How do you see me? Coming out in counselling

Recent large-scale survey research has raised serious concerns in both the counselling community and the mass media about the ways in which counsellors work with lesbian, gay and bisexual (LGB) clients. The current questionnaire-based research focused on client experiences of their own, and their counsellor's, self-disclosures of sexuality. Most clients did not require counsellor disclosure. However, failure of the counsellor to disclose could result in problems and assumptions being made by the client. We conclude that LGB awareness is improving, but there is still much need for training in this area to challenge limiting assumptions by some counsellors and to avoid the need for clients to educate them.     

An Exploration of Young Clients' Experiences in Counseling With Post‐Master's Counselors

This phenomenological study adds to current literature about clients' meaningful experiences in counseling by exploring the experiences of eight young clients (ages 8–18) in individual counseling with post‐master's counselors in an outpatient setting. Interviews with these clients revealed the following six themes: (a) the process of growth, (b) having a safe place to talk, (c) counselor accepts and meets the client where they are, (d) counseling is a team effort, (e) supportive accountability from the counselor, and (f) understanding self and others. The final theme includes two subthemes: learning coping and emotion management skills, and learning better ways to communicate and behave. Findings and implications for counselors are discussed.     

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.     

Ontological and epistemological reflexivity: A core skill for therapists

This paper argues that a core skill needed to be an effective therapist is to have developed an awareness of one's own ontological and epistemological positions in relation to one's work as a therapist. In the same way that researchers need to develop reflexive awareness of their assumptions about what there is to know (ontology) and how they can come to know about it (epistemology), therapists need to be aware of their fundamental assumptions about human beings and the world they live in (ontology), as well as their beliefs about how best to develop an understanding of their clients and the meaning(s) of their experiences (epistemology). Regardless of which therapeutic model is adopted, the language used to talk about (and in) therapy, the kinds of questions asked of clients and the comments/interpretations offered, all presuppose and reinforce particular versions of human being and experiencing, which are themselves not usually questioned or challenged during the course of therapy. It is essential that therapists are aware of their own fundamental assumptions about what it means to be human and that they recognise their ontological and epistemological positions as positions that they are taking (rather than perceiving them to be self‐evident truths). This is important for two reasons: (a) if clients do not share the therapist's assumptions, the therapeutic work cannot proceed and be effective; and (b) without such an awareness, therapists are at risk of unwittingly imposing their own model of the person upon the client which raises ethical issues.     

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

Theory and Practice: Assessing the psychological presentation of gifted and talented clients: a multicultural perspective

Researchers suggest that gifted individuals have both strengths and areas of intrapersonal and interpersonal concerns as a result of their talents. The purpose of this paper is to apply a multicultural model of psychological assessment, the Multicultural Assessment Procedure (MAP), to better understand the social and emotional needs of gifted clients. This application is based on the following assumptions: a) giftedness is a sub-culture, b) people with special gifts also identify with and operate in multiple cultural contexts, and c) in order to be effective in working with gifted clients, one must accurately understand the interaction of the client’s multiple cultural identities. Implications for counselling practice are discussed.     

Diagnostic judgments as a function of client and therapist race

The purpose of the present investigation was to examine the process of differential evaluation of clients as a function of client and therapist race. It was hypothesized that race of client and therapist would interact, influencing the judgments of client psychopathology, appropriateness for therapy, verbal facility, and likelihood of treatment success despite standardization of the clinical stimuli. Graduate students in clinical psychology and with varying levels of training (i.e., 1 to 5 years) were asked to rate videotaped interviews of clients in which race of the client and level of psychopathology (i.e., normal, neurotic, and psychotic) were systematically varied. There were significant differences in ratings as a function of race of client, race of therapist, and level of psychopathology observed. Black clients were not rated differently on degree of psychopathology but were rated as less verbally skilled and less appropriate for treatment but more likely to benefit from treatment than white clients. Contrary to expectations, white therapists tended to underrate the pathology of black clients. On the other hand, black therapists tended to overrate the pathology of white clients and made mixed judgments of black clients. The implications of these findings are discussed.This study was supported in part by NIMH Research Centers in Minority Institutions (RCMI) Grant G12RR03206-2.     

