Action: a bridge between vocational and mental health counselling*

A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.     

Gregersen's Vision of a Theonomous Universe

In his article, "The Idea of Creation and the Theory of Autopoietic Processes," Niels H. Gregersen has proposed an important thesis: God supports and sustains autopoietic processes in nature. This contribution underscores what Paul Tillich called theonomy , a conception of the divine presence or action as one which under-girds, makes possible, and brings to perfection the creature's autonomy and creativity. The concept of theonomy is represented not only in contemporary Christian theology, but also in the work of Alfred North Whitehead and the Japanese Buddhist thinker, Tanabe Hajime. Gregersen shows that this concept extends not only to existential realities, but also to science and the processes of nature. There are connections, as well as differences, to be noted between Gregersen and Whitehead. This train of thought would be further enhanced if it included a discussion of the concept of God as the power to be—a connection that certainly is implied in Gregersen's argument.     

The relationship between existential-phenomenological and cognitive-behaviour therapies

The tendency of GPs to cap the number of counselling sessions offered to their patients in primary care has led to an ongoing debate about the effectiveness of time-limited counselling and brief therapy models. the advantages and disadvantages of brief as opposed to open-ended models of counselling in primary care need to be considered from the point of view of the client, the counsellor and the GP. Given that outcome research shows no difference between the two methods, a cost-benefit analysis would indicate that, for the majority of cases, time-limited counselling works very well. But there is still a minority of clients who do need open-ended therapy, and their needs are not being served by the present NHS system. Counsellors should therefore not be debating for either brief or open-ended style in primary care, but should be organizing themselves into expanding the service to give GPs the choice of both approaches.     

Carers’ beliefs about counselling: a community participatory study in Wales

This interpretivist community participatory study explores carers’ beliefs about the potential usefulness of counselling in relation to the caring role. Twenty semi-structured interviews with carers were transcribed and analysed thematically. All participants thought counselling could potentially be helpful to carers, but their ideas about the ways in which it would help varied according to whether or not they had personal experience of counselling. Only carers with counselling experience had an awareness of counselling as focussing on changing feelings, thoughts, attitudes and behaviours. The implications of the findings for the provision of counselling services are discussed.     

Pastoral counselling in Britain: an introduction

A brief historical survey is given of the development of pastoral counselling in Britain. The positive contribution and qualities of the British pastoral counselling movement are acknowledged, but it is also recognised that the pastoral counselling scene in Britain is deeply fragmented and the causes of this fragmentation are briefly discussed. The articles in this symposium are welcomed as a sample of current thinking within British pastoral counselling. Four of the articles are fundamentally concerned with the nature and identity of pastoral counselling as a discipline, and another two explore specific elements of therapeutic practice (namely, prayer and forgiveness) that are historically associated with pastoral care. The presentation of original empirical research within some of these articles is also welcomed as a constructive development in the context of British pastoral literature.     

The politics of careers education and guidance: A case for scrutiny

Political aspects of processes involved in defining careers education and guidance are brought to light through an examination of debates surrounding the definition of guidance at four different points of the journey from policy to practice, and of related 'gaps' between 'theory' and 'practice'. It is argued that these 'gaps' cannot be adequately conceptualised within a curriculum evaluation paradigm. They result from the conflictual nature of curriculum change which, in this case, produced repeated contests over the definition of guidance, with different outcomes in different occupational settings. These outcomes, it is argued, were influenced not only by rational debate but by the distribution of power between the various groups of actors concerned. The politics of careers education and guidance are placed on the agenda for consideration by both researchers and practitioners.     

Exploitation in therapy and counselling: a breach of professional standards

Exploitation in therapy and counselling may occur in only a minority of cases, but when it does, its effects are potentially damaging to both the client and the profession. Exploitation in therapy may take the form of psychological, covert and overt abuse. The most reported form of abuse of the therapeutic relationship is of a sexual nature. However, psychological abuse usually forms the backdrop to sexual exploitation, preceding and perpetuating the sexual involvement. Sexual exploitation in therapy is an abuse of the power imbued in the therapist by nature of his professional role. It allows the therapist a sexual gratification which he would not have been likely to achieve outside the therapeutic relationship. The prevention of sexual exploitation in therapy is an issue of concern to training, employing and professional organisations who seek to maintain high standards of counselling delivery. Determining the variables which may contribute to exploitation is fundamental to avoiding its incidence. This paper discusses the factors underlying the use of therapy and counselling as a medium for therapist abuse. It examines (i) the prevailing conditions for abuse to occur, (ii) how the therapist overcomes client resistance, and (iii) the implications for the maintenance of professional standards.     

