The professional identity of counselling psychologists in health care: a review and call for research

Despite (a) anecdotal evidence which suggests that it is possible to be a counselling psychologist in non-traditional settings, and (b) the potential integration of counselling psychology foci with the medical model, there has been some discussion about whether counselling psychologists who practice in health care settings might experience a change in their professional identity. Professional identity is defined here as a sense of connection to the values and emphases of counselling psychology. The retention of professional identity seems important for counselling psychologists in health care settings. This is considering that the application of counselling psychology principles has the potential to make their contributions unique among mental health professionals in the health care arena. Here, the authors describe the evolution of ‘counselling health psychology’ and address issues of professional identity. Limitations of existing literature are examined. Recommendations for future research are also made.     

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.     

Group psychodynamic counselling with final-year undergraduates in clinical psychology: A clinical methodology to reinforce academic identity and psychological well-being

Educational institutions should ensure that students develop a professional identity, as well as safeguarding their well-being and activating awareness and change processes. The aim of this study was to assess the efficacy of group psychodynamic counselling as a means of reinforcing academic identity – considered the forerunner of professional identity – and psychological well-being in a group of final-year undergraduates studying clinical psychology. Thirty-three final-year-students of clinical psychology who participated in six group psychodynamic counselling sessions were compared with sixteen final-year students of clinical psychology who had never participated in an intervention of this kind. The results suggested that group psychodynamic counselling made students feel more capable of managing their lives and more open to new experiences as well as encouraging them to perceive their relationships as more positive and satisfying, to believe that their life is meaningful, and to achieve greater self-acceptance. The in-depth exploration also prompted students to consider their commitment to their choice of career. Group psychodynamic counselling also reinforced students’ educational choice, as the likelihood of students becoming less committed to this choice was reduced after the intervention. Thus, the study confirmed the efficacy of group psychodynamic counselling as a means of reinforcing both academic identity and promoting well-being and demonstrated that it is a tool clinical psychologists and university teachers could use to activate self-reflection and change within educational settings.     

Advertised Australian counselling psychologists: A descriptive survey of their practice details and self perceived competence in six counselling psychology practice areas

This survey research in a field setting aimed to describe psychologists who advertised themselves in the Australian Yellow Pages as counsellors, thus providing a snapshot of advertised counselling psychologists in Australia. Data was collected using a multiple mailing survey method and resulted in a 62.2% return rate. The psychologists’ (a) demographic characteristics, (b) training and development, (c) provision of services, (d) professional involvement, and (e) their self perceived competence in working with (i) depression, (ii) anxiety, (iii) substance use, (iv) clients from non English speaking backgrounds and Indigenous and Torres Strait Islander individuals, (v) clients who are same sex attracted (gay, lesbian, and bisexual individuals), and (vi) clients using electronic mail and instant messaging were assessed. Advertised Australian counselling psychologists tend to be female, mature and Caucasian. The majority of the psychologists surveyed live in urban areas. Master and Bachelor level degrees were most often reported, a minority held doctoral degrees. The average psychologist charged $96.32 per hour, less than the Australian Psychological Society (APS) recommended fee for an hour of service. Eclectic and cognitive behaviour therapy were indicated most often as the theoretical orientations guiding psychological work. Psychologists belonged almost exclusively to the Australian Psychological Society as a professional association. Surprisingly, 2.9% of psychologists indicate not following an ethical code in their work and 3.9% failed to ensure that their work was covered by professional indemnity insurance. Advertised psychologists are thus described and suggestions are given for the further development of the profession. Regarding their self perceived competence, Australian advertised psychologists present as having self perceived strengths and areas of weakness regarding their counselling competence. This indicates that they are aware of their varying ability to work with various issues and populations. The self perceived competence of Australian psychologists in six specific counselling practice areas and suggestions for future training and development are provided.     

The role of psychologists in requests to hasten death: A literature and legislation review and an agenda for future research

The opportunity for patients to request support to die is legalised in several countries and is associated with the development of a social and political debate that has taken place in recent years. We believe that psychologists can contribute to this debate. Here, we conducted a literature and legislation review with the aim of understanding arguments regarding the roles of the psychologist in hastening death. A systematic review of the peer-review literature in this field was carried out. The legislation of each country with hasten death practices was analysed to understand if psychologists are included in the protocols of hasten death practices. Despite a lack of literature, we found competence assessment, communication, psychological counselling, research and training and public policy to be the possible roles of psychologists in requests to hasten death. Based on the review, an agenda for future research is developed. We highlight the importance of psychology, raising its profile in the study of the various forms of death hastening requests.     

