Psychoanalytic psychotherapy and student counselling

This paper explores the experience of a psychotherapist working in a university counselling service, indicating the contribution I think a psychoanalytic orientation can make to this kind of work. The exposed ‘coal face’ nature of the work is illustrated, and some of the psychotherapeutic implications of working within a large organisation discussed. There is an exploration of institutional dynamics which bear directly upon the psychotherapist, in terms of what it is possible to provide, and of professional self-preservation and self-esteem. Analysis of the uses made of the counselling service is seen as a contribution towards enabling the service to represent properly itself and its concerns within the institution.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

Leisure counselling, coping skills and therapeutic applications

Leisure counselling is defined as the systematic exploitation of a client's past, existing or prospective hobbies, activities and interests for broad psychotherapeutic purposes. It functions as a powerful agent in the invigoration of a range of existing but inadequate coping skills, and can also act in an innovatory style when such key skills are absent. The effective functioning of leisure counselling, as this paper argues, requires a methodology of application, and the author's main contribution has been to identify a triad of approach techniques open to the leisure counsellor, namely, distraction, anticipation and confrontation, and to outline appropriate settings in which they may be fruitfully implemented. Effective leisure counselling requires a new mode of thinking, wherein leisure becomes instrumental and hobbies, activities and interests, its tools. So as to sharpen awareness of the full possible range of leisure counselling's application, this paper outlines how it may be applied across a wide span of coping needs and covers three broad domains: the need to ease phobias, panics, stress and tension states, and the aftermath of traumatic episodes; the need to create and sustain positive moods; and the need to contain and limit the destructive demands of habits and impulses as well as address the very sharp therapeutic challenge of obsessions and compulsions.     

Meeting the challenges of the new NHS for counselling in primary care: a service manager perspective

This paper addresses the challenge of meeting the requirements of the new NHS in primary care, whilst at the same time protecting conditions for counselling as a creative rather than a mechanical process. In managed teams this tension has to be held without the benefit of a long professional history of change and adaptation. The profession of counselling and psychotherapy in primary care has to rapidly find its place within the new structure and take on board new expectations for a profession that has traditionally enjoyed a high level of clinical autonomy.     

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.     

'The power of being seen': an interpretative phenomenological analysis of how experienced counselling psychologists describe the meaning and significance of personal therapy in clinical practice

There is a widely acknowledged lack of clarity in psychotherapeutic training about the role of personal therapy in developing practitioner competence. This paper presents part of a wider ongoing qualitative study exploring the role that personal therapy plays in the clinical practice and training of experienced counselling psychologists. Results derived from an interpretative phenomenological analysis suggest that personal therapy is valued mainly as a means of enhancing reflectiveness within clinical work. Detailed examination of a subset of the data offers scope for exploring how this process may occur within therapy, and points to the potential significance of early attachment experiences in the development and amplification of participants' reflective capacities. A possible theoretical framework is proposed and implications for future research discussed.     

Psychotherapie auf Palliativstationen

Exemplary for psychotherapeutic activity in the ??sphere of death?? the article focuses on the present situation of psychotherapists working on palliative care units in Germany. For that a questionnaire has been developed which includes 17 items dealing with fields of concrete psychotherapeutic work, psychotherapy training, relations with teams and institutions, subjectively felt burden and contentment etc. The questionnaire was sent to most of the German palliative care infirmaries. There is a high presence of psychotherapists in these units who are well trained in different therapeutic methods, numerically led by behavior therapy and non-directive therapy. In addition most colleagues are qualified in psychooncology and specialized pain management. Surprisingly topics, such as death or spirituality are not so often found in therapeutic contacts as would be expected. Furthermore there is a rather negative outlook on the preparation for the palliative working field during psychotherapy training. This requires extensions and supplementary curricula concerning existential themes in psychotherapy. The psychotherapists feel well integrated in their therapeutic teams but many of them have a feeling of at best a mediocre appreciation in their institutions. In spite of the difficult and stressful work the general job satisfaction is stated as high to very high.     

Gambling counselling in Australia: focus on cognitive counselling techniques

A number of specialised counselling services are now available to assist individuals who experience difficulties as a result of problem gambling behaviour. Clinicians within these services may utilise one or a number of counselling approaches depending on their own preferences and their assessment of the counselling style suitable for use with particular clients. The purpose of this paper is twofold. The first is to describe the range of specialised gambling counselling services now available in Australia. The second aim is to provide clinicians in the field with a range of practical cognitive counselling strategies that may be used to good effect to assist clients to reassess their attitudes towards and thoughts about gambling.     

