Referring patients to counsellors in primary care: Qualitative investigation of general practitioners’ perceptions

Despite growing evidence of the effectiveness of counselling in primary care, questions arise concerning the role of general practitioners in the referral process. This involves both liaison with counsellors and the management of people who do not wish to see counsellors. Respondents (n=23) in this qualitative study of general practitioners’ perceptions were clear about which patients should be referred to counsellors, based on guidelines. Additionally, these doctors perceived their role and skills as negotiating with their patients about referral to a counsellor, and managing patients who are either waiting to see a counsellor or who prefer not to see a counsellor. These doctors feel inadequately trained in managing this latter group, whose outcome they perceive as unclear. Despite this, respondents accept a role in ongoing support for their patients with consequent training issues for doctors and opportunities for liaison and mentoring by counsellors.     

Clients' suitability for counselling: The perception of counselors working in general practice

This study investigated the attitudes of 112 counsellors in general practice towards various factors concernig the selection of clients. Response indicate that counsellors are influenced, not only by diagnostic criteria, and other factors relating to the client, but also issues relating to the counsellor and the setting in which she or he works. The diagnostic critreria whcih seem to be considered most important are desire for change, motivation for therapty and evidence of psychopathology, althoug there is no clear consensus about the criteria overall. Importance varied according to the age and sex of the counsellor, but not by the experience, training, model of working, desire for further training, or number of sessins available.     

Research into the organisation,training and effectiveness of counsellors who work for free

The activities of voluntary or ‘paraprofessional’ counsellors, who work for free, represent a highly significant component of the delivery of psychological therapy in Britain and other countries. However, in recent years there has been relatively little published research into issues associated with the provision of service by counsellors who work on a voluntary part‐time basis, and who typically receive limited training and supervision. This paper introduces a special theme section on counselling in the voluntary sector, which highlights some recent examples of research into the context, organisation, training and effectiveness of such counsellors. Some suggestions are made concerning the research agenda for counselling in the voluntary sector.     

What do employers want of counsellors and counseling training?

Abstract

A Psychotherapy and Counselling Network, funded by the Department for Education and Employment, was researching employment and training of therapists and counsellors during the period September 1996 to April 1998. Its main task was examining the relevance of current psychotherapy and counselling training, as perceived by the courses, by the graduates and by the employers of psychotherapists and counsellors. This article summarizes the work carried out in the project, drawing particular attention to what employers might be looking for when they interview candidates for counsellor and psychotherapist posts.     

Genetic Counsellors and Private Practice: Professional Turbulence and Common Values

Genetic counsellors face tensions between past and future identities: between established values and goals, and a broadening scope of settings and activities. This study examines the advent of genetic counsellors in private practice in Australia and New Zealand from the perspectives of the small numbers working in this sector and those who have only worked in public practice. Semi-structured interviews were conducted with 16 genetic counsellors who had experience in private practice, and 14 genetic counsellors without private sector experience. Results demonstrated that circumstantial and personal factors can mitigate the challenges experienced and the amount of support desired by those who had established a private practice, and those who were employed by private companies. Notably, most participants with private sector experience perceived themselves to be viewed negatively by other genetic counsellors. Most participants without private sector experience expressed concern that the challenges they believed genetic counsellors face in private practice may impact service quality, but wished to address such concerns by providing appropriate support. Together, our results reinforce that participants in private and public sectors are strong advocates for peer support, multidisciplinary team work, and professional development. These core values, and seeking understanding of different circumstances and support needs, will enable genetic counsellors in different sectors to move forward together. Our results suggest supports that may be acted upon by members of the profession, professional groups, and training programs, in Australia, New Zealand, and overseas.     

Exploring Perspectives on the Hiring of School Counsellors: from Directive to Direction

Currently, there is no national framework or standardized procedure for the selection and recruitment of counsellors for schools in India. Hiring as a practice aids the selection of a professional counsellor in alignment with the needs of the school. In order to bring this area into research focus, the present study employs a qualitative design to explore perspectives of five school principals and five school counsellors on the hiring of prospective school counsellors. In-depth interviews were conducted with the participants, and data collected were subjected to thematic analysis. Findings describe reasons underlying the hiring of school counsellors, the criteria that are used to guide selection, the process of hiring itself and issues currently encountered during selection. They indicate a need for structured formal guidelines for selection and recruitment of school counsellors at the school and policy level. On the basis of findings, a checklist is presented to serve as an initial guide in the hiring process in the absence of a defined system of selection and recruitment.     

