Clients talk about their experience of seeking counselling

The purpose of this study was to explore the help-seeking behaviour of a sample of counselling clients using a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in, affordable counselling agency located in a mid-sized city in New Zealand. Specifically, clients were asked if they had received counselling previously, what efforts they had made to solve their problems before seeking counselling and with what success, why they chose this particular agency, their initial impression of their relationship with their counsellor, and their reactions to participating in the research. The data were analysed to ascertain themes associated with their decision-making and choices. Findings were discussed in relation to the literature on seeking counselling, how clients determine their need for counselling and the process they go through in deciding when and where to get it. Implications for counsellors are discussed.     

Client perceptions of hindering experiences in counselling

The purpose of this study was to increase understanding of what clients perceive as hindering experiences in counselling. In‐depth interviews combined with concept mapping were used to gather, organize, and understand clients' perceptions of hindering aspects of therapy. In the initial data gathering stage, 8 adult client participants, aged 18 or older (average of 14.1 sessions) were asked to respond to the following open‐ended questions:

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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.     

Scaling questions: asking and answering them in counselling1

Solution-focused counsellors use “scaling questions” to construct understandings of clients’ concerns and solutions to them. We examine how these questions are asked and answered, offering evidence of what is constructed from within counselling discourse. Also, clients and counsellors offer their retrospective accounts of their participation in question and answer sequences in their dialogues. We conclude by speaking to the implications we see from this research as it relates to collaborative and resourceful dialogue between counsellors and clients.     

Counsellor and client perceptions of the effectiveness of time-limited counselling in an occupational counselling scheme

Counsellors providing brief counselling (6 sessions) in a British Social Services Department completed post intervention questionnaires for 429 clients. These provided information on several measures about the degree to which they felt that their clients had benefitted from the counselling, how far they felt that the number of sessions was adequate, and the nature of the clients' problems. Two hundred and twenty-three of the clients also completed post-intervention questionnaires indicating their degree of satisfaction on a number of measures. There was fair agreement between counsellors and clients that outcomes were satisfactory, and that the number of sessions was adequate, although clients were more satisfied than counsellors. Counsellors identified a range of personal and occupational presenting problems, and around two thirds of problems belonged in the personal domain. Long-tern personal problems received lower satisfaction ratings and were more frequently referred on to other agencies.     

Clients talk about their experience of the process of counselling

The purpose of this study was to ascertain clients’ experiences of their counselling. This was done through use of a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in agency located in a mid-sized city in New Zealand. Several themes were identified and discussed in relation to the literature on clients’ perceptions of their own counselling. Specifically, clients were asked to comment on whether their counselling was effective, how much of their improvement was due to counselling versus other factors, the quality of the relationship with their counsellor, specific in-counselling events that were helpful or unhelpful, and how their counselling was terminated. Implications for practice were suggested.     

What difference does counselling make? – The perceptions of drug‐using clients on low incomes

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi‐structured interviews with six participants. Findings: Findings included changes in the clients’ internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives.     

Assessing the structure of learning outcomes from counselling using the SOLO taxonomy: an exploratory study

Thirty-five clients who had received counselling completed a letter to a friend describing in as much detail as possible what they had learned from counselling. The participants' written responses were analysed and classified using the Structure of Learning Outcomes (SOLO) taxonomy. The results suggested that an expanded SOLO offers a promising and exciting way to view the outcomes of counselling within a learning framework. If the SOLO taxonomy is found to be stable in subsequent research, and clients are easily able to be classified using the taxonomy, then this approach may have implications for the process of counselling. To maximise the learning outcomes, counsellors could use strategies and techniques to enhance their clients' learning.     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

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.     

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.     

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.     

Beyond resolution of presenting issues: Clients' experiences of an in‐house police counselling service

The availability of counselling services for employees has expanded significantly in recent years. However, despite an increase in appreciation of the value of counselling within the police service, there has been little research into the effectiveness of counselling with police personnel. The present study assesses an in‐house counselling service provided by the welfare and counselling department of a Scottish police force. Thirteen former clients (including both police officers and civilian support staff) were interviewed about their views on four areas of the counselling provision: how they entered counselling, the issues they brought, their experiences during counselling, and their assessment of the impact of counselling on their lives. Interviews were analysed using a grounded theory approach, which identified four main categories: initial engagement, learning by participating, experiencing moments of deep self‐examination, and moving beyond resolution of presenting problems. All of those who were interviewed appreciated the provision of a counselling service within their employment, and the majority reported that they had not only been helped to resolve their presenting problems, but had also made important gains in self‐awareness and work effectiveness. Findings are discussed in terms of implications for service delivery and future research.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

New approaches in counselling: Healthy diversity or anti-therapeutic?

Concern is expressed about the proliferation of new or 'innovative' approaches in counselling or psychotherapy. Most of these approaches appear to be regressive in that they ignore what we have learned about the importance of certain conditions for the therapeutic relationship. They place the counsellor or therapist in the position of a charismatic expert controlling and directing the lives of his clients. The potential dangers of these methods are noted. Yet there seems to be no good way to protect clients either from well-intentioned but misguided professionals or from the untrained non-professional. If professionals are not successful in policing the field, injured consumers and an aroused public may succeed in imposing unnecessarily rigid restrictions on all practice of counselling and psychotherapy.     

The client as a self‐aware agent in counselling and psychotherapy

Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self‐awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over‐arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non‐directive and directive counsellor performances alike. Vignettes selected from the participants' reports illustrate the theme. Implications for the practice of counselling and psychotherapy are discussed.     

Using a cross‐contextual qualitative diary design to explore client experiences of psychotherapy

Qualitative research in counselling and psychotherapy has largely been based on interviews carried out with clients and therapists. However, other approaches to qualitative data collection are possible. The present paper uses a diary design to explore the connection between what goes on in therapy sessions, and client activities and experiences in other contexts. Clients and counsellors kept diaries about significant aspects of therapy sessions, while clients also kept diaries about new and different experiences in other contexts in their lives. Ethical and practical issues involved in the use of diaries are discussed, and the methods that were employed to analyse diary‐based data are described. The types of findings that the study generated are presented, along with discussion of their implications for research into client experiences of therapy.     

Getting curious about meaning-making in counselling (1)1

Counselling offers many experimental opportunities from which counsellors can learn and develop their meaning-making skills. Recent developments in qualitative research, and in social constructionist approaches to counselling, point to new ways of conceptualising the conversations of counselling and guidance. In particular, a hermeneutic view of counselling attunes counsellors and guidance practitioners to the particular meanings and meaning-making potentials clients and students bring to counselling and guidance conversations. Accordingly, our questions and proposed solutions can be seen as engaging the meaning-making efforts of clients in ways we, and they, can learn from. Our conversations offer many potential experiments in meaning-making, should we think of what others do with what we say—as occurring across a gap of conversational potential. This article explores ways to adopt, and learn from, such a hermeneutic frame in our conversations with clients and students.