Universities are not a good place for psychotherapy and counselling training

This paper outlines eight aspects of institutional practice in university teaching that are at odds with the ethos of therapy: the linearity of university training has consequences for conceptual and cultural issues that may be antithetical to genuine therapeutic practice; certain notions about what reality is and what counts as truth may be reinforced by university trainings; academic knowledge in universities is standardized so as to sabotage therapeutic work; the university privileges a cognitive account; the university trains therapists in ways that are antithetical to the ethos of therapy; universities keep alive hierarchies that sit uneasily with the project of therapy; university training encourages the therapist to develop an identity that is anathema to many traditions in therapy; and compartmentalization of ethics in university-based trainings would run against the ethics of therapy.     

Therapy and the challenge of evil

This paper expresses the author's personal view on the question of evil as considered by psychotherapeutic theories. It challenges the psychotherapeutic tendency to avoid the moral and existential dimensions of evil via the transformative language of psychopathology which allows theorists and practitioners either implicitly or explicitly to rely upon metaphors of disease or immaturity—be it physical or psychic. The author argues that such views are problematic not least because they mimic the separatist attitudes of those persons who have been labelled as evil since both rely upon notions of being 'less than fully human'. Further, taking a perspective that is informed by existential-phenomenological theory, the author highlights the inconsistencies and limitations that arise when the issues surrounding evil are considered from an intrapsychic perspective. As an alternative to this dominant tendency within psychotherapy and psychology, the author presents an inter-psychic viewpoint derived, in part, from the writings of Martin Heidegger and seeks to demonstrate that while such a perspective illuminates further complexities with regard to our understanding of evil, nonetheless, it also provides a more adequate, if disturbing, interpersonally focused viewpoint.     

Ethical issues in internet counselling

This paper examines the advantages and difficulties associated with using the internet as a communication medium for counselling. Access to the internet is increasing rapidly and counselling services are starting to be offered to clients. Such services may be particularly attractive to clients who may not be able to find such services locally. The disadvantages of using the internet for counselling include the loss of the non-verbal communication level. The paper addresses the ethical implications of counselling in this medium. It concludes that there is a need for more guidelines in professional codes of practice.     

Working Through the Trauma of Sexual Assault in an Undergraduate Class

Processing the trauma of sexual assault is a complicated and often prolonged process that may occur both within and outside a formal psychotherapeutic context. The second author describes an undergraduate class that explores various aspects of sexual assault, followed by a paper written by a female student in which she describes how the class impacted her intellectual understanding of and emotional reactions to her own sexual victimization as a high school student. Finally, the authors discuss the concept of “working through” as it applies to recovery from sexual assault, and they propose that a didactic course experience, even if not designed as a therapeutic enterprise, may nonetheless serve such a function.     

Sequential Analysis: Monitoring counselling sessions via skin resistance

Very little has been published on the application of the galvanic skin response (GSR) to counselling and psychotherapy, since research has concentrated on applications to lie detection and biofeedback. Dr Ian N. Marshall developed Sequential Analysis in 1968-69, as a system of psychotherapeutic procedures monitored by GSR, but most of his work remains unpublished. Certain meter techniques are described. It is suggested that the ‘paradoxial’ phenomena would be explained by correlating high/low resistance with withdrawal/involvement rather than with relaxation/arousal. The procedures of Sequential Analysis are described briefly. Finally it is suggested that giving oneself sessions is an effective method for training as a counsellor or psychotherapist, because of the experiential understanding of the processes so obtained.     

Counselling the community: The contribution of counselling psychologists to the development of primary care

The primary care groups (PCGs) newly introduced to the National Health Service require general practitioners and primary care teams to improve the health of their communities by addressing the health needs of their population, promoting the health of that population and working with other organizations to deliver effective and appropriate care. Community-oriented primary care (COPC) is an internationally tested model for primary health care development which is now being employed within the UK. This paper outlines the COPC model, and demonstrates how the skills and knowledge base of counselling psychologists and primary care counselling can contribute to a community-oriented primary care approach.     

