Counsellor and client perceptions of the effectiveness of time-limited counselling in an occupational counselling scheme

Counsellors providing brief counselling (6 sessions) in a British Social Services Department completed post intervention questionnaires for 429 clients. These provided information on several measures about the degree to which they felt that their clients had benefitted from the counselling, how far they felt that the number of sessions was adequate, and the nature of the clients' problems. Two hundred and twenty-three of the clients also completed post-intervention questionnaires indicating their degree of satisfaction on a number of measures. There was fair agreement between counsellors and clients that outcomes were satisfactory, and that the number of sessions was adequate, although clients were more satisfied than counsellors. Counsellors identified a range of personal and occupational presenting problems, and around two thirds of problems belonged in the personal domain. Long-tern personal problems received lower satisfaction ratings and were more frequently referred on to other agencies.     

Exploring counsellor perceptions of the impact of counselling supervision on clients

This qualitative study explores counsellors’ experiences and perceptions of how counselling supervision impacts upon their clients. Data collection combined open‐ended questionnaires (n = 13) and semi‐structured interviews (n = 6). The findings indicate that supervision impacts client work both helpfully and unhelpfully. Areas that emerged as having the most direct impact on client work were the counselling relationship dynamics and self‐awareness, professional development, emotional support, clients not discussed in supervision and the quality of the supervisory relationship. Congruence and confidence were the most direct link between supervision and client work.     

Counselling adults who were abused as children: Clients' perceptions of efficacy, client-counsellor communication, and dissatisfaction

Despite the amount of clinical material relating to adults who were abused as children, there is a dearth of research which has examined the effectiveness of counselling such clients. In order to examine the perceived efficacy of counselling with this client group, a total of 53 in-depth interviews were undertaken with a sample that included adults abused as children who had received counselling, counsellors working with this client group, and counselors-who-were-abused-as-children. The findings indicate that there are many similarities in what abused clients and the general client population judged to be helpful and unhelpful factors in counselling. However, certain aspects of the counsellor-client relationship appear to have specific impacts and meaning for an abused client group, especially when they have little prior knowledge or experience of counselling. Data are presented relating to clients' evaluations of counselling. These illustrate clinically relevant issues in relation to communication and experiences of dissatisfaction. One conclusion from the study is that in terms of their responses to counselling, it is simplistic for adults who were abused as children to be categorisied as a unitary group. Nevertheless, there are certain aspects of counselling with such clients which do merit particular attention if practitioners are to minimise the possibility of counselling being ineffective, unhelpful or, at worst, re-traumarising.     

Replacing client-centred counselling with culture-centred counselling

Models of psychotherapies and counselling do not develop in a social vacuum. They arise out of and rest on several fundamental assumptions-social, linguistic and cultural-most which are understood and shared by the client group and the therapists andor counsellors. The extent to which there is a congruence of shared assumptions facilitates the process of counselling and/or therapy. It does not, however, guarantee its successful outcome. This paper examines the fundamental assumptions underlying client-centred counselling and argues that there is at present a lack of correspondence between the assumptions of the counsellors and those of their client groups-even within their own culture. But among the client groups comprising the ethnic minorities originating from the Indian subcontinent, there is a wide chasm. The clients do not understand or share the fundamental assumptions of their counsellors. As a result, client-centred counselling is irrelevant and does not serve the needs of the clients groups comprising the ethnic minorities. It is in urgent need of a paradigm shaft. It is argued that client-centred therapy needs to be replaced by culture-centred counselling, in which counsellors can be trained. The paper presents the main features of a model of counselling that is applicable not only to the white indigenous population in Britain but to the above ethnic minorities living in Britain.     

Clients talk about their experience of seeking counselling

The purpose of this study was to explore the help-seeking behaviour of a sample of counselling clients using a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in, affordable counselling agency located in a mid-sized city in New Zealand. Specifically, clients were asked if they had received counselling previously, what efforts they had made to solve their problems before seeking counselling and with what success, why they chose this particular agency, their initial impression of their relationship with their counsellor, and their reactions to participating in the research. The data were analysed to ascertain themes associated with their decision-making and choices. Findings were discussed in relation to the literature on seeking counselling, how clients determine their need for counselling and the process they go through in deciding when and where to get it. Implications for counsellors are discussed.     

