The client as a self‐aware agent in counselling and psychotherapy

Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self‐awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over‐arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non‐directive and directive counsellor performances alike. Vignettes selected from the participants' reports illustrate the theme. Implications for the practice of counselling and psychotherapy are discussed.     

A qualitative exploration into how the use of prayer in counselling and psychotherapy might be ethically problematic

Aim: This research article contributes to the debate on the value and limitation of the use of spiritual strategies, like prayer, in counselling (Foskett & Lynch, 2001) by disseminating the insights that were gained from a qualitative study of mainstream counsellors whose work includes prayer. Method: Participants were 19 British Association for Counselling and Psychotherapy (BACP)‐accredited and Churches Ministerial Counselling Service (CMCS)‐approved counsellors who use prayer in their practice. They were interviewed, and the data were analysed using Interpretative Phenomenological Analysis. Results: The data reveal that counsellors who use prayer are aware that ethical problems may be encountered: if prayer changes the way that the counsellor is perceived; when using prayer with issues of psychopathology; if the counsellor uses prayer to impose faith on a client; when being professionally held to account; if prayer is used for avoidance or as a defence; if prayer is used to enhance the counsellor's power; if prayer is not part of the client's agenda; if prayer is used routinely; if prayer cannot be challenged; if there is a cultural pressure to pray; and if the prayer method is not matched to the client – but that their concern over potential ethical issues is not of sufficient strength to override their therapeutic use of prayer if facilitated with due care.     

‘My language thing … is like a big shadow always behind me’: International counselling trainees' challenges in beginning clinical practice

Background: While counsellor education becomes increasingly culturally diverse, little is known about international trainees' experiences of training. Objective: The present study explores one aspect of training, namely clinical practice from the perspective of international, non‐native speaking trainees. In particular, this paper focuses on the challenges this group encounters when practicing in a second language. Methodology: Semi‐structured interviews with four non‐native English‐speaking trainees were conducted and analysed following the principles of interpretative phenomenological analysis (IPA). Results: Findings suggest that participants encounter practical difficulties related to their non‐native/foreign identity in practice, such as problems with articulate self‐expression and understanding the client's speech. These difficulties generate anxiety and impact on the trainees' confidence. Conclusions and implications for counsellor training: This study elucidates language as a fundamental aspect of culture, and identifies second language use as a significant source of difference in counselling practice. This paper highlights the need for attention to linguistic diversity and for appropriate support during counsellor education. This will improve international trainees' experiences of training, but also enhance all trainees' understanding of difference, resulting in better service provision for the community.     

Addressing disparities: The impact of a lesbian,gay, bisexual,and transgender graduate counselling course

Background: Lesbian, gay, bisexual and transgender (LGBT) individuals experience serious mental health disparities and treatment inequities. Counsellor education has been identified as both a contributing factor to these problems as well as an ameliorating mechanism to address these inequalities. Aim: The purpose of the current study was to evaluate the impact of an LGBT‐affirmative counselling course. Method: A total of 23 students enrolled in a graduate LGBT counselling course were administered the Sexual Orientation Counselor Competency Scale (SOCCS, Bidell, 2005) and the Lesbian, Gay, and Bisexual Affirmative Counseling Self‐Efficacy Inventory (LGB‐CSI, Dillon & Worthington, 2003) pre‐ and post‐course. In addition, a comparison group of 23 matched counselling students was obtained from an existing data source in order to make further assessments of the course's effectiveness. Those in the comparison group were not enrolled in the LGBT course, but were administered the SOCCS at analogous time intervals. Results: After completing the LGBT course, enrolled students demonstrated significant improvements regarding their sexual orientation counsellor competency and self‐efficacy. In addition, these students showed significant gains in SOCCS scores versus those in the comparison group. Implications: Results from this study show the positive effect a full‐credit LGBT psychotherapy course can have on graduate counselling students' sexual orientation counsellor competency and self‐efficacy. The findings also indicate that such a course can significantly impact counselling skills, a facet of LGBT cultural competency found to be the most attenuated. Findings are discussed in conjunction with LGBT‐affirmative counsellor training and clinical practice.     

