Tools for Many Trades: Reaffirming the Use of Grief Counselling by Health, Welfare and Pastoral Workers

The use of counselling is increasingly questioned as an appropriate and viable activity for professionals in statutory and general settings whose work roles and tasks are varied. This paper looks specifically at grief counselling and examines some of the reasons why applications of grief theories and grief counselling by such workers have been narrow and limited. It then suggests a framework for teaching the subject, offering relevant applications. Finally, it points to developing areas of grief counselling in multi-disciplinary contexts and argues that working with grief and loss must be recognised and fostered as core, generic skills for the non-specialist.     

Professional and ethical dilemmas experienced by counselling supervisors: The impact of organisational context

This paper examines the ethical and professional dilemmas faced by counselling supervisors working in a range of diverse organisational contexts. Questionnaires and interviews were used to explore supervisor experiences of working in counselling agencies, industry, education and health service settings. Ethical and professional dilemmas outlined by supervisors were examined in connection with their role within the organisation. It was found that both external and ‘in‐house’ supervisors were exposed to dilemmas focused around issues of responsibility, confidentiality, boundaries, professionalism, relationships, contracts and ethical practice. Supervisors were divided in their opinions about playing a more active, educative role within organisational systems. There was considerable support for the construction of more explicit relationships between supervisors and their employing organisation.     

Laying mother to rest: Working with grief-related nightmares through exposure therapy and imagery

Cognitive behavioural therapy of unresolved grief is usually presented as a fairly rapid approach for reducing psychological problems. The present case study shows how behavioural cognitive and symbolic approaches can be integrated to foster griefwork at several levels. The counselling adopted a behavioural exposure technique specifically for eliminating a significant anxiety-provoking obstacle to mourning, namely the experience of recurrent death-related nightmares that surfaced every time the bereavement was recalled in depth. The client was also encouraged to explore the symbolic meaning of the dream images and in drawings modified these images in ways that helped to alleviate her feelings of long-standing guilt. Drawing as well as verbal representation could also be regarded as an effective form of exposure therapy, helping the client to stay with the anxiety-provoking death-related images. The client once relatively free of nightmares could mourn the loss of the mother more deeply in subsequent less directive counselling sessions.     

The impact of Christian counselling on survivors of sexual abuse

The absence of research and growing involvement of Christians in all areas of counselling gave rise to this study which explores the impact of Christian counselling on adult survivors of sexual abuse. The sample of 44 women and 5 men from an inter-denominational, self-help network, completed a self-report questionnaire of perceived Christian and professional counselling experiences involving issues of trust, power, directive approach, use of prayer and Scripture, responsibility and outcome. Results show that Christian counselling is experienced as qualitatively different from professional counselling: Christian counsellors are perceived as significantly more directive and more powerful than professional counsellors and the overall outcome was perceived more negatively. A number of key factors were identified which influenced the negative experience of some Christian counselling. These included having experience of professional counselling, an emphasis on the use of prayer and Scripture, perceiving the counsellor to have different goals from the client, feeling blamed for continued distress and having prior experience of prayer ministry. Implications for counselling practice and training are discussed.     

Private work in public places: Confidentiality and role tensions in a university counselling service

This paper aims to explore issues of confidentiality relating to working with undergraduate and postgraduate students in a university counselling service. The context of a counselling service within our institute of higher education has to be understood in its relationship to academic, administrative and managerial staff, to medical and psychiatric services personnel and to the wide range of other student support and welfare services in the organization whether run by university staff or the students' union. Some reflection will be given to the need for clarity in the range of roles counsellors have to play within the different functions of the university. The client-counselling relationship cannot be seen as a dyad but as a triad or an even more complex constellation of relationships when regarded in an institutional context. The central premise is based on understanding the conscious and unconscious dynamics in the institution and how these impinge on the relationship between client and counsellor in challenging or assuming the confidentiality held by the service. Such boundary issues are identified in consultation and referral, breaking confidentiality, referral of disruptive students, calls for help and holding confidentiality. The case material drawn on to illustrate these five areas is also described in terms of anxieties raised and how these are projected, introjected and contained.

Within the service client and counsellor contract to work together. It is made clear that counselling is a professional relationship with agreed boundaries and a commitment to confidentiality. This is crucial to the working relationship and is a means of providing the client with both safety and privacy. Any limitation on the degree of confidentiality offered may reduce the usefulness of counselling. Bound by his or her professional code of ethics the counsellor will reach an agreement with the client at the outset about the extent of confidentiality they are offering, take care not to disclose information given in confidence and, when possible, be able to negotiate any change in agreement with the client.

Exceptional circumstances which may occur and give rise to the counsellor's decision to break the confidentiality formerly agreed between him or herself and the client are those which give grounds for believing the client will cause serious harm to others or themselves or have harm caused to them. Reference will be made to the role of consultant supervision in such situations and how any breaking of confidentiality can best be minimized. Attention will be given to the relevant ethical codes to which counsellors adhere and the issues of confidentiality within the legal process as well as whether the requirements of providing counselling services for students in higher education impel us, logically and practically, towards certain policies in regard to boundaries.     