Deconstructing 'brainwashing' within cults as an aid to counselling psychologists

With the approach of the new millennium there was increased activity within many of the new cultic movements. Many of these organizations promise a future paradise on earth, and can be identified as millenarian cults. Others predicted the end of the world with the focus for this event being the new millennium, the beginning of which is mutable, some claiming it for the year 2000 others the year 2001. The date for the end of the world can by quite idiosyncratic. It was, for instance, believed by the Movement for the Restoration of the Twelve Commandments to be due in March 2000, when over 1000 members of this particular Ugandan cult lost their lives, many through strangulation. The death toll was a stark demonstration of what appears to be some form of extreme control exercised within such groups. It has been estimated that there are between 500 and 800 different cults active in the United Kingdom with membership ranging from under ten people to thousands. This activity indicates that counselling psychologists need to be aware of the problem of the psychological damage with which some members or ex-members of cults continue to present and of the techniques of control practised within the cult and the effect that these techniques have on members. These types of techniques and the resultant negative psychological consequences are the focus of this paper. This paper aims to begin to educate counselling psychologists in the techniques used within cults which effect social control. It intends to equip counselling psychologists to work with a group of clients, that they will meet on an increasing basis as the new millennium, whatever date is allocated to it, approaches and passes. That is if heaven on earth or the earth's destruction does not materialize.     

Counselling Psychology in Canada

Counselling psychology in Canada has experienced tremendous growth and greater recognition within the last 30 years. However, there is little empirical research on the practice of counselling psychology in Canada and the characteristics of Canadian counselling psychologists. We administered a 74 item questionnaire to 79 counselling psychologists who were members of the Counselling Psychology Section of the Canadian Psychological Association, achieving a 35.4% response rate. The survey asked various questions organized under the headings of: Background Information, Theoretical Orientations, Professional Activities, Training and Career Experiences, and Future. Overall, these Canadian counselling psychologists seem to see the discipline as moderately different from clinical psychology and from counsellor education, and are largely satisfied with their choice of career in counselling psychology. Results further indicate that independent practice is the most common work-setting and that respondents spend a large share of their time providing individual, non-career related, counselling/psychotherapy of primarily a rehabilitative/treatment-oriented nature. A strengths-focused approach was also highly valued by the sample. The development of the field, distinctive characteristics of Canadian counselling psychology, the place of counselling psychology in the Canadian health care delivery system, credentialing, professional organizations, education and training issues, allied professions, opportunities for the field, and threats to the field are also discussed.     

Exploring unique roles for psychologists

Presents a comment on "Psychological Treatments" by D. H. Barlow. Barlow highlighted unique roles that psychologists can play in mental health service delivery by providing psychological treatments--treatments that psychologists would be uniquely qualified to design and deliver. In support of Barlow's position, the authors draw from their own clinical practice with special psychiatric populations, such as adults with severe and persistent mental illness and behaviorally disordered youths, to illustrate some potential unique roles for psychologists. The authors believe psychologists are uniquely trained to design such individualized functional behavioral analysis protocols because of their training in research design, behavior analysis, learning theory, and behavior change. Psychologists may also be uniquely qualified to design, implement, and evaluate many specialized therapy techniques, as Barlow has outlined and suggested.     

'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.     

“Outsiders”: How some counselling psychologists construct themselves

The identity of counselling psychology in Britain is still developing. This study aims to contribute to our understanding of what counselling psychology is through an analysis of discourses that practitioners draw on when talking about their work. Drawing on data from interviews with eight practicing counselling psychologists, we identity a “maverick” repertoire and examine how it is used by the participants. This repertoire is used to characterize counselling psychology as occupying a position outside established schools of psychological therapy. We also identify how the maverick/outsider repertoire provides solutions to problems of internal consistency within counselling psychology. We discuss implications for the future and the importance of self-awareness for the profession.     

Profiling a Profession: A Victorian Survey Assessing Lay Attitudes Toward and Knowledge of Counselling Psychologists

The current study employed a mixed‐methods approach to examine perceptions towards and knowledge of counselling psychologists, including perceived differences between counselling and clinical psychologists. One hundred and fourteen adult members of the Victorian general public participated in the study and completed a 65‐item questionnaire, the Counselling Psychology Status Survey. As predicted, results from quantitative analysis showed that counselling psychologists were reported to be highly needed, valued, and respected by the current sample of Victorian residents. Respondents also reported a high level of confidence in counselling psychologists to treat various mental illnesses. Thematic analysis of qualitative textual data derived from written responses to an open‐ended question revealed that compared with clinical psychologists, counselling psychologists were understood to be less qualified, less skilled, and to work with less severe or complex client presentations. Taken together, results from this study suggest that although counselling psychology appears to occupy a positive public image, the importance of public promotion and awareness‐raising of the specialist profession of counselling psychology, and the continuing need for public education into the nature of psychological services and the qualifications, skills, and competencies of practitioners of psychological service provision, particularly compared with clinical psychology, cannot be underestimated.     

Suicide assessment and evaluation strategies: a primer for counselling psychologists

Suicide is a recognized national health risk in many countries. In order to effectively intervene in suicidal crises, it is important for mental health professionals to understand facts about suicidal behaviour, procedures for assessing an individual's risk of self-harm, and the evaluation of the lethality of a client's suicidal gestures. With updated knowledge and proper training, counselling psychologists can play a vital role in suicide prevention. This paper summarizes for counselling psychologists current statistics about suicide, general and specific risk factors for suicidality, and assessment tools used to evaluate suicidal risk.     