New Directions in Counseling Women

A revolution in counseling women is one logical outcome of recent changes in the social, political, and economic movements that have predisposed individuals to modify their life-styles and value systems. This article discusses four facets of that revolution and concludes that new counselor training programs are required to meet the needs of emerging client populations. The conclusions are supported by research that indicates (a) new sources of knowledge about the development and functioning of women clients; (b) new groups of client populations whose needs are not being met by traditional counseling strategies; (c) innovative procedures specifically tailored to the unique characteristics of these client groups; and (d) revised standards of ethical practice to ensure competent and appropriate services for all client populations. Training programs are outlined that provide guidelines for sex-fair education for all counselors and more intensively focused training for counselors who select the counseling of women clients as a career specialty.     

The challenge of counselling and psychotherapy research

Aims: The purpose of this commentary is to argue that the value of counselling and psychotherapy research lies, not only in what it teaches us as therapists, but also in its ability to challenge us and our assumptions. Method: The paper identifies eight beliefs that may be prevalent in sections of the counselling and psychotherapy community, and presents evidence that challenges them. Findings: While many of our beliefs may hold true for some clients some of the time, the research evidence suggests that they are unlikely to be true for all clients all of the time. Discussion: By questioning and challenging therapists' a priori assumptions, research findings can help counsellors and psychotherapists to be less set in their beliefs; and more open to the unique experiences, characteristics and wants of each individual client.     

The Practice of Counselling HIV/AIDS Clients

AIDS/HIV has been described as one of the most pressing medical and social problems of this century. A review of the psychosocial and counselling literature relating to it indicates that the predominant psychotherapeutic approach with clients is symptom-focused and presents psychological problems as being inevitable in the course of illness. A systems approach is considered to have a good fit' with HIV-related problems because of issues relating to unpredictability, relationships, interaction, complexity and secrecy which arise in the course of the illness and its management. Some of the counselling tasks of an AIDS counsellor are set out. Consideration of these can help the system (client, family, health care team, counsellor) both to define problems and to find solutions to them without resorting to prior assumptions about either.     

Experiences of Support Staff with Expanding and Strengthening Social Networks of People with Mild Intellectual Disabilities

A supportive social network is crucial for facilitating social inclusion. The social networks of people with intellectual disabilities (ID) are often small and typically include very little contact with friends and acquaintances who do not have ID. Professionals can play an important role in strengthening and expanding the social networks of clients. In this study, experiences with interventions aimed at doing this were examined. Six group interviews were held with a total of 27 professionals. The results showed interventions to strengthen social networks (e.g. attention to the maintenance of contact with network members) and interventions to expand social networks (e.g. participation in leisure time activities and working with volunteers). However, a large number of impeding factors was mentioned, such as the limited size of the social networks, characteristics of the client, different perceptions and clients falling between the cracks when it comes to leisure time. The large number of impeding factors shows the strengthening and expansion of social networks to be complicated in actual practice. Recommendations are thus made to strengthen and expand the social networks of clients in an innovative manner which also takes these impeding factors into account. Copyright © 2013 John Wiley & Sons, Ltd.     

Client attendance measures in counselling psychology trainees

Counselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients’ engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement.     

