Specialist counsellors in primary care: The experience and preferences of general practitioners

This paper reports the results of a postal questionnaire, pre-coded by practice, which was sent to all 484 Leicestershire general practitioners. Practitioners who could and who could not refer to an in-house counsellor were compared in terms of their views about counselling provision, both within the practice and by agencies outside, such as mental health teams and specialist counselling services. General practitioners having access to a counsellor belonged to practices which were larger and had fundholding status. No signijicant dafference was found between rural and urban practices in their employment of an in-house counsellor, although those doctors working in rural areas were less likely to see this service as having a high priority. General practitioners without in-house counsellors estimated a referral rate (for counselling) in excess of twice that of the actual rate reported by those with practice counsellors. Those having an in-house counsellor were more likely to agree with statements that emphasized the benefits of this form of provision as against that offered by either mental health teams or specialist counselling services.     

Forgiveness and mental health practice

Forgiveness has become a very popular topic in recent years. To this end, various definitions and practices have been offered to facilitate it in counselling. This article seeks to provide some specific resources to the mental health counsellor when utilising forgiveness in counselling. By reviewing various psychological and theological definitions of forgiveness, guidelines will be offered to assist the spiritually sensitive counsellor to facilitate forgiveness that fosters further participation in the reign of God from a Christian spiritual perspective. Specifically, counsellors approaching the therapeutic use of forgiveness from Fowler's perspective address some of the concerns using forgiveness mainly as a therapeutic intervention.     

'If you don't want to tell anyone else you can tell her': young people's views on school counselling

The aim of the research was to assess the views of young people about school counselling. In total, 415 pupils from five secondary schools took part in the survey. A smaller number of these pupils took part in focus groups (n=9) to explore their views in more depth. In general, the young people seemed to value having a school counsellor. Most were aware of the school counselling service, although a substantial number (21%) indicated a lack of awareness. For many who were aware, their knowledge of the service was limited. Just over one third of the pupils stated that they would go to see the school counsellor, and girls were more likely to state this than boys. The confidentiality of the service was perceived to be one of the benefits. However, this was also reported to be a hindering factor—the concern that it may not, in fact, be confidential. Two other main reasons for not accessing the service were the counsellor being a stranger and (for boys in particular) a concern about other people finding out (associated with the social stigma of going for counselling). Suggestions to improve the school counselling service included a room in a discrete location, better promotion of the service, more counsellors or a full-time counsellor, and ways to get to know the counsellor better. Those responsible for developing and managing school counselling services should consider these suggestions.     

Dual realities – The search for meaning: Psychodynamic therapy with physically ill people

Abstract

We summarize Kohut's (1971) bi-polar self which enables counsellors to understand and treat narcissistic behaviours and narcissistic personality disorders in a psychoanalytic framework. After Patton and Meara (1992), we describe Kohut's formulations regarding self-development and disorders of self and how such formulations inform critical components of psychoanalytic counselling with particular emphasis on the explicit and implicit strategies and characteristics the counsellor brings to the process. Finally, we suggest that a promising arena for future theorizing and applications of Kohut's ideas is consultation with parents, teachers and other community leaders to help prevent or remedy psychological self-injuries with systemic interventions outside short-term counselling or long-term therapy.

We have suggested that Kohut's self psychology is a good vehicle for understanding what brings a client to counselling: namely, disorders of the self or self-injury. We review strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We also examine implicit qualities (beyond the achievement of a mature bipolar self) we believe a counsellor or any facilitator must have if counselling or other helping relationships are to be effective. We purpose further conversations and empirical analyses which specifically and conceptually link critical components of psychoanalytic counselling to self psychology and to essential counsellor traits or virtues that seem intrinsic to good counselling practice.     

Towards networking in counselling: a follow-up study of Finnish school counselling

A follow-up study (1990-1997) and in-depth interviews on school counselling practices and problems in Finland showed that in the last 10 years the work of the school counsellor has extended and become more diversified. This article analyses this change in school counselling in terms of the problems and core tasks of counselling and the new challenges faced by Finnish counsellors, such as dismantling the traditional gender divisions in working life and counselling for immigrants. In addition, the article examines how school counsellors have attempted to solve the problems related to their work, for example, by establishing counselling networks inside and outside the school.     

