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.     

Family therapy in Macau: development,challenges and opportunities

Family therapy in Macau is in its early stages of development. The Satir model and structural family therapy were the first two therapies introduced. Later on, solution‐focused brief therapy and narrative therapy were also introduced. Macau has been undergoing dramatic socioeconomic changes since the relaxation of the gambling licenses. In sociocultural terms this has led to significant changes: the so‐called ‘dealer's complex’, gambling, drug abuse and youth deviance have become more prevalent. To address complicated family problems, various counselling institutes and training centres were established to conduct family therapy. However, there are still some limitations and challenges that must be addressed in order to have a thriving family therapy profession in Macau.     

Online counselling: a descriptive analysis of therapy services on the Internet

This study investigated the emerging practice of online counselling. Although the traditional practice of counselling involves face-to-face interaction between counsellor and client, a growing number of practitioners are providing counselling or therapy services via the Internet. In the present study, a total of 67 online counsellors completed a questionnaire exploring the backgrounds, services, fees, and communication technologies of practitioners offering online counselling to the public. Results suggest that online counselling is conducted by relatively experienced, primarily Western-based practitioners and is characterised by the use of email. Online clients are mainly female and receive relatively short-term interventions. Although the field appears to be evolving as its popularity increases, some ethical concerns raised by early research remain inadequately addressed.     

A case for taking the dual role of counsellor-researcher in qualitative research

There is ongoing debate about whether the challenges of practice-based research in counselling, with clients’ discourses providing the raw data, can be overcome. This article begins by considering the argument of whether taking a dual role of counsellor-researcher within case study research is a legitimate qualitative approach. A case example using sand-tray in short-term therapy with adults from a pluralistic perspective is provided to demonstrate how the challenges of the dual role can be managed to produce effective research findings. It is suggested that this approach closes the gap between research and practice to produce findings that are highly relevant to the counselling context. The ethical considerations of taking a dual role of counsellor-researcher are considered, and opportunities and challenges when adopting this approach are identified.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services. Methods: Three focus groups with adults with CHD (total of 14 participants aged 19-67) were conducted and thematic analysis was used to identify emerging themes. Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges. Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

Couples therapy with gay clients: Issues facing counsellors

Couples therapy is widely practised by a range of different counselling professionals, but, as yet, concentrates on heterosexual clients, to the exclusion of gay people. This paper argues that couples therapy should be more readily available for gay clients. A review of the major issues which need to be addressed by counsellors before embarking on couples therapy with gay men is presented, with illustrative case material. It is concluded that established forms of intervention are effective with gay clients, providing that the specific needs and problems of the gay community are recognized by the counsellor.     

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services.

Methods: Three focus groups with adults with CHD (total of 14 participants aged 19–67) were conducted and thematic analysis was used to identify emerging themes.

Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges.

Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

Counselling foreign students: A review of strategies

This article focuses on the unique counselling needs of foreign students as reflected from a review of the literature. As more and more students from developing countries opt to further their education in the West, knowledge about counselling foreign students is of increasing interest. Distinctive aspects of foreign student clients and the typical problems faced by them are described. The issues which need to be addressed and the competencies which need to be developed in order to effectively counsel foreign students are discussed. Finally, specific strategies for counselling foreign students are suggested in the context of general guidelines for cross-cultural counselling.     

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.     

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.     

Fifteen years of doing qualitative research on psychotherapy

The conduct of qualitative research in psychology goes against the grain of customary praxis and thus raises many challenges. The author summarises the experience of having spent a large part of his academic career using the grounded theory form of qualitative research. In the account, he indicates how he became interested in this methodology and describes his experience of using, publishing and teaching it. These considerations are contextualised in the sociology of research praxis in psychology. The appraised is made that a movement toward acceptance of qualitative research is currenuy under way in the counselling and psychotherapy research community, albeit cautiously in some quarters. Some implications of this development are addressed.     

The Challenges of HIV/AIDS Counselling in Nigerian Secondary Schools: A Case Study of Kwara State

The study investigated the challenges of HIV/AIDS counselling in Nigerian secondary schools as expressed by school counsellors in Kwara state, Nigeria. The respondents comprised 132 purposively selected counsellors in Kwara state public secondary schools (Male=85; Female=47). Data were collected with the use of a survey instrument and the data were quantitatively analyzed. The study identified the challenges hindering effective implementation of HIV/AIDS counselling in Nigerian secondary schools as ignorance, non-existence of governmental policy on HIV/AIDS counselling in schools and negative attitudes of school administrators, students and teachers to HIV/AIDS. Geographical location and job status had significant influence on the respondents' views of the challenges facing HIV/AIDS counselling in Nigerian secondary schools. The Counselling Association of Nigeria (CASSON) should enlighten Nigerians on the importance of HIV/AIDS counselling in schools.     

Counselling with Biofeedback: A Review

Biofeedback increasingly appears to be used as an aid to specified counselling goals. A typical counselling situation using galvanic skin reflex (skin biofeedback) is analysed. The ethical and practical challenges involved in biofeedback-aided counselling are considered.     