Counselling for Problem Drinking: Employee assistance programs versus employee counselling programs [A Commentary]

Employee Assistance Programs have received more attention in combatting alcoholism than have Employee Counselling Programs. The needs from which these two types of programs arose differ, yet the similarities between the two are greater than their contrasts. The importance in realisation of their similarities is that in so far that the spread of Employee Assistance Programs is restricted in the U.K. relative to other countries. A Comparison of the two types of program suggests there to be a greater potential benefit with the Employee Counselling Program, since it does not only have a curative element, but by its very nature, also a preventative one.Since the major characteristic of Employee Counselling Programs is to advise on coping strategies, problems tend to be brought earlier for counselling, and, indeed, by counselling antecedent problems, drinking problems still to be incurred are being negated.     

The dynamics of school-to-work transition processes of university graduates: An analysis of French data

Understanding the dynamics of school-to-work transition processes is of major interest for individuals involved in these processes, for guidance and counselling institutions, and for education policy. This knowledge is particularly important in order to assess the relevance of education inequality correction policies implemented in most countries of the European Union. On the basis of surveys of the school-to-work transition of university graduates conducted in France, this article demonstrates that transitional processes are governed by various dynamics (chaotic, determinist and stochastic). The article concludes that individual strategy and public policy as well as guidance and counselling should be adapted according to the nature of the transitional processes in which individuals are involved.     

Physicians’ views on men's mental health and the role of counselling services – a pilot study

This pilot study aimed to explore how physicians understand men's avoidance of mental health counselling services and to elicit physicians’ views on pairing mental health assessment with routine physical examination. Initially, physicians’ views on men's avoidance of mental health counselling services were explored through a focus group. A short survey exploring views on pairing mental health assessment with a routine physical examination was then developed and sent to 125 physicians at a local medical centre. Physicians discussions indicated that male socialisation processes, the stigma of needing help, and ignorance about counselling sessions, all contribute to men's avoidance of mental health counselling services. The survey results suggest that combining a mental health assessment with an annual physical examination was viewed positively by most physicians (80%), that they would encourage this approach (75%), and would appreciate the support of counselling services in this process (80%). However, these survey results were influenced by the age and sex of the physician. The focus group suggestion to pair mental health assessments with routine medical examinations, with support from counselling services, was viewed by most physicians as a positive way to engage men. Preliminary services could be established that utilise this approach and examine its efficacy.     

The Automaton Self: Defensive organisation,psychodynamics and treatment approaches

Abstract

This paper is not primarily concerned with the content of theory and what we then, in the light of this and of our own experience, say to our clients. Rather, it is concerned with the nature of this knowledge that we are using and that the client in turn uses and experiences in the counselling.

How, or the way in which, we know, defines our knowledge as much as the actual content of that knowledge. The paper delineates two fundamental ways of knowing. One is our ordinary practical and rational way of understanding reality and is usually about achieving some goal – this is what I am calling the product side of counselling: the other is concerned with our more immediate first-hand experiential knowing of ourselves and our world.

The paper opens with a definition of these two kinds of knowledge, product and process, and presents some clinical material to show how these different ways of knowing can have a real effect on the counselling. It then moves on to the question of why counselling trainings are becoming increasingly concerned with product knowledge, and ends with a discussion of how Freud himself was constantly using both ways of knowing as if they were the same, without understanding the implications of this for therapeutic practice.     

Comment on ‘counselling in dyslexia’ by T. R. Miles

Using as examples, the problems encountered when counselling dyslexics and their families, Professor Miles has drawn attention to a number of interesting issues which are relevant not only in counselling dyslexics, but also in counselling in general and, indeed in all forms of intervention and the giving of advice. I propose to deal with just three of those, namely the relationship between the counsellor and clients, diagnostic labels and ‘brussel-sprout therapies’.     

Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom

Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.     

Defining Nano,Nanotechnology and Nanomedicine: Why Should It Matter?

Nanotechnology, which involves manipulation of matter on a ‘nano’ scale, is considered to be a key enabling technology. Medical applications of nanotechnology (commonly known as nanomedicine) are expected to significantly improve disease diagnostic and therapeutic modalities and subsequently reduce health care costs. However, there is no consensus on the definition of nanotechnology or nanomedicine, and this stems from the underlying debate on defining ‘nano’. This paper aims to present the diversity in the definition of nanomedicine and its impact on the translation of basic science research in nanotechnology into clinical applications. We present the insights obtained from exploratory qualitative interviews with 46 stakeholders involved in translational nanomedicine from Europe and North America. The definition of nanomedicine has implications for many aspects of translational research including: fund allocation, patents, drug regulatory review processes and approvals, ethical review processes, clinical trials and public acceptance. Given the interdisciplinary nature of the field and common interest in developing effective clinical applications, it is important to have honest and transparent communication about nanomedicine, its benefits and potential harm. A clear and consistent definition of nanomedicine would significantly facilitate trust among various stakeholders including the general public while minimizing the risk of miscommunication and undue fear of nanotechnology and nanomedicine.     