Pilot randomised controlled trial of counselling in a community mental health setting: Pitfalls and learnings

The establishment of counselling and psychotherapy as “evidence‐based” interventions is contingent on the effective implementation of randomised controlled trials (RCTs) in real‐world clinical settings. This paper identifies some of the pitfalls that led to the termination of a practical RCT in a community mental health setting. It reflects upon the significance of the lessons learned by drawing on similar challenges that are documented in the wider literature. Issues surrounding staff turnover, counsellor engagement and procedural clarity are discussed, as is the conflict between the time required for research procedures and counsellors’ clinical time constraints. In our recommendations, we recognise the decisive role of collaboration and counsellor motivation in research partnerships, and the significance of clinical relevance, communication, training and research co‐production in achieving them. Time commitment is identified as the pivotal challenge in the formation and maintenance of collaborative research, but one that also must be overcome for the advancement of the counselling and psychotherapy field.     

Counselling values and their relationships with self-efficacy among Chinese secondary school teachers in Hong Kong

Two-hundred-and-ninety-nine Chinese secondary school teachers in Hong Kong were assessed on their endorsement of counselling values using a 19-item self-report checklist, and on their perceived self-efficacy towards helping using the 10-item Schwarzer-Wegner scale. These teachers were found to share the same counselling values as counselling psychologists. They prized most highly the humanistic counsellor qualities, followed by counselling practice with a preventive, developmental and holistic perspective. Their relative endorsement of scientific values suggested that they were not resistant to the promotion of empirically supported and evidence-based treatment approaches. Teachers’ self-efficacy towards helping was also predictable from endorsing values related to interpersonal relationships and diversity in counselling practice. Implications of the findings for improved counselling training for teachers are discussed.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

Counselling for Tolerance

Tolerance is not neutrality, nor should tolerance in counselling be equated with a spiritual and emotional vacuum. Tolerance applies to style rather than stance, and a counsellor needs a conception of the ideal — broadly speaking, a moral position.
Originally proclaimed against religious and political tyranny, the political ideal of tolerance has in the twentieth century become confused with permissiveness, and is thus sometimes charged with generating many of the ills of modern society, including crime and family breakdown. Counselling has become the universal remedy, replacing punishment and compulsion.
The counsellor needs
(a) a view of human nature
(b) a conception of what is good for those possessing that nature.
Constants in the first mean there cannot be too much variation in the second. Society is varied and plural, so the counsellor must be non-judgemental, but while this means accepting the person , it does not necessarily mean endorsing the conduct.
A distinction is drawn between therapeutic and philosophical counselling; the latter considers a problem , where the former focusses on the client , but both may fall short of offering a holistic view. Counselling may also exacerbate some of the problems of modern life by too readily accepting the conditions which cause them. Some ethical problems raised by confidentiality and informed consent are discussed. It is concluded that the counsellor must be tolerant, but not morally ambivalent, nor a relativist.     

Cognitive behaviour therapy: an evidence-based clinical framework for working with dysfunctional thoughts

This paper discusses and illustrates three evidence-based clinical strategies that could be used to work with modifying clients’ dysfunctional thoughts. An effective strategy in shifting the client's dysfunctional thought is to engage the client in an examination of the logic of his/her dysfunctional thinking and to develop objective and abstract thinking that the client could relate to his/her personal experience/problem. Another useful strategy is to help the client to realize the consequences of holding on to his/her dysfunctional thinking and the potential benefits of changing. The purpose of the present paper is to discuss the conceptual and practical issues that underpin an evidence-based clinical framework for working with dysfunctional thoughts. This framework will be of interest to practitioners and counsellor working in diversity of settings such as schools, university and college counselling centres, mental health clinics and hospitals.     