Cognitive therapy and social power

This paper addresses the capacity of cognitive therapy to engage with issues of social power. Some indicators of ‘power‐sensitised counselling’ are proposed and these are discussed with reference to cognitive therapy. ‘Power‐sensitised counselling’ for the purposes of this paper is described as counselling that takes account of power differentials, both across society and within the counselling room. The paper opens a discussion about the potential developments of cognitive therapy that could facilitate an engagement with issues of social power. The significance of these issues for research into cognitive therapy is discussed.     

Mastery or mystery? Therapeutic writing: A review of the literature

Recent developments in online support and counselling suggest that the users of chat rooms, for example, or the Samaritans' e-mail 'listening' service, have already discovered the power of writing as a self-help vehicle. Developments in computer-mediated counselling and therapy are essentially text-based and client-driven. The therapeutic use of expressive and reflective writing is not widely recognised in British counselling and therapy circles. The empirical foundations for the therapeutic uses of the literary arts are, however, well established. This review aims to map the use of 'writing therapy' by drawing together cross-disciplinary research and practitioner reports which might support the place of writing as a creative therapy in its own right, whether as an adjunct to face-to-face counselling or as a self-help tool.     

Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study

Given that many patients referred to cardiac rehabilitation (CR) are obese, diet therapy, exercise training, nutritional and psychological counselling for both obesity and psychological distress should be included as important components in all CR programmes. In this practice-level, observational study we evaluated the short-term within-group effects of a four-week multi-factorial inpatient CR programme specifically addressed to weight loss, fitness improvement and psychological health increase on 176 obese in-patients with coronary heart disease (CHD). Outcome measures were exercise capacity measured with estimated metabolic equivalents (METs), body mass index (BMI) and psychological well-being (PGWBI). Results show statistically significant improvements in all the PGWBI sub-scales and total score, except in general health (p = 0.393). No moderation effects were found for BMI class, age, diabetes and ejection fraction (EF). METs significantly increased by 30.3% (p < 0.001) and BMI decreased by 1.37 points (p < 0.001). Significant correlations were found between BMI and weight reductions with PGWBI anxiety and total score improvements. This multi-disciplinary CR programme including diet therapy, exercise training and psychological counselling provides indication for short-term within-group effectiveness on functional exercise capacity, BMI and PGWBI in a sample of obese in-patients with CHD. However, controlled studies are needed to corroborate the results we found.     

Moving beyond counselling and psychotherapy as it currently is – taking therapy outside

Research was undertaken by the author in order to describe, interpret and explain what happens when counsellors and psychotherapists who have been trained to work indoors with their therapy clients take their therapy practice into outdoor natural spaces. A central research question addressed ‘What happens when counsellors and psychotherapists, who have been trained to work indoors with their therapy clients, take their therapy practice in to outdoor natural spaces?’ Semi-structured interviews were undertaken with therapists who practised outdoors. Three dominant themes emerged critiquing aspects of current counselling and psychotherapy practice. These were related to the unfolding ecological crisis, the context of the work and moving beyond current conceptions of distress and the role of therapy in addressing this.     

Working for free: A fundamental value of counselling

This paper challenges two myths about voluntary sector counselling, namely (a) that volunteer counsellors and voluntary sector counselling are the same thing, and (b) that standards of practice in the voluntary sector are significantly different from those elsewhere. The paper also argues that voluntary sector counselling nurtures a deeply felt commitment to respond to human need without monetary recompense. Drawing on evidence from a study of voluntary sector counselling in Scotland, we show that a substantial proportion of voluntary sector counselling is undertaken by paid workers, and that many counsellors who volunteer in one setting undertake paid counselling work in another setting. We demonstrate that the majority of voluntary sector counselling agencies in Scotland work within ethical frameworks developed by the professional bodies for counselling, and we argue that these agencies have been at the forefront of efforts to enhance the quality and safety of counselling services available to the public. We identify and illustrate three overlapping reasons why large numbers of highly qualified counsellors give their time and expertise for free: because of their desire to support the work of agencies through which the accessibility of counselling is extended; because volunteer counselling constitutes personally rewarding and meaningful work; and as an expression of their commitment to give freely of themselves. In conclusion we argue that voluntarism is central to counselling, but that parts of the counselling world are at risk of forgetting this core value.     

Development and current status of counselling psychology in Taiwan

This article details the three stages of counselling psychology’s development in Taiwan, including pre-legislation, legislation and post-legislation. In pre-legislation stage, a brief historical review of the growth of counselling and guidance is introduced, which is the root of the contemporary counselling psychology. The process of the Psychology Act’s legislation is described in legislation stage and the relationships between counselling teachers and clinical psychologist are also discussed. In the post-legislation stage, the licensure system, training programmes, main professional organizations, work settings, and the major opportunities and challenges for the counselling psychology field are presented. In addition, the article refers to data from a national survey of 124 counselling psychologists to provide a profile of the counselling psychologists in Taiwan.