disability; as scapegoat, he assumes society's guilt unobtrusively; and as lightning rod, he draws off and grounds the anger of the disabled toward society. If the rehabilitation counselor persistently or willfully plays these roles, he risks being perceived as a “rat fink” who is unworthy of respect or rewards. The authors suggest possibilities for altering these roles.     

An initial study of transgender people's experiences of seeking and receiving counselling or psychotherapy in the UK

Background: There are no published empirical research studies exploring transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. As a result, counsellors know little about why transgender people seek counselling, who they seek counselling from, and what their experiences are of receiving counselling. Aim: To address this gap in the literature, this study investigated transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. Funding for this study was provided by a BACP Seedcorn grant. Method: A mixed method small‐scale qualitative research design was employed, comprising an online survey and five semi‐structured interviews. Findings: Participants tended to seek counselling on two or more occasions and received between 2 and 12 sessions. Participants sought counselling for common psychological concerns as well as gender identity and coming out issues. A fear of being discriminated against and exploring gender for the first time were significant barriers in seeking help. Participants reported mixed experiences of counselling but valued a therapeutic relationship in which they felt affirmed, listened to and understood. Discussion: The findings from this study mirror aspects of previous research conducted in the USA concerning transgender clients' experiences of counselling. However, these findings point to the importance of recognising the potential vulnerability transgender clients experience when seeking counselling and the need for therapists to develop greater awareness, knowledge and competence regarding working with transgender clients.     

Young clients' narratives of the purpose and outcome of counselling

This study explores how adolescent clients construct the purpose and outcome of counselling. A narrative analysis was performed on interviews with 22 clients (aged 16–18) who had used a school-based counselling service. The aim was to identify the purpose and outcomes that participants attributed to their counselling experience. The analysis identified four narrative forms that young clients used to describe counselling. These included ‘transformative’, ‘supportive’, ‘pragmatic’ and ‘disappointed’ narratives. Each narrative form constructed a different purpose and outcome for counselling. Engaging with clients' narratives about the purpose and intended outcome of counselling may allow counsellors to better match their expectations and approach to fit with their young client or to work with them to co-construct more flexible narratives that support helpful outcomes.     

Counseling Persons With Disabilities: Are the Feelings,Thoughts, and Behaviors of Helping Professionals Helpful?

Seven counseling “syndromes,” with illustrative vignettes, focus on some of the feelings, thoughts, and consequent verbal and nonverbal behaviors of counselors working with physically disabled clients. Nathanson urges counselors and other helping professionals to become aware of their feelings and thoughts, and to monitor their interactions with disabled clients so that existing beliefs and biases will not interfere with positive client growth.     

Transference with the borderline client

This paper addresses the question of what is involved in psychodynamic counselling with borderline clients. The concept of borderline functioning or structure is explained and the technical difficulties of working in this area noted, especially in the establishment of a working alliance. The types of transference manifestations with borderline clients are then described, looking in particular at the emergence of a psychotic transference. Two case examples are given of working with borderline clients, where the transference was dominated by primitive elements, provoking powerful countertransference reactions in the counsellor. How both the client and the counsellor can be contained in the therapeutic work is then addressed. Finally, some implications of this discussion are drawn out for the training of psychodynamic counsellors, in order to equip them best for working with borderline clients. Three features of what a training should offer are identified: it should provide students with the opportunity for the exploration of the psychotic parts of their own personality; it should allow for and encourage the internalization of psychoanalysis itself as a sustaining internal object; and it should provide students with the experience of working with clients over sufficient time and at sufficient depth so they can learn about the timing and effectiveness of interventions in work with borderline clients.     

Oppression within the counselling room

This paper suggests that the oppression experienced by disabled people in society is sometimes replayed in the counselling room by counsellors who are unaware of their own disablist attitudes and prejudices. Whilst the provision of Disability Equality Training (DET) within counselling courses would ameliorate the problem, I believe that disabled people would be most empowered by a counselling approach which recognises the potential for oppression within the counsellor‐client relationship. One solution may be the creation of a new counselling approach (disability counselling) which includes the social model of disability as one of the foundations. An alternative solution may be found within the emerging counselling approaches that treat counselling as a social and political process and place emphasis on developing comprehensive anti‐discriminatory practice.     

Book review

Voluntary or involuntary migration and international work patterns have made it necessary for many people to adopt a new country and with it, a new language. Some of these latter-acquisition proficient bilinguals may seek therapy in this country. A small scale qualitative study was conducted, informed by a constructionist epistemology, in order to explore the meanings that participants gave to their experience of working in English with a client or patient who used English, proficiently, as a second language. Interviews were conducted with 10 therapists who had been contacted through counselling and psychotherapy organizations, and professional networks. Results indicated that participants experienced varying degrees of separation and distance from their bilingual clients. They found it necessary to pay extra attention to their clients' communications on all levels in order to make a good connection. An awareness of the underlying psychodynamic implications of bilingualism is helpful for the assessment of bilingual clients, in supervision and training, and in the ongoing work.     