Universes of discourse: implications for counselling and psychotherapy

All individuals can be envisaged as living within a number of parallel universes of discourse, where different meanings and values may apply; these may be characterised by different language 'registers'. The process of counselling and psychotherapy itself constitutes such a universe. The inner and outer worlds of the client also constitute different universes that may themselves each consist of a number of distinct universes. Decisions made with respect to one universe may have different meanings or adverse consequences in another; it therefore beholds the therapist to be aware of, and alert to, these differences.     

Grief counselling in context: Multiple roles and professional compromise

The issues involved in the use of counselling skills and approaches by members of professions such as nursing and social work have received relatively little research attention. Grief counselling represents an appropriate area in which to explore these issues, since members of many diverse professional groups may be called on to work therapeutically or supportively with the bereaved. This paper explores the use of grief counselling in a variety of professional and voluntary contexts, through an analysis of the experience of students who had undertaken a bereavement counselling course. The aim of the study was to explore the level of awareness shown by employing organisations to the 'loss' element of client experience, and the implications of organisational context for the role of counsellor as a worker responding to client grief. A range of practice characteristics emerged. At one end of the spectrum was clearly focused and contracted grief counselling, usually within the context of specialist voluntary agencies. By contrast, there were practitioners whose counselling response to grief was concealed within a multi-professional perspective characterised by compromise, usually working in complex organisational contexts in the statutory sector. It is argued that the range of practitioner activity cannot be understood simply by describing some activities as counselling and others as the use of counselling skills; it seems that there is a real and sometimes subtle middle ground which lies between the two. This is territory which is determined by the context of practice and needs to be understood and defined as such     

Cross Cutting Issues in the Practice of Psychotherapy in Nigeria

The need to bridge the gap between western based psychotherapeutic intervention and African psychotherapeutic interventions is the main objective of this paper. In order to do this, cross cutting issues in psychotherapy in Nigeria were reviewed. This review covered socio cultural, economic conditions and other contemporary issues such as child maltreatment, HIV/AIDS, chronic illness, terrorism and the impact of western civilization on Nigerian culture and how it has produced a heterogeneous Nigerian society described as westernized, traditional and transitional types of Nigerians. Also salient peculiarities that must be taken into consideration in bridging the gap between western and African based psychotherapy were identified. Some of these salient peculiarities were adumbrated and they include frequent somatic complaints of psychological origin, beliefs in spirits including ancestral spirits, independent spirits and the supreme spirit God to whom duties are owed to keep the moral order. Given this situation the authors expressed uncertainty in the use of western diagnostic illness categories. Also an attempt was made to describe traditional methods of treatment such as the popular prayer houses and traditional healers. From lessons learnt based on these cross cutting issues the authors reported the development of Harmony Restoration Therapy and Meseron treatment frameworks as attempts at indigenizing western psychotherapeutic methods. From these they proposed the way forward as a cultural blend through using culture based psychotherapeutic framework. This they suggest can be applied in other societies.     

Freud's Irma dream and the origins of psychoanalysis

This paper investigates Freud's Irma dream as a response, in part, to the publication of Studies on Hysteria (Breuer & Freud, 1893-1895). As such, Freud's dream and associations reveal a great deal regarding the origins of psychoanalysis. The preamble to the dream reflects Freud's concern with the ground rules and boundaries of the psychotherapeutic technique that he was in the process of developing. This paper cites evidence for Freud's concerns regarding the consequences of alterations in these basic tenets. The Irma dream and Freud's associations also convey a deep and apparently unconscious concern within Freud in respect to the concept of transference, which he may have realized on some level had been used to defensively deny disturbing inputs by the therapist into the treatment situation and patient. The dream may be understood also as reflecting a deep sense of concern regarding unrecognized harmful effects of psychoanalytic psychotherapy and Freud's concern that the treatment process might be more destructive than helpful. The curative aspects of psychotherapy are viewed in terms of action-discharge rather than insight. In all, this reanalysis of the Irma dream focuses on Freud's unconscious conflicts, fantasies, and anxieties at a time when he, along with Breuer, presented a burgeoning psychoanalytic treatment modality to the professional world.     

Exploring the Use of Family Therapy with Adults with a Learning Disability

Clients with a learning disability have received little attention so far from psychotherapeutic services. Systems thinking seems to have obvious potential for this group, given the stresses which such a disability puts on the client and his family and the variety of different organizations with which they become involved. This paper describes the use of family therapy within a clinic setting and considers similarities to and differences from general family therapy practice. Ways of overcoming communication difficulties are highlighted, as is the need to redress the power imbalance within the therapeutic situation.