Cleaner fish Labroides dimidiatus recognise familiar clients

Individual recognition has been attributed a crucial role in the evolution of complex social systems such as helping behaviour and cooperation. A classical example for interspecific cooperation is the mutualism between the cleaner fish Labroides dimidiatus and its client reef fish species. For stable cooperation to evolve, it is generally assumed that partners interact repeatedly and remember each other's past behaviour. Repeated interactions may be achieved by site fidelity or individual recognition. However, as some cleaner fish have more than 2,300 interactions per day with various individuals per species and various species of clients, basic assumptions of cooperation theory might be violated in this mutualism. We tested the cleaner L. dimidiatus and its herbivorous client, the surgeon fish Ctenochaetus striatus, for their ability to distinguish between a familiar and an unfamiliar partner in a choice experiment. Under natural conditions, cleaners and clients have to build up their relationship, which is probably costly for both. We therefore predicted that both clients and cleaners should prefer the familiar partner in our choice experiment. We found that cleaners spent significantly more time near the familiar than the unfamiliar clients in the first 2 minutes of the experiment. This indicates the ability for individual recognition in cleaners. In contrast, the client C. striatus showed no significant preference. This could be due to a sampling artefact, possibly due to a lack of sufficient motivation. Alternatively, clients may not need to recognise their cleaners but instead remember the defined territories of L. dimidiatus to achieve repeated interactions with the same individual. Electronic Publication     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.     

The role of beneficence in clinical genetics: Non-directive counseling reconsidered

The popular view of non-directive genetic counseling limits the counselor's role to providing information to clients and assisting families in making decisions in a morally neutral fashion. This view of non-directive genetic counseling is shown to be incomplete. A fuller understanding of what it means to respect autonomy shows that merely respecting client choices does not exhaust the duty. Moreover, the genetic counselor/client relationship should also be governed by the counselor's commitment to the principle of beneficience. When non-directive counseling is reexamined in light of both these principles, it becomes clear that there are cases in which counselors should attempt to persuade clients to reconsider their decisions. Such attempts are consistent with non-directive counseling because, while respecting the clients' decision-making authority, they insure that clients act with full knowledge of the moral consequences of their decisions.     

Ethical Considerations for Therapists Working With Demographically Similar Clients

The increasing emphasis on multicultural competence within psychotherapy continues to highlight the need for being sensitive to key differences between therapist and client. However, this attunement to the psychotherapeutic impact of therapist–client differences may obscure the equally critical need to evaluate ethical problems associated with therapist–client similarities. It will be argued that therapists treating clients who are demographically similar to themselves encounter a unique set of ethical challenges that warrant careful consideration and caution precisely because of therapist–client matching. The extant research on matching therapists and clients based on demographic similarities is discussed, with a particular emphasis on psychotherapeutic outcomes and client preferences. Attention then turns to the nonrational heuristics and biases that can often cloud therapists’ ethical decision making regarding the appropriate uses versus contraindications for demographically matching therapists and clients. Within the discussion of nonrational heuristics and biases, suggestions are offered for managing related challenges for ethical decision making.     

当事人的投入与会谈效果、咨询效果的关系研究

本研究探索了当事人会谈时的投入与即时会谈效果的关系;当事人咨询初期的投入与整体咨询效果的关系。结果发现当事人会谈时的投入与即时会谈效果、在咨询初期的投入与整体咨询效果都呈现显著的正相关。进一步回归分析发现,当事人在咨询初期的投入与整体咨询效果呈现正U型的偏态分布,少数投入水平最低的当事人获得中等水平的咨询效果,中等投入水平的当事人咨询效果最差,投入水平最高的当事人的咨询效果最好。     

Client Aggression Towards Therapists: Is It More or Less Likely with Transgendered Clients?

ABSTRACT

It is well known that clients occasionally threaten or assault their therapists. No studies to date have attempted to systematically measure client aggression by transgender patients towards clinicians. One of the major questions of this study was to determine if clients with gender dysphoria have greater levels of aggression towards therapists than non-gender dysphoric clients. One hundred and fourteen professional therapists who are members of the Harry Benjamin International Gender Dysphoria Association responded to a questionnaire that addressed aggression by both transgender and non-transgender clients. Transgender clients were shown to commit significantly less acts of aggression than did non-transgendered clients (p = 0.0094). Within the relatively small subgroup of transgender clients that did commit acts of aggression, male-to-female transgender clients were significantly more likely to do so than female-to-male clients (p = 0.002). While the transgendered client undergoes significant suffering in violating inviolable gender boundaries, this suffering, in general, does not translate into acting out behaviors directed towards their therapists.