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.     

Counselling and well-being: on the road to realities

This article aims to discuss the rationale and some guiding principles for the realm of counselling in the fostering of well-being. After some brief observations of a theoretical nature, the principles analysed are: the revitalisation of counselling; the reflection on the concept of dialogue, including the notion of context; the perspective of counselling as social activity; understanding counselling and how it adjusts on the road to realities. From this perspective, practitioners view counselling as a social activity aimed at self-construction and life designing. In following that view, the idea of counselling as being socially produced is also examined. At the end, some considerations on the future of counselling are discussed.     

Addressing Urgent Community Mental Health Needs in Rwanda: Culturally Sensitive Training Interventions

Rwandan leaders in the health and educational sectors have begun to discuss the necessity for establishing culturally appropriate community-based mental health counselling services in Rwanda, especially trauma counselling. The need for a community psychology approach is anchored in the lingering effects of the genocide and the continuing post-traumatic stress symptoms suffered by many in the population. Capacity building in an effort like this would require the design of multi-level counselling curricula that are sensitive to the social structures within Rwandan culture. These curricular endeavours call for the development of a National Counselling Centre to serve as a structural mechanism for organizing community-based counselling initiatives. We consider the community health services needs in Rwanda here, along with associated challenges and strategies for effective mental health services in a country with a recent history of genocide. A community psychology approach to mental health would benefit Rwandan society by making trauma counselling and recovery services available and accessible to citizens throughout the country.     

Counselling a Taiwanese woman with infertility problems

The purpose of this case report is to describe, analyse and discuss the process and outcome of counselling a 38-year-old Taiwanese woman with infertility problems by a female Taiwanese counsellor who employed the relationship-centred counselling (RCC) approach. The client's long-standing fertility has been deeply connected to her symptoms of depression, anxiety, psychological and physiological pain, and social stress. During a 10-month counselling intervention, the client gradually minimized her physiological symptoms, reduced her negative emotions, improved her interpersonal relationships, built up her social support network, and enhanced her sense of internal control, self-esteem and satisfaction with life.     

Using doctor-patient communication to affect patients' lifestyles. theoretical and practical implications

Abstract

Physicians very often do not perceive themselves as being efficient in affecting patients' life style. The aim of this article is to elucidate theoretical constructs and models in health education and their practical implications for individual health counselling in daily work as a guidance for physicians. The current most commonly used strategies are giving information and exhorting people, which have a limited ability to change peoples' behaviour. Derived from current behavioural constructs and models in health education - such as the health belief model, social learning theory, health beliefs, self-efficacy, self-determination theory - principles for successful strategies are described: to use patient-centredness instead of directing, to encourage patients to reflect and decide on their behavior, to find out the patient's readiness to change, to present knowledge as neutral facts instead of valuations, to focus on the actual behaviour instead of information-giving, to highlight patients' health beliefs and to discuss the advantages and disadvantages which the patients experience with their life style. The article concludes with a comprehensive model for individual health counselling in consecutive steps.     

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.     

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.     

Assessment of HIV counselling and social care services in a London hospital

The use of, and satisfaction with, counselling and social care services was investigated among HIV-infected clients attending HIV specialist climes at Guy's Hospital and Southwark Social Services, London. A survey of 71 clients with HIV infection was carried out using a self-administered questionnaire. The greatest demand was for advice about income support, housing, counselling for the HIV test, counselling for depression or anxiety, psychological support for coping with HIV, help with sleeping problems, mobility allowance, and help with furniture/household appliances. Overall, 57% thought the service was good or excellent; 66% of respondents thought they would use the services in the future. Over nine in ten clients had used the psychosocial support services at some stage since their HIV diagnosis, although only two-thirds anticipated that they would have need of these services in the future. The psychosocial support service will need to remain responsive to the shift in demand for this service, as well as the changing needs of clients who use it.     

Positive living with anxiety: A morita perspective of human agency

Morita therapy, a Japanese cognitive behavioural approach, is applied to a Western context. This paper intends to focus on one of the Morita key concepts, namely the positive acceptance of social anxiety, and its underlying meaning of human agency that can be interpreted in daily life and counselling situations. Some similarities and differences between Morita philosophy of human anxiety and Western therapeutic conceptions of anxiety feelings are highlighted in order to clarify Morita principles as they are incorporated into counselling process in Western society. Suggestions for counselling, with special focus on counsellor attitude, client cognitive behavioural transformation, and client existential meaning making, are provided.     

Discourse analysis: Rich pickings for counsellors and therapists

Aim: It is only relatively recently that discourse analysis has begun to rise to prominence in the fields of counselling and psychotherapy. This paper briefly explains ways of understanding discourse analysis, discussing what the approach can offer counselling research and practice. Approach: An initial categorisation of recent discourse analysis studies is offered, to demonstrate diverse ways in which this type of research can address issues relevant to counselling practice. The five categories proposed range from the examination of language use in therapy to analyses that focus on the social structures, meanings and power relations related to therapy. Implications: The paper demonstrates that through the critical analysis of counselling sessions, research interviews, written texts and other materials, discourse analysis can provide insight into ways in which counselling operates as a social practice, and so help counsellors to contextualise their work within broader social structures and processes.     