Transformation in Counselling

The view is put forward that counselling appears to be undergoing a transformation which renders the old distinction between counselling and therapy no longer meaningful or practical. This transformation reflects the psychic backdrop of our times; it has come about because the needs of people seeking help, as well as the needs of those counselling, have altered and developed. Increasingly, clients are acknowledging the need for radical change which involves exploration of all levels of their being. This transformative work, a moving across inner barriers and coming into wholeness, necessarily involves active awareness of spirit. Thus it is no longer possible to be a client-centred counsellor without being willing to address the spiritual dimension ofhuman-beingness.     

Support and self-care: professional reflections of six New Zealand high school counsellors

In many Western societies there is increasing demand for counselling; in turn, heightened levels of support needs have been identified for counsellors themselves. Despite calls for practitioners to adopt a more proactive approach to self-care, research suggests many still pay insufficient attention to alleviating on-the-job stress or achieving ‘work–life balance’. These issues were examined within the context of inviting six high school counsellors in New Zealand to talk generally about their professional lives. The authors suggest findings support calls for counsellor education programmes to offer structured opportunities for trainees to reflect upon the task of discursively constructing professional roles.     

Subsequent careers of teachers trained as counsellors

This survey report is divided into six sections. First there is a detailed analysis of data concerning those who work as counsellors within schools. The second section compares this counsellor data with that obtained from a sample of students on full-time courses. Section three indicates the senior positions which counsellor-trained people have achieved in schools, while the next section looks at those employed in other non-counselling positions within the school. The fifth section indicates the various routes of possible mobility outside the school milieu which are open to trained counsellors. Section six deals briefly with a group of teachers interested in counselling who have not undergone full-time counsellor training. Finally, various questions raised by the study are posed.     

Running a counselling project in primary schools: The role of training and supervision

The provision of mental health resources for young children within a school setting is a challenging proposal. An early project by Kolvin et al. (1981) showed the efficacy of a number of interventions for disturbed children selected by assessment criteria. This highlighted the gap between mental health and education. A small-scale project operating in inner London utilizing volunteer counsellbrs is evaluated to examine the training and supervision needs of such counsellors if they are to be used to provide counselling services for children and, at the same time, further their own qualifications.     

Community Participation Needs of Families With Children With Behavioral Disorders: A Systems of Care Approach

The purpose of the current study was to convey findings regarding the community participation needs of families who have children with behavioral disorders. The changing focus of community-based service provision to the systems of care approach for children with mental health needs requires family input to identify and better address their needs. This study identified characteristics of community participation in families of children with mental health needs through a survey, using mixed methods design and purposeful sampling. Evolved themes supported challenges for policymakers to make changes in professional, school, and community supports. Occupational therapists have a strong skill set to offer these families and must work collaboratively with family organizations, provide support for successful engagement in desired social activities, and build adaptive behaviors in children with mental health needs.     

Counselling in primary care: past, present and future

The rapid growth of counselling in primary care has happened unofficially and almost by stealth over recent years until it has established a niche within many primary health care teams. If it is to survive following the latest reform of the NHS, it has some serious challenges to face. These challenges are to the very nature of counselling and involve the need to establish the professional identity of the counsellor in primary care. The current bias towards the regulation of health professionals also impinges upon counsellors in this domain, along with the need for their effective management and harmonisation of services within the health service. Evidence for the effectiveness of counselling is a pressing concern in a realm where the random control trial has reigned supreme. Whether or not counselling in primary care is subsumed into other health care professionals' roles is a matter for much speculation. Perhaps counselling will become 'medicalised' or perhaps it will develop further and continue to offer a different perspective on health and healing and remain in place to further enrich the services offered in primary care.     

Group Work in Counsellor Training: Research and Development in One Programme

Group work as an integral part of counsellor training appears to have been under-utilised. Certainly it is the case that empirical evaluations of such group work appear rarely in guidance and counselling journals. An attempt is made to remedy these deficiencies by reviewing studies relevant to counsellor training and to report on 17 years of research and experience with group work within a counsellor training programme at a New Zealand university.