Psychodynamic counsellor training integrating difference

Abstract

Psychodynamic counselling has been criticized for being inflexible, authoritarian, antiquated and unresponsive to the issues of modern-day society. Psychodynamic counsellor training is sometimes seen as a poor relation of ‘proper’ psychotherapy therapy training. This article is written by two psychodynamic counselling course trainers who have wresded with the above criticisms and who have striven to deliver a training course that is coherent in its adherence to a psychodynamic counselling model but which embraces equal opportunities issues and takes account of a diverse society. The article focuses on ways in which sexual identity, race and culture are integrated into the course curriculum and indeed into the course philosophy and community. Traditional psychoanalytic interpretations of homosexuality are challenged and multicultural counselling ideas are merged with psychodynamic counselling theory and skills.     

Counsellors' attitudes towards Disability Equality Training (DET)

This paper explores the attitudes and conceptions held by trainee and practising counsellors towards people with disabilities. Awareness of counsellors' own views of disability and impairment can complicate the counsellor-client relationship when the latter is seen primarily from a deficiency model perspective or self-defined model of disability, rather than a person in their own right. DET was introduced to 25 counsellors on a postgraduate training programme. Participants indicated that coverage of disability awareness and equality issues was vital if they were to reflect the principles of open access to counselling services for all, as set out in the Disability Discrimination Act Part III (1996, 1999). Benefits and implications of inclusion of this subject area in counsellor training and suggestions for content are considered in the light of the author's own experience of counselling as a disabled person.     

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.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Men's experience of considering counselling: ‘Entering the unknown’

Agency statistics in the UK and North America reveal that fewer men than women attend counselling, at a ratio of about 1:2. This study investigated men's experience of considering counselling, with the aim of gaining further understanding of factors that might contribute to the existing gender discrepancy in utilisation of counselling. Following responses by 47 men to written questionnaires, 10 men who had considered and ultimately attended counselling were interviewed, and a grounded theory method of analysis was used to generate and analyse the participants' experiences. Three interconnected categories emerged: societal perceptions of counselling and gender roles; change of experience over time; and knowledge — ‘knowing’ and ‘not knowing’ the protocols of counselling. The implications of these findings are discussed. It is recommended that prospective male clients should be provided with information about the counselling process, and that there needs to be increased awareness by counsellors and referring agents of male gender issues.     

Counsellors' responses to clients' non-attendance at counselling sessions

Although there has been some study of clients who miss psychotherapy appointments, very little attention has been given to therapists' responses in such circumstances. A questionnaire survey of student counsellors working in British higher education institutions invited them to consider whether or not they would initiate any further contact with each of eight hypothetical non-attenders, described in case vignettes. It was predicted that responses would be influenced both by the subjects' theoretical approach to counselling and by their level of interpersonal dependency, as measured with the Interpersonal Dependency Inventory (Hirschfeld et al., 1977). It was found that the majority of counsellors were not subject to institutional guidelines about contacting non-attenders, and that responses ranged from contacting none to contacting all of the clients. Psychodynamic counsellors were found to be significantly more likely to initiate contact than were humanistic counsellors. There were no significant correlations between contact scores and intepersonal dependency scores but women were significantly more likely to initiate contact than were men. Many of the psychodynamic subjects had commented on their therapeutic use of written communications to interpret non-attendance to their clients.     

Predicting Psychologists' Intentions to Integrate Complementary and Alternative Therapies Into Their Practice

Drawing on an extended Theory of Planned Behaviour (TPB) framework, we employed a cross‐sectional design study to investigate psychologists' intentions to integrate complementary and alternative therapies (CAT) into their practice via recommending CAT to clients or referring clients to CAT practitioners. Participants were registered practicing psychologists from a range of therapeutic orientations (e.g., narrative, cognitive behavioural, psychodynamic). The psychologists were either recruited by phone, following a search of the Internet, or were contacted through their place of employment (hospitals, university counselling service). Those who agreed to participate (N = 122; n = 88 females, n = 34 males) completed a questionnaire that included standard TPB items of attitude, subjective norm, and perceived behavioural control, along with items measuring perceived risk, past behaviour, CAT knowledge, and gender. The outcome variables of interest were (a) intention to recommend CAT to clients and (b) intention to refer clients to CAT practitioners. Structural equation modelling revealed that the extended model was a good fit, explaining 69% (recommending CAT) and 51% (referring to CAT practitioners) of the variance in intentions. For both behaviours, direct paths from attitude and subjective norm to intentions were observed, with perceived risk and past behaviour influencing the TPB predictors of attitudes, subjective norm, and perceived behavioural control. The findings illustrate the role that cognitive and risk factors have on psychologists' decisions to integrate CAT into their practice. Understanding psychologists' cognitions and decisions about CAT integration forms an important basis on which to consider future changes in policy or practice.     

Incidence and impacts of psychotherapists' feelings toward their clients: A review of the empirical literature

The empirical literature examining the incidence and impacts of psychotherapists' feelings of fear, anger, and attraction toward clients is reviewed, including: (a) studies reporting the incidence of psychotherapists' feelings toward their clients; (b) studies investigating the measurable impact of psychotherapists' feelings on clients, psychotherapists, and the therapeutic process; and (c) examinations of the psychotherapist-factors that affect either the incidence or impact of psychotherapists' feelings toward their clients. Fear, anger, and attraction toward clients are common experiences for psychotherapists. Many psychotherapists report that they are confused, ashamed, and stressed by these feelings. These feelings, although occasionally an important therapeutic resource, were often reported to have a direct and negative impact on the therapeutic processes or cause behaviors that were destructive. Most psychotherapists feel that they were inadequately trained to acknowledge and successfully manage these common and stressful experiences. Recommendations for research and training are provided.