Spontaneous Self‐Practice of Cognitive Behavioural Therapy (CBT) by Aboriginal Counsellors During and Following CBT Training: A Retrospective Analysis of Facilitating Conditions and Impact

Previous cognitive behavioural therapy (CBT) training studies have suggested that therapists who practice CBT strategies on themselves during training may experience professional and personal benefits. However, it has also been reported that some CBT trainees are reluctant to engage in self‐practice. The present study reports an incidental finding from a CBT training study with Aboriginal counsellors: all five counsellors reported that they practiced CBT techniques on themselves without specific encouragement by the trainers to do so. This paper therefore posed three questions: (a) Why—in contrast to some other trainees—did this group choose to apply CBT to themselves? (b) How did they apply it—with what purpose, in what contexts, and which skills? (c) What was the impact of CBT self‐practice? Data from the group's reflections were qualitatively analysed by two of the researchers, and “member checked” by the remainder. Results indicated that the counsellors were motivated to practice CBT on themselves for two principal reasons: the value they placed on CBT, and their personal need resulting from the high number of crises experienced while living and working in their communities. The counsellors reported practicing CBT in a wide variety of contexts as part of their learning. As in previous studies, the impact of CBT self‐practice was that it increased their confidence and competence as therapists. It also appeared to be a valuable burnout prevention strategy. If the results are generalisable, they suggest that self‐experiential training in CBT may be a culturally responsive and adaptive way for Aboriginal counsellors to enhance their learning of CBT skills.     

Counsellors' attitudes towards Disability Equality Training (DET)

This paper explores the attitudes and conceptions held by trainee and practising counsellors towards people with disabilities. Awareness of counsellors' own views of disability and impairment can complicate the counsellor-client relationship when the latter is seen primarily from a deficiency model perspective or self-defined model of disability, rather than a person in their own right. DET was introduced to 25 counsellors on a postgraduate training programme. Participants indicated that coverage of disability awareness and equality issues was vital if they were to reflect the principles of open access to counselling services for all, as set out in the Disability Discrimination Act Part III (1996, 1999). Benefits and implications of inclusion of this subject area in counsellor training and suggestions for content are considered in the light of the author's own experience of counselling as a disabled person.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.     

An exploration of the experience of Christian counsellors in their work with both Christian and non‐Christian clients,with particular reference to aspects of cultural transition

Aim: This study explores the experience of Christian counsellors working in both Christian and secular settings, paying particular attention to the possibility of regarding their development as a form of cultural transition. Method: Heuristic methodology was used, interviewing 22 counsellors with varying churchmanship (i.e. Christian tradition/denomination) and counselling training. Findings/Discussion: A spectrum of experiences with both Christian and non‐Christian clients emerged. The level of overtness of the counsellors’ faith with these clients varied considerably. Parallels with the experience of these counsellors and that of immigrants in terms of cultural transition are discussed. Conclusions: The experience of Christian counsellors differs with respect to the level of Christian influence (i.e. Christian or secular input) in training, supervision and work context. Those with higher secular influence have less difficulty working with clients with different belief systems and values. Implications: Christian counsellors need to be more reflexive with respect to the effect of their own value systems when working with clients, particularly if they work mostly in a Christian context. Trainers need to be aware of cultural transition aspects in the development of counsellors who have a Christian faith.     

Theoretical orientation and reported practice: A survey of eclecticism among counsellors in Britain

There is an increasing trend for counsellors to report that their practice is based on a combination of methods and approaches, rather than being grounded in a 'pure' model. However, there has been a lack of research on the proportion of counsellors in Britain who define themselves as eclectic or integrative in orientation. This study reports on a survey of eclecticism and integrationism in counsellors and other therapists in Britain. Results indicate that as many as 87% of counsellors can be regarded as taking a 'non-pure-form' approach of some kind. Issues in interpreting data on counsellors' self-reports of orientation are discussed, and implications for training and further research are outlined.     

Objections to personal counselling in schools

This paper seeks to identify some of the more compelling arguments put forward by those who oppose or criticise personal counselling in schools. These arguments cannot be dismissed lightly, and counsellors will have to give them serious consideration if a satisfactory resolution of the issues is to be achieved.     

Evaluation of a microskills programme with field-based counsellors: Effects on core attitudes and counselling skills

Two issues relevant to the role of microtraining in counsellor training are examined. Firstly, due to the increasing use of the microcounselling framework for training counsellors, either directly or indirectly, in the Rogerian attitudes, the effects of such a programme on counsellor attitudes was investigated. Secondly, although microskills training has been generally found to improve and increase trainee's helping skills usage and effectiveness, its effects on field-based counsellors have rarely been evalulated. Thus the second objective of the study was to examine this issue. The subjects were 12 counsellors from a number of counselling agencies. Six of these counsellors participated in a microcounselling programme which taught the skills of nonverbal communication, questioning, reflecting, listening, self-disclosure, reinforcement, opening and closing. The data base for the study consisted of videorecordings of each subject's participation in two extended interactions—one involving an individual discussing a real concern, and the other involving an individual discussing a simulated concern. Various measures of counsellor attitudes, effectiveness, skills, and actual behaviours were obtained. Comparison of the experimental and control groups indicated that the microcounselling programme had little effect on any of the aspects of counsellor performance examined. It is concluded that, although aspects of the design may have influenced the results, an integrated microcounselling approach may be more effective in developing attitudes. In addition, it appears that the characteristics of a professional population, such as counsellors, may differ from those of novices, such that problems in effecting change in skilled performance will occur with the former group.     