Moments of empowerment: A qualitative analysis of positively experienced episodes in brief person‐centred counselling

38 positively experienced episodes in brief person‐centred counselling with six clients were analysed. The Interpersonal Process Recall (IPR) method was used as the prime research tool. Clients were asked to identify positively experienced moments in the counselling session during a post‐session review interview. Clients and counsellors were invited to report on the feelings, perceptions and intentions they recalled experiencing during these moments. Three analyses were used to categorise the meaning and feeling quality of these moments, and a taxonomy of types of positively experienced episodes was also created. The most frequently reported positive client experiences were associated with empowerment, safety and insight. Other significant themes emerging from the analysis included: freedom in the relationship, shortcomings of the relationship, assurance of the relationship, unfolding of the client's personal meaning, and the importance of the counsellor's presence. Taxonomy of episodes revealed nine categories: four of them focused on the strengthening of the therapeutic relationship, and five focused on the empowerment of the client's self. These findings are discussed, and implications for theory and practice explored.     

'What did we talk about last week?' a study of forgetting in one schizophrenic and two borderline clients in counselling

Abstract

This paper describes ‘forgetting between sessions’ by two borderline and one schizophrenic client in counselling. What was forgotten included: progress made, awareness of dependence, an experience of having a helpful and sympathetic counsellor, and the ability to think. Understanding of this phenomenon is explored in terms of schizoid mechanisms (Klein 1946), omnipotent narcissistic object relations (Rosenfeld 1987) and attacks on linking and thinking (Bion 1959, 1962). The need to avoid or evacuate painful experiences which are intolerable to the individual, or to recreate and remember existentially infantile traumata, are proposed to be some of the reasons behind this forgetting. The counsellor's capacity to remember, forget, contain, and think about the client's experiences is considered.     

Counselling young people: Counsellors' perspectives on ‘what works’ – An exploratory study

Aim: Counsellors who work with young people in a range of contexts know that they are not engaging with ‘mini‐adults’. The issues young people bring to counselling are often complex, challenging and wide‐ranging, as adolescents are experiencing times of turbulence and change in their physical, emotional, social and psychological development. This paper focuses on a research project undertaken with five counsellors who work with young people, and asks the question: ‘What works?’ Method: The research project is an in‐depth qualitative study into the counsellor's experience of counselling young people, using a narrative approach. Findings: Four key shared themes emerged: the significance of ‘safety’ in the relationship; building the therapeutic alliance; flexibility and integration relating to theoretical orientation; and the use of creativity. Outcomes: This paper offers counsellors the opportunity to reflect on ‘what works’ and consider the professional knowledge, which underpins their own counselling practice with young people.     

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.     

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.     

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.     

Philosophical Counselling, Truth and Self-Interpretation

Philosophical counselling, Ran Lahav and others claim, helps clients deepen their philosophical self-understanding. The counsellor's role is the minimalist one of providing the client with the philosophical tools needed for reflective self-evaluation. Respect for the client's autonomy entails refraining from intervening with substantive moral criticism, theories, and methods; the client's ways of working out fundamental questions like ‘Who am I and what do I really want?’cannot be assessed by the counsellor in terms of their truth-value, but only in terms of whether they reflect the client's autonomous choice to express him/herself in a certain way. I argue that this view, which is informed by an anti-realist account of self and life-history, undermines the distinction between self-knowledge and self-deception. Once interpretive and criteriological free rein is given to the client, and once personal, pragmatic and aesthetic considerations take precedence over truth-value, then the way is left open to clients to generate the most morally convenient self-interpretation to suit their current needs. I defend the view that truth matters in philosophical counselling; more specifically, that there is a basic distinction between true and false forms of self-understanding. To do this, I offer a broadly realist account of self and reflective self-evaluation. If this is right, then philosophical counsellors shoulder a significant burden of responsibility in helping their clients achieve an accurate, defensible, action-guiding and truth-oriented self-understanding.     

Working with suicidal clients: The person‐centred counsellor's experience and understanding of risk assessment

Background: Client risk assessment within the person‐centred paradigm is traditionally seen as squarely opposed to its ethos. Aim: To determine how the person‐centred counsellor experiences and understands the issue of risk assessment within the confines of their work ethos. Method: Semi‐structured interviews with seven person‐centred counsellors using thematic analysis were conducted. Findings: Three main themes emerged following thematic analysis: The impact of the risk assessment process on self; The counsellor's experience of self, and The therapeutic process in relation to risk assessment. Discussion: The findings suggest that person‐centred counsellors conduct risk assessments taking a holistic approach involving not only individual risk predictors and characteristics of the client but also individual factors related to self.     