General practitioners' perceptions of psychologists: A response to the Medicare changes in Australia

General practitioners (GPs) have historically been at the centre of primary health‐care delivery in Australia, including delivery of mental health‐care services. Recent changes, however, by the Australian Federal government have led to the creation of a number of mental health‐care items provided by psychologists that are now available on the Medicare Benefits Schedule. The aim of the present study was to examine GPs' perceptions of psychologists and the ways in which GPs have responded to these policy changes in making referrals for mental health patients. Nine GPs were interviewed regarding the provision of mental health‐care services. Analysis of the interviews indicated a number of themes including the benefits of the new Medicare policy in increasing accessibility of psychologists, GPs' frustrations with the bureaucracy surrounding the use of this policy, GPs' knowledge about the specific skills and training of psychologists, and the importance of GPs' matching patients and clinicians. Recommendations are made to facilitate the professional and clinical relationship between GPs and psychologists.     

The future of Canadian counselling psychology: Doctoral students

Little is known about the overall characteristics and beliefs of Canadian counselling psychology doctoral students. An online survey was administered to 43 doctoral students across all Canadian counselling psychology programmes, representing an approximate 26% response rate. Results indicated that the average age of doctoral students in the sample was about 32 years and that the majority were women (about 77% in the sample). Additionally, findings can be taken to suggest that participants were satisfied with their choice of counselling psychology as a career. The doctoral students sampled primarily practised from an integrationist theoretical standpoint and spent very little of their practice time providing formal psychological assessment services or career counselling. Participants generally intervened through individual counselling or psychotherapy and were focused on disorder treatment rather than preventative or developmental services. Curriculum changes that should be considered from the results of this study pertain to the topics of assessment, career counselling, advocacy/media skills, professional identity development and prevention/developmental interventions. The results of this study can also be taken to predict characteristics of the next generation of Canadian counselling psychologists and the future practice of counselling psychology in Canada.     

Stresses reported by UK trainee counselling psychologists

This study examined stressors and psychological distress in 109 UK counselling psychology trainees. The research focus was two-fold. What is the profile of stressors that counselling psychology trainees report about the components of training? What relationship is there between this profile, and other characteristics of trainees, including their level of current psychological distress? Data from a stress survey and from the General Health Questionnaire were examined. High stress scores were found on three aspects of the stress survey (‘academic’, ‘placements’, ‘personal and professional development’), but not–surprisingly–on the aspect, ‘lack of support systems’. Significant stress differences were reported for gender and age of participants, and highly significant positive relationships were found between General Health Questionnaire and stress scores. Overall, the results suggest actions to be taken. Further research is needed to clarify unavoidable and avoidable stressors in training, and the reduction of trainees’ experience of training stress to the necessary minimum needs to be adopted as an active target by programmes.     

Counselling psychology in South Africa

The origin and development of counselling psychology in South Africa has been profoundly influenced by the country’s sociopolitical history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country’s mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentialising or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country’s health care and education systems.     

Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.

Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life. Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting (ANV); the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists. This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists. Seventy-two consecutive cancer patients with ANV were randomly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists, 6 clinical oncologists, or 10 oncology nurses. The treatment was found effective in reducing anticipatory nausea, anticipatory vomiting, posttreatment nausea, and posttreatment vomiting compared to control patients, with no significant differences in effectiveness found between clinical psychologists and oncology staff. Although medical personnel should not engage patients in psychotherapy or other interventions that cannot be completed successfully, they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care.     

Cost-effectiveness analysis: A primer for psychologists

Given the more to managed care and capitated budgets, psychologists mus tnow prove that the treatments being offered are clinically effective in allaying symptoms and are cost-effective. Cost-effectiveness analysis (CEA) is often seen as a daunting task requiring one to pour over spread sheets with little empathy for the patient. This article attempts to break this daunting task down into nine reasonable steps. By using CEA, psychologists will have the data to compete for dollars in this time of limited funds. An overriding attempt was made not to use excessive technical jargon or formulas in this review. The goal of this article is to offer the average practitioner, clinic director, or department chair an casily understood method that can be adapted and applied to his or her unique environment. If psychologists, individually and as a profession, choose to ignore the power of CEA, other professionals may step in and take this power and control our future.     

A model of short-term counselling in primary care

Counselling in prima y care settings has received much interest throughout Britain. Many surgeries employ counsellors or psychologists as part of the primay health care team. This paper describes a model of primary care counselling using an example of a case encountered in general practice. It emphasizes the advantages of offering on-site counselling services, such as better possibilities of liaison with the referring doctor and coordination of patient care. Progress was made in seven sessions of short-term cognitive-behavioural treatment and a more stigmatizing referral (for example, to psychiatric services) was avoided. The case can be seen as an appropriate referral in the context of primay care counselling and illustrates the benefit of this approach to the treatment of psychological and social problems in general practice. Names and details have been changed to preserve confidentiality.