Introduction to the Special Section ‘Innovative counselling and psychotherapy research methods’: Defining the future of counselling and psychotherapy research

In the call for papers for this Special Issue, we sought submissions that would introduce innovative methods with the potential to shape counselling and psychotherapy research into the future. We believe that we accomplished this goal and that this issue introduces a range of valuable examples of current innovations in counselling and psychotherapy research methods. Through the review process, we encouraged authors to offer practical guidelines on how to innovatively assess and analyse change and other relevant aspects of therapy. We also guided authors to not only provide the field with an update on cutting‐edge methodology, but also describe these methods in a practice‐friendly way. As such, the Special Issue aims at becoming a building block for future practice‐friendly research in counselling and psychotherapy.     

Survey of the Definition of Fetal Viability and the Availability,Indications, and Decision Making Processes for Post-Viability Termination of Pregnancy for Fetal Abnormalities and Health Conditions in Canada

The purpose of this study was to explore the definition of fetal viability and the availability, indications, and decision making processes for post-viability termination of pregnancy for fetal abnormalities and health conditions in Canada. An online survey of members of the Canadian Association of Genetic Counsellors, the Canadian College of Medical Geneticists, and the Canadian Society for Maternal-Fetal Medicine who provide direct counselling to, or management of, prenatal patients in Canada (total sample size 815). Results of this study showed that the majority of respondents indicated that their centre will offer post-viability termination of pregnancy (98/123; 80 %). Sixty-seven percent (68/101) of respondents reported the definition of fetal viability to be 24 weeks’ gestation. Most respondents reported that a collaborative decision making process was used to determine if post-viability termination of pregnancy would be offered (136/170; 80 %). For conditions presumed to be lethal/likely lethal, the majority of respondents would “sometimes” or “always” offer post-viability termination of pregnancy, whereas for conditions presumed to have a mild effect, the majority of respondents would “rarely” or “never” offer post-viability termination of pregnancy. Ninety percent (77/86) of respondents reported that perinatal hospice is offered as an alternative to termination of pregnancy. In conclusion, this study suggests that although post-viability termination is available in many provinces in Canada, variation in the definition of fetal viability and indications appear to exist. While these variations may lead to unequal access to post-viability termination of pregnancy across Canada, they might also represent the complexity of the decision making process and the importance of examining individual factors to ensure that the most appropriate decision is made in each case.     

Supplanting the venom of litigation with alternative dispute resolution: the role of counsellors and guidance professionals

This literature review attempts to interface counselling with alternative legal practice. The authors proceed by contrasting the adversarial nature of litigation with the conciliatory nature of alternative dispute resolution (ADR) with a view to encouraging seekers of dispute resolution to opt for ADR in lieu of litigation. The paper discusses the Ubuntu world view in conflict resolution in relation to ADR practices. While not presenting ADR as a replacement for litigation nor proscribing litigation in itself, this paper prescribes the use of ADR to arrive at settlements that are more satisfactory and longer lasting. The paper finally shows how counsellors and guidance professionals may be involved in ADR processes to effectively give succour to conflicting parties.     

“That is just your stuff”: The potential use and abuse of congruence in counselling and psychotherapy practice and training

This piece discusses the potential use and misuse of congruence within counselling training and practice. A definition of congruence is provided, and how deliberate misuse of congruence could result from two separate emotional communications (bullying and gaslighting) is discussed. Current representations and misrepresentations of congruence in counselling and psychotherapy have been highlighted. A new term of “Intentional Congruence Misuse” was coined to explain this position (not to be confused with incongruence). “Intentional Congruence Misuse” is the deliberate bullying of another individual using terms related to congruence. A discussion has been provided to emphasise the evident implications for counselling, psychotherapy practice and training. The author acknowledges that this opinion piece will be from a biased perspective. Still, it does not aim to detract from others who have found their therapy and counselling training beneficial.     

Sources of Tension in Teaching the Psychology of Women

This article examines sources of tension in teaching the psychology of women. The essential conflict is a clash of values between the traditional academic setting and a revolutionary, nontraditional curriculum area. The first major source of conflict identified involves the knowledge base of the field and includes debate over the definition of the field and the appropriateness of diverse processes of knowledge acquisition. The second major source of conflict discussed concerns the roles of teacher and student in the classroom context and the larger role of the teacher as a faculty member in a traditional academic institution. In each of these cases the issue of power is critical. Such conflicts are irreconcilable, for reconciliation would either do irreparable damage to the nature of the study of the psychology of women or would cut the field off from potential benefits to be gained from the academic discipline of psychology. However, several courses of action in the face of conflict and tension are presented.