Predicting Military Flight Training Success by a Compensatory Tracking Task

This study evaluated the validity of a compensatory tracking task for pre- dicting success in naval flight training. Its purpose was to determine if psychomotor test scores would add unique variance to the current aviation selection model. Aviation candidates (N = 187) admitted on the basis of current selection test scores were administered a 20-min computer-based tracking task before beginning flight training. Performance on the task was compared with flight training outcomes as measured by passlfailure and cu- mulative flight grade. The results indicated that the tracking task scores differentiated candidates who completed training from those who failed. Multiple regression analyses confirmed that the tracking task scores added unique variance to the current selection model.     

A profile of counsellors working in non-statutory alcohol services

There are 39 voluntary sector alcohol agencies in the UK who meet minimum standards of counselling set out by the national organization Alcohol Concern through their Volunteer Alcohol Counsellors Training Scheme (VACTS). This paper reports on a study to create a profile of volunteer counsellors who work in VACTS-recognized agencies. Fifeen agencies agreed to take part in the study, and 141 counsellors completed and returned a mailed survey questionnaire, to elicit information about demographic characteristics, current and previous counselling training, reasons for undertaking the VACTS training and level of experience within agencies. The results suggest that this cohort of counsellors tend to conform to the volunteer stereotype of the middle-aged middle-class woman. Many counsellors utilize their experience within agencies to develop counselling skills, often in connection with further counselling courses, or to consider a change in career direction. Some counsellors wish to use personal experience of alcohol problems to help others undergoing similar difficulties. In contrast to those in the generic volunteer field, counsellors appear to retain long-term involvement with their agencies. The study concludes that alcohol services in the UK rely greatly upon a group of committed and competent volunteers to deliver individual counselling to problem users of alcohol.     

How honest do counsellors dare to be in the supervisory relationship?: An exploratory study

A study was conducted to investigate the extent to which psychodynamic counsellors feel able to disclose sensitive issues in supervision. Ninety-six counsellors in supervision responded to a questionnaire that asked about supervision arrangements, the supervisory working alliance, and the likelihood of disclosing issues such as erotic feelings towards clients and discomfort with the supervisor. Results showed that supervisees were likely to disclose more in individual rather than in collective supervision, when their supervisor was someone whom they themselves had chosen rather than had allocated to them, and when they were supervised independently of the setting in which they counselled rather than in-house. There was a positive correlation between the quality of the supervisory working alliance as experienced by the supervisee and the extent of his or her disclosure. Implications of counsellors feeling inhibited from disclosing particular issues in supervision, and the impact on the quality of their work with clients, are discussed.     

Spiritual Experiences in Counselling

Three questions are addressed. First, what are spiritual experiences? The one-two-three-infinity theory of spirituality is questioned, and it is suggested that there are at least nine distinguishable spiritual experiences. Second, how do we use such experiences in counselling? Examples are given of how this approach is useful in counselling. and particularly in dream work. The importance of intuition is stressed, and group work is discussed. Third, what are the implications for the training of counsellors? The issues of ego inflation and psychosis are raised, and it is suggested that the training of future counsellors needs to include the coverage of such issues, as well as the more general material dealt with in this paper.     

Gender Essentialism and Responses to Candidates’ Messages

People often form negative attitudes against those who deviate from gender norms. Within the political realm, this has the potential to translate into effects on perceptions of candidate likability and traits. Female candidates who tend to focus on issues stereotypically thought of as feminine are generally more positively evaluated than those who focus on stereotypically masculine domains. The current studies investigate whether these effects vary depending on the extent to which people endorse gender essentialism, which is the tendency to attribute gender differences to relatively more intrinsic, innate, and immutable factors versus believing that gender differences are largely due to cultural and learned factors. Current data with adults across two studies suggest a number of interesting findings: Evaluations of candidates depended on an interaction between respondents’ gender essentialism and whether or not the candidate’s message fit traditional stereotypes. In particular, high essentialist respondents felt significantly more negative toward male candidates with nonstereotypic messages.     

Supervising counsellors who work with survivors of childhood sexual abuse

This paper draws attention to issues for supervisors who support counsellors working with adult survivors of childhood sexual abuse from the perspective of trauma theory. The author describes the effects of vicarious traumatization and the unconscious dynamics that contribute to this experience. A narrative approach is included as another way of supervisors listening to distressing stories, both those of clients and of their counsellors, and reflects on the value of bearing witness to those stories in supervision and of recognizing them as a source of healing.