Exploration of counsellors' perceptions of the redesigned service pathways: a qualitative study of a UK university student counselling service

To address the mental health needs of students, UK universities offer bespoke student counselling services. Economic pressures have led services to find innovative ways of redesigning their service pathway. Few studies have investigated staff perceptions of these changes. The aim of this study was to investigate perceptions of staff employed as counsellors at a student counselling service at a UK university that underwent service delivery changes. Face-to-face interviews were conducted with counsellors (n = 5). Framework analysis was used to identify themes and meta-themes. Five meta-themes were identified: the overarching service ethos and service working style; change in the university context; impact of change on working practice; recording and perceived impact on confidentiality; acceptability and effectiveness. Changes to the service resulted in a more efficient service that is perceived to be more acceptable to students. Staff perceptions differed regarding how changes have affected their counselling practice. Despite these differences, the increase in workload was consistently expressed. Tensions remain as staff strive to maintain high standards of service in this changing context. Future research should investigate the process of developing and implementing change as student counselling services strive to evolve sustainable ways of working.     

Rehabilitation Counselling: The Development of a New Course Specialism in British Counselling

The introduction of rehabilitation counselling to the UK in 1990-initially as a diploma and now as an MSc—is described. The worldwide development of rehabilitation counselling from its beginnings in America in the 1950s is outlined, highlighting key areas of debate. Evidence of the need for rehabilitation counselling in the UK is presented, and the current course is described with reference to its integrative counselling approach and specialist areas of enquiry. The future development of rehabilitation counselling in the UK is considered, emphasising the need for this specialism as we move towards more holistic models of care.     

Counselling Supervision: The British context

Counselling/psychotherapy supervision is on the verge of a professional breakthrough in Britain today. Training courses are emerging, accreditation for supervisors is in progress and a Code of Ethics for Supervisors is finalised. Yet supervision is still little understood. There are few agreed definitions and certainly no agreed tasks, roles, or even goals of supervision. Conflict still abounds about whether it is more akin to therapy than to education, about whether or not it shold be evaluative, and about what areas of counselling it should cover. Supervisors are poorly trained in supervision and areas such as the legal implications and responsibilities of supervision not clear and often not even considered important. What research has been done is confined largely to United States and few attempts have been made to apply findings to Britain, e.g. how valid in Britain is the current research on Developmental Models of supervision which outline the stages through which counsellors in training travel.

Supervision is still tied to counselling theory despite its efforts to become a discipline on its own. Most supervisors in Britain seem to apply their theory of counselling to supervision setting. However, some of the conflicts are being faced and some questions raised about the future of supervision, about the kind of relationship involved, about its relationship to counselling. This article raises some current issues in the field and asks the kinds of questions that need answering before we are able to talk about a British understanding and application of counselling supervision.     

Creating a research agenda in career counselling: the place of action theory

After identifying historical and current problems in career counselling research, we propose a research agenda based on contextual action theory. This theory has been used as a framework for research in the career field and for general counselling practice. It is advantageous for several reasons including its conceptual basis, its detailed qualitative and quantitative research method, and the significant link it provides between research and practice. It is supported by the action-project method, an integrated set of procedures developed for conducting research. Contextual action theory and the action-project method can address major emerging issues in career counselling, for example the place of emotion and the use of narrative, and advance the research agenda in this field.     

Action: a bridge between vocational and mental health counselling*

A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.     

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.     

A counselling service as a growth centre

The Associates programme at the University of East Anglia is designed as an opportunity for self-development and as a testing ground for those who want to explore their own helping abilities. The structure and content of the programme are described; some examples are provided of the range of follow-up activities which have arisen from it; and attention is given to the potential of the programme as a contribution to the development of the institution as a community.     