A qualitative study of client experiences of working with novice counsellors

Aims: This paper reports on a qualitative analysis of written accounts by clients who participated in a counselling relationship with beginning-level trainees. The purpose of the study was to explore how clients experience the process of counselling with novice practitioners. Method: Consensual qualitative research was used for data analysis. Findings: Three general thematic categories were identified – client perceptions of self in counselling; client perceptions of the counsellor; and client perception of the counselling process. Conclusions: Overall, the findings suggest that these clients saw the interpersonal qualities and skills of the counsellor as major contributors to their experience. Implications: Clinical training of novices should start by developing the interpersonal and collaborative skills of trainees.     

Fight the power: A heuristic exploration of systemic racism through dreams

Systemic racism, like many forms of difference and diversity, is poorly understood within the realms of counselling and psychotherapy. Whereas our profession has shied away from using its skills to explore the meaning and relevance of racism, this author over a number of years has studied many forms of intersectional otherness and recognises that racism is as much a relational experience between subject and other, both internally and externally. This paper therefore explores how an internalised experience of systemic racism can be understood through client work and dreamwork, offering ideas as to how the dreams of the racialised other may be understood; the symbolism, and the relevance of the racial complex hidden within them.     

Using a cross‐contextual qualitative diary design to explore client experiences of psychotherapy

Qualitative research in counselling and psychotherapy has largely been based on interviews carried out with clients and therapists. However, other approaches to qualitative data collection are possible. The present paper uses a diary design to explore the connection between what goes on in therapy sessions, and client activities and experiences in other contexts. Clients and counsellors kept diaries about significant aspects of therapy sessions, while clients also kept diaries about new and different experiences in other contexts in their lives. Ethical and practical issues involved in the use of diaries are discussed, and the methods that were employed to analyse diary‐based data are described. The types of findings that the study generated are presented, along with discussion of their implications for research into client experiences of therapy.     

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 evaluation of the long-term outcomes of small-group work for counsellor development

A questionnaire was designed which enquired into the long-term professional applications and outcomes of Rogerian small-group and Tavistock Group Dynamics training. The 92 respondents were graduates of either a Master's degree or a Diploma in Human Relations or Counselling Studies in a university course where a 'small-group' module was a compulsory element of the taught course. Respondents were drawn from graduates of these one-year full-time or two-year part-time courses over a 21-year period. All respondents were involved either directly in professional or voluntary counselling, in the application of counselling skills in their work, or in training in counselling and counselling skills at work. The respondents reported no loss of learning gains over time: ascribed the application of many specific counselling skills to the small-group training process; reported on the affective component of the learning process; and provided only minimal evidence of forms of psychological damage which could be directly ascribed to the experience. These outcomes have to be considered in the light of the relatively low response rate of 33% and the difficulties in monitoring the precise behaviour of the facilitators in the groups.     

Theory in counselling: Using content knowledge

An underlying theoretical principle of person‐centred counselling is that this approach has no requirements for a content knowledge base in terms of client groups and client issues. This is also the position implicit in UK professional accreditation criteria. Yet counsellors do acquire and do use content knowledge in addition to knowledge of process. Thus professional ethos and professional practice are, it is suggested, at variance.     

Suitability and context for brief therapy

Abstract

The main point of this paper is that a client's suitability for brief or time-limited therapy is determined by various factors, including context. There is still agreement on the validity of Malan's selection criteria, which included ‘mild illness, recent onset, high motivation and response to trial interpretation’, yet many additional issues have since emerged and need to be considered. For instance, the counsellor's suitability, training and work experience, the counsellor's assessment skills and ability to establish a dynamic focus, the clients' capacity for self-reflection, their ego strength and their response to a trial therapy in the first session. Then there is the importance of the various contexts in which nowadays much brief counselling is offered free to clients, whether in education, at the workplace, in primary healthcare settings or by charitable organizations. This means that issues of money and markets have come to the fore and an initial differential assessment needs to be carried out in order to decide which method or model of therapy is best for the client. Matching the counsellor's personality to the needs and to the pathology of the client, and matching the treatment to the client's developmental stage or life stage crises are other aspects of the work, which determine the issue of suitability. In the end as always there is much that remains unknown about what works for whom and how the client's decision to take up help is made.     

The notion of professional identity among practitioners working with asylum seekers. A discursive analysis of practitioners’ experience of clinical supervision and working context in work with asylum seekers

The present study analyses interviews that were conducted with eight professionals who have provided therapeutic work to asylum seekers. It explores practitioners’ perspective on the impact of clinical supervision on their work as well as the impact of their working organisational context on the way they experience their professional identity. The findings of the study suggest that the experience of working with this population produces a notion of professional identity that offers a more politicised engagement with clinical work. This politicised notion of professional identity is reflected in the practitioners’ perspective on the use of clinical supervision as well as in the manner in which they position themselves within their organisational context.     