Psychological distance,stated values and values in use: An approach to considering interactions for counselling within organizations

The work of Argyris (Reasoning, Learning and Action: Individual and Organisational: San Francisco Jossey-Bass, 1982) demonstrated the gaps that we tend tio have between our stated values and those that we actually use in practice. That of Micholt (Transactional Analysis Journal, 22, 228–233, 1992) illustrated the concept of psychological distance as applied tio facilitating groups in an organizational setting. These are both important works which can be very useful in conceptualizing the organizational context of counselling and also the client's problem situation. By combining these two approaches, it is possible to demonstrate a more detailed picture of the psychological distance and some of the potential problems inherent in interactions among three (or more) parties. For counselling, the combined approach emphasizes the importance of the counsellor remaining aware that the client's story is likely to reveal their stated values and that only by gaining a values-in-action perspective (i. e. behaviour) about the client's life can the counsellor adequately assess the client's situation. The examples given in this paper relate to counselling in an organisational context, but the approach may be applied tio facilitation, geneal management or consltancy.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

Experiencing gay affirmative therapy: An exploration of clients' views of what is helpful

Gay affirmative therapy is a counselling approach that emphasises an affirming, non‐pathologising approach to therapeutic work with lesbian, gay and bisexual clients. In this study, lesbian and gay clients who had experienced counselling that they defined as affirming identified what they perceived to have been helpful. Questionnaires and interviews were used to collect the views of a sample of lesbian, gay and bisexual informants. The material gathered was analysed using a grounded theory approach, which generated six main categories: communicating a non‐pathologising perspective on homosexuality; the counselling relationship; the counselling space; what the counsellor brought to the relationship; humanity; and the counsellor adopting a holistic approach. Some of these identified affirming elements are unique to gay affirmative therapy and cannot be attributed to other factors. The possible significance of the findings for practitioners is discussed.     

Minority Stress and Same‐Sex Relationship Satisfaction: The Role of Concealment Motivation

Most lesbian, gay, and bisexual (LGB) people want a stable, satisfying romantic relationship. Although many of the predictors of relationship outcomes are similar to those of heterosexual couples, same‐sex couples face some additional challenges associated with minority stress that also impact upon relationship quality. Here, we investigate the association between minority stressors and relationship quality in a sample of 363 adults (M age = 30.37, SD = 10.78) currently in a same‐sex romantic relationship. Internalized homophobia and difficulties accepting one's LGB identity were each negatively associated with relationship satisfaction via heightened concealment motivation. We also examined the protective role of identity affirmation on relationship quality, finding a direct positive relationship between the two variables. Minority stressors were negatively associated with couple relationship satisfaction via heightened concealment motivation. The finding that identity affirmation directly predicted increased couple satisfaction also highlights the important role of protective factors in same‐sex couple relationships.     

Dynamics of perceived social network support for same‐sex versus mixed‐sex relationships

Individuals in mixed‐sex (n = 248) and same‐sex (n = 159) romantic relationships completed several online questions for each member of their social network, including the member's perceived support for their romantic relationship. Those in same‐sex relationships perceived less support for their relationship, but only from family members, not from friends. Levels of relationship support were lower among subjectively more distant network members than among closer network members. As hypothesized, associations between perceived support for the relationship and relationship, mental, and physical well‐being were weaker for those in same‐sex compared to mixed‐sex relationships. Principles of social network management and attributional ambiguity were used to explain the findings.     

Counsellor response to clients' metaphors: An evaluation and refinement of Strong's model

Experienced counsellors recorded clients' metaphors, their responses to the metaphors and their views on the effects of the interchange. Two of the three responses in Strong's model of counsellor response to clients' metaphors were used frequently. They were: explicating what is implicit in a metaphor and therapeutically extending or modifying it. The third response proposed by Strong'the counsellor creating and delivering a 'therapeutic metaphor''was used only once. A further kind of response was found: the counsellor recognizing and remembering a client's metaphor for possible future use. Overall, Strong's model was supported. The effect of counsellor orientation on counsellor response to clients' metaphors and the value and use of metaphors in counselling are briefly discussed, and some guidelines suggested.     

Constructive conversations: Revisiting selected developments with clients and counsellors

Aim: to examine client and counsellor experiences in using and responding to social constructionist (e.g. solution‐focused, narrative and collaborative approaches) questions and other conversational interventions. Method: retrospective comments were elicited from 32 clients and 12 counsellors (trained in social constructionist counselling approaches) in reviewing their videotaped use of (or response to) questions and interventions from the social constructionist approaches in single session lifestyle consultations. These comments were transcribed then analysed using the constant comparison method of grounded theory. Results: five common themes (but with different emphases for clients and counsellors) were identified: exploring and adopting the client's perspective; identifying alternative perspectives; identifying strengths, possibilities, and solutions; developing a shared understanding; struggling to talk in a different way. Conclusions: the findings will be useful to counsellors interested in improving their responsive use of questions and interventions in dialogues with clients.