Using the sixth sense: The place and relevance of language in counselling

Counsellors' primary skills, apart from listening to clients' words, lie in responding with well-chosen words. Ideal counsellors say just the right thing, at just the right time, in just the right way. It is suggested that emphasising how words relate to cognitive, emotional and relationship events can take counselling on to new ground. In addition to felt experience being in sight, sound, feeling, smell and taste, language itself is posited as a 'sense' through which we perceive, and are joined to, our environment. From the starting point that counsellors use words to heal, attention is paid to how wrong words injure clients, how words are a major component in making relationships, and how they create and define felt experiences. 'Metaphorical schemas' are posited as bases for shaping felt experience. These schemas are a theory of subjectively felt emotion and cognitive understanding.     

The Functioning of British Counselling Hotlines: A Pilot Study

A role-player called ten counselling hotlines and presented them with a personal problem. According to the writer's assessment, the hotlines functioned at levels varying from good to less than minimally facilitative.     

The development of counselling psychology in a clinical psychology service

This paper will describe one Clinical Psychology department's efforts to incorporate Counselling Psychology into the service. It is written from the experience of the Chartered Counselling Psychologist.     

Counselling in Action: A multimodal assessment and rational emotive behavioural approach to stress counselling: a case study

This paper demonstrates how the multimodal approach, developed by Arnold Lazarus (1989 Lazarus A.A. 1989 The practice of multimodal therapy: systematic, comprehensive and effective psychotherapy Baltimore John Hopkins University Press  [Google Scholar]), can be used to aid assessment of a client suffering from the effects of chronic, work-related stress. A rationale is provided for integrating the multimodal approach with rational emotive behaviour therapy theory, techniques and strategies (Kwee & Ellis, 1997 Kwee M. Ellis A. 1997 Can multimodal and rational emotive therapy be reconciled? Journal of Rational-Emotive & Cognitive-Behaviour Therapy 15 2 95 132 [Crossref] [Google Scholar]). A modality profile and a second order BASIC I.D. profile were developed and used as the link between assessment and the stress counselling programme (Palmer, 1992 Palmer, S. 1992. Multimodal assessment and therapy; a systematic, technically eclectic approach to counselling, psychotherapy and stress management. Counselling, 3(4): 220–224.  [Google Scholar]). A range of assessment tools were used to assess progress and a session by session report is provided.     

HIV counselling in the national blood transfusion service

The problems caused for the NBTS by the advent of HIV are reviewed, with particular reference to the impact on blood donor numbers, the strategies adopted to minimise the risk of HIV infection through blood transfusion, and the counselling dilemmas faced by the Service in the setting of the blood donor clinic. The notification procedure for blood donors found anti-HIV positive is described, with the importance of confirmation of such results before approach to the donor emphasised. Counselling issues arising from indeterminate and false positive lest results are explored and those arising from enquiries generated by cases of possible post-transfusion HIV infection are examined.     

Counselling breast cancer patients: A specialist nurse service

The evaluation of a specialist nurse-counselling service is described. Forty newly diagnosed breast cancer patients, treated by mastectomy, were randomised to receive either routine care or routine care plus counselling by a nurse. Psychological morbidity was assessed at one week, 3 months and 12 months postoperatively to determine the efficacy of this service. Comparisons between the groups indicated that counselled patients were significantly less depressed at 3 months postoperatively and reported more beliefs in personal control over health. At 12 months postoperatively there were no significant differences between the groups. Although both groups continued to adjust throughout the year following surgery, this adjustment occurred more rapidly if patients were counselled. The results suggest that a nurse-counselling service can be of value in helping to reduce the amount of distress experienced as a result of the diagnosis and treatment of breast cancer.     

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.     

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.     

Counselling, counselling skills and encouraging pupils to talk: Clarifying and addressing confusion

The context in which counselling approaches operate in schools is outlined. The issues that arise from the location of counselling skills and the practice of counselling in the framework of pastoral care and of personal and social education are discussed both from a historical perspective and in terms of the current educational climate. Ways in which counselling and counselling skills might be more appropriately and effectively used in schools are considered.