How effective are minimally trained/experienced volunteer mental health counsellors? Evaluation of CORE outcome data

Background: Existing research findings indicate that minimally trained/experienced paraprofessional counsellors can be as effective as professionally trained and experienced counsellors. More research into the effectiveness of paraprofessionals with specific client populations is required to determine the conditions under which they can be most effective. Aims: To evaluate the effectiveness of a group of 12 minimally trained/experienced volunteer mental health counsellors. Method: Data were collected over a one year period on 118 clients referred to a voluntary sector counselling agency. The CORE-OM was used to measure clients' levels of distress on a session-by-session basis. Clients and counsellors also completed a range of additional self-report measures. A benchmarking strategy was used to evaluate the outcomes achieved by participants in this study against three benchmark studies selected from published literature. Results: Paraprofessionals in this study were less effective than their professional counterparts. Results showed that participants in this study achieved an effect size of .70 compared to effect sizes of 1.36, 1.39 and 1.42 in the selected benchmark studies. Implications: Findings suggest that minimally trained/experienced paraprofessional counsellors working in mental health settings may benefit from longer and more targeted training programmes before engaging in practice. Conclusions: The benchmarking strategy provided a valuable and practical means of evaluating the comparative effectiveness of paraprofessional and professional counsellors. Findings should be interpreted cautiously as the selected benchmarks are not precise measurements and may not reflect the organisational factors operating within voluntary sector counselling agencies.     

The context of counselling: A neglected dimension of trainings research and practice

The context of counselling includes such factors as the physical environment of the counselling room, the emotional climate of the counselling agency, the relationship between the agency and the community it serves, and the cultural beliefs and values which inform both counsellor and client. It is argued that these factors can make a difference to the relationship between counsellor and client, and the process and outcome of counselling. It is suggested that contextual issues have been largely ignored in counselling theory, research and practice, and that increased attention to context has the potential to contribute to the creation of more responsive and effective counselling services.     

A qualitative content analysis of ChatGPT's client simulation role-play for practising counselling skills

Role-play is often used as a pedagogical technique by counsellor educators to help counsellors-in-training (CITs) learn and practise counselling skills. This study used qualitative content analysis to assess the effectiveness of Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI) chatbot, in simulating client role-play to facilitate practising counselling skills. The author used 10 case vignettes to conduct a simulated role-play where ChatGPT was asked to simulate the client and author as counsellor. The results indicated that ChatGPT demonstrated authenticity, consistency, appropriate emotional expression, cultural sensitivity, empathy and self-awareness while portraying the client. However, at times, ChatGPT's responses to the counsellor's questions appeared overly idealised, lacking the authenticity typically observed in real clients. Furthermore, ChatGPT, as a simulated client, lacked non-verbal cues, limiting the overall experience of counselling skill practice. Recommendations for CITs and future research are discussed.     

The challenges of designing and piloting a system for measuring the impact of counselling provided by a national voluntary agency

This paper describes the issues, processes and difficulties encountered and solutions proposed when introducing an evaluation system into a large and complex voluntary organisation providing counselling and relationship support services. The organisation Relate has 2,000 counsellors in over 600 locations operated by a network of 81 Relate Centres, and over 140,000 people use its services annually. The present project arose from a need clearly identified at a Mental Health Foundation conference in 1993, for a common measure to evaluate ‘talking’ therapies; to identify ways of measuring costs and benefits; and to assess the skills and competencies of therapists. This project set out to (1) identify and pilot a validated scale that could demonstrate the value of Relate; (2) develop and pilot a further measure of Relate's work, broader than the validated scale, in order to foster organisational learning and develop good practice. The pilot encountered a range of methodological challenges, and it is believed that recognition of these might smooth the way for any other similar organisation planning to develop an ongoing system for evaluation of counselling and relationship support.     

A feasibility study of the systematic evaluation of client outcomes in a voluntary sector counselling agency

There is an increasing demand on voluntary sector counselling agencies to evaluate the effectiveness of their work with clients. A pilot study was carried out in a voluntary sector counselling agency to assess the feasibility of adopting a well‐established evaluation system (CORE) designed to measure client outcomes. The paper describes the issues and complexities involved in introducing such a system, and explores the impact of the evaluation on counsellors, staff and users of the service. It is suggested that evaluation can play an important role within voluntary organisations in enabling counsellors and staff to reflect on their work.     

Grief Counseling: A Funeral Home—Based Model

Loss and grief are issues that require special understanding and skills from the counselor. This article describes how one funeral home implemented an innovative response to loss involving death by inaugurating a thorough professional grief counseling program for its clientele and the community it serves.     

Counselling psychologists' perceptions of the impact of mandatory personal therapy on professional development--an exploratory study

A qualitative study was carried out with recently qualified and trainee counselling psychologists to investigate their opinions as to the impact of mandatory personal therapy on their professional development. The methodology employed was grounded theory using data obtained from indvidual and group interviews. The results indicate that mandatory personal therapy can lead to perceived positive outcomes in terms of professional development including: a sense of the self as a professional through developing reflexivity as a result of being in the role of client; socialization into a professional role through validational and normative experiences such as the therapist modelling good and poor practice; support during times of personal difficulty; and, personal development that leads to a perceived improved ability for the participant to distinguish between personal issues and those of the client. An important effect for participants who did not have a previous substantial experience of personal therapy appeared to be the validation of therapy as an effective psychological intervention.