Understanding the Psychosocial Effects of WES Test Results on Parents of Children with Rare Diseases

The use of whole exome sequencing (WES) for diagnostics of children with rare genetic diseases raises questions about best practices in genetic counselling. While a lot of attention is now given to pre-test counselling procedures for WES, little is known about how parents experience the (positive, negative, or inconclusive) WES results in daily life. To fill this knowledge gap, data were gathered through in-depth interviews with parents of 15 children who underwent WES analysis. WES test results, like results from other genetic tests, evoked relief as well as worries, irrespective of the type of result. Advantages of obtaining a conclusive diagnosis included becoming more accepting towards the situation, being enabled to attune care to the needs of the child, and better coping with feelings of guilt. Disadvantages experienced included a loss of hope for recovery, and a loss by parents of their social network of peers and the effort necessary to re-establish that social network. While parents with conclusive diagnoses were able to re-establish a peer community with the help of social media, parents receiving a possible diagnosis experienced hurdles in seeking peer support, as peers still needed to be identified. These types of psychosocial effects of WES test results for parents are important to take into account for the development of successful genetic counselling strategies.     

Therapists' views of the relative benefits and pitfalls of group work and one-to-one counselling for bereavement

Aim: To explore therapists' perceptions of the relative benefits and pitfalls of group work and individual counselling for bereaved clients. Method: Semi-structured interviews with nine experienced bereavement therapists from a range of different contexts generated data which was analysed using grounded theory methodology. Findings: Groups were perceived as having a normalising influence, helping members make new social contacts and practice social skills. Individual counselling was seen as facilitating the initial telling of the story and the expression of extreme emotion. Discussion: The findings suggest that individual counselling may be useful as a primary intervention easing ‘emotional loneliness’ caused by the death of a spouse or attachment figure. Group work may be of more benefit later in the bereavement process, facilitating an engagement with the outside world and alleviating ‘social loneliness’. Implications for practice: This suggests that bereavement services might usefully combine group and individual provision. Initial assessment could help clients clarify their needs and facilitate their choice of service. This would be more cost effective and potentially ease clients' bereavement experience.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

Both group peer counselling and individual counselling reduce anxiety and depression,and increase self-esteem and overall life satisfaction in palliative cancer care

This study compared group peer counselling and individual counselling in relation to quality of life, well-being and perceived control in individuals receiving palliative cancer care. The study utilized a quasi-experimental pretest-posttest design to assess the effectiveness of counselling type, in a sample of individuals diagnosed with breast, bowel or lung cancer. Nine females underwent group peer counselling and nine underwent individual counselling. Individuals were administered self-report questionnaires which included standardized subscales that measure quality of life in terms of psychological well-being and perceived locus of control before and after counselling. Both group peer counselling and individual counselling significantly increased self-esteem, self-reported levels of overall life satisfaction, and reduced anxiety and depression. Self-esteem, overall life satisfaction, and anxiety and depression were comparable in the two counselling types, both at outset and after counselling, however, individuals with internal locii of control scored higher for self-esteem on post-test, and lower for depression and anxiety, irrespective of type of counselling.     

Client experiences of counselling and treatment interventions: A qualitative study of family views of family therapy

The case is made that personal experience and social life are inherently meaningful. The presence of meaning in human affairs requires all participants to develop interpretive skills if they are to understand what is happening. Researching social life is greatly helped by methods which acknowledge the hermeneutical quality of interpersonal experience. The use of qualitative research methods to investigate all aspects of counselling is therefore highly appropriate. To illustrate the use of qualitative research designs and methods of analysis, a study of family members' views of family therapy is briefly described.     

Going against the grain: supporting lesbian, gay and bisexual clients as they 'come out'

It has been acknowledged in principle that those who provide counselling or support should respect differences and the diversity inherent within any society or culture. In this article we focus upon sexual orientation as a resource: a means by which it is possible to expand upon skills and understand the experiences of those who have embarked upon alternative trajectories of sexual development. We consider the process of development from the perspective of the 'everyday' and, based upon interviews with 16 lesbians and gay men, explore the process of identity formation and the role of those professionals and volunteers who provide support during this transitional period in a person's life. We suggest that it is important for those providing counselling or support to an individual who is lesbian, gay or bisexual to understand the role of context and social influence in their personal and interpersonal development. We suggest that working with lesbian, gay and bisexual clients can provide the practitioner with insights and opportunities to further expand their supportive skills through an exploration of what it means to grow up as a member of a minority group.     

Social justice and remembering “the personal is political” in counselling and psychotherapy: So,what can therapists do?

This brief contribution argues for the importance of a social justice perspective in counselling and psychotherapy, particularly within the current international socio‐political context. Much has been said about social justice over recent years in the fields of psychology, psychotherapy and counselling. Professionals and academics have expressed some concerns about what it might actually mean, or how difficult it might be in practice to engage with this perspective. In this paper, the activist phrase “the personal is political” (Hanisch, 1970) is used to illustrate the way in which a social justice approach to counselling and psychotherapy does not need to be complicated, but rather a foregrounding of a particular understanding of well‐being and the people we work with. Following this, some concrete and straightforward suggestions for how therapists might begin to act on their social justice values are made.     

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

Brief psychodynamic counselling with young adults

Short-term counselling is frequently employed within university counselling services in which there can often be an inherent institutional objective of returning students to the academic treadmill as soon as possible (Coren, 1996). On the other hand, this is perhaps tempered by the availability of counselling throughout the student's academic career, affording them the opportunity to return for further intensive short-term work (or longer-term if indicated or required). However, research into the effectiveness of short-term counselling suggests that interventions of less than eight sessions are as effective as those lasting significantly longer (Barkham, 1989). This may be particularly true in the case of students experiencing transitory problems relating to their life at university. This paper uses a case illustration to examine the value of short-term psychodynamic counselling in a university situation.