Scaling questions: asking and answering them in counselling1

Solution-focused counsellors use “scaling questions” to construct understandings of clients’ concerns and solutions to them. We examine how these questions are asked and answered, offering evidence of what is constructed from within counselling discourse. Also, clients and counsellors offer their retrospective accounts of their participation in question and answer sequences in their dialogues. We conclude by speaking to the implications we see from this research as it relates to collaborative and resourceful dialogue between counsellors and clients.     

The client as expert: Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.     

Christian counsellors' views on working with gay and lesbian clients: Integrating religious beliefs with counselling ethics

Thirty‐one counsellors who identified themselves as practising, committed Christians, returned completed questionnaires that investigated how they integrate their Christian beliefs with their professional ethical code when counselling gay and lesbian clients. It was found that although most respondents believed that they were able to accept gay and lesbian clients, a minority demonstrated incongruence in relation to members of this client group, and were judgmental about perceived gay/lesbian behavious. Counsellors who took a rational stance in their understanding of the Bible and Christianity expressed more open and accepting views. Counsellors with a literalist approach to the Bible appeared to be lacking in acceptance and were unaware that they may not be offering the core condition of respect to their gay or lesbian clients. These findings are discussed in terms of their implications for supervision, research and practice.     

An initial study of transgender people's experiences of seeking and receiving counselling or psychotherapy in the UK

Background: There are no published empirical research studies exploring transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. As a result, counsellors know little about why transgender people seek counselling, who they seek counselling from, and what their experiences are of receiving counselling. Aim: To address this gap in the literature, this study investigated transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. Funding for this study was provided by a BACP Seedcorn grant. Method: A mixed method small‐scale qualitative research design was employed, comprising an online survey and five semi‐structured interviews. Findings: Participants tended to seek counselling on two or more occasions and received between 2 and 12 sessions. Participants sought counselling for common psychological concerns as well as gender identity and coming out issues. A fear of being discriminated against and exploring gender for the first time were significant barriers in seeking help. Participants reported mixed experiences of counselling but valued a therapeutic relationship in which they felt affirmed, listened to and understood. Discussion: The findings from this study mirror aspects of previous research conducted in the USA concerning transgender clients' experiences of counselling. However, these findings point to the importance of recognising the potential vulnerability transgender clients experience when seeking counselling and the need for therapists to develop greater awareness, knowledge and competence regarding working with transgender clients.     

Marriage Guidance Counselling: Ii. What Counsellors Want to Give

Seventy-six counsellors practising under the auspices of the Scottish Marriage Guidance Council responded anonymously to a postal questionnaire. This was designed to survey their attitudes regarding various aspects of counselling and, by means of case-studies, to in vestigate the extent to which they adopted a uniform approach with all clients. The counsellors considered marriage guidance to be appropriate for a wide range of problems. In general, 'nonspecific' factors were considered helpful. However, in line with current trends towards flexibility and eclecticism, the counsellors considered that some interventions, styles and approaches were more appropriate for some problems than for others. The implications of the findings are discussed and some practical recommendations are made.     

Responses to Marriage Counselling

The experiences of clients who received marital counselling from trained volunteer marriage guidance counsellors were investigated. Fifty-one clients from 42 marriages were interviewed and questioned about why they chose the agency, what expectations they held, what happened during counselling, how they felt about the counsellor, and what if anything was achieved through counselling. They were also asked how they had fared since. Rating scales were used after the interview to evaluate satisfaction with counselling, benefit from counselling, aspects of the counselling relationship, etc. The clients were also asked to do a card-sort of statements about counselling to determine what aspects had been valuable and disappointing. Some of the preliminary results of the study are presented and discussed.     

Young clients' narratives of the purpose and outcome of counselling

This study explores how adolescent clients construct the purpose and outcome of counselling. A narrative analysis was performed on interviews with 22 clients (aged 16–18) who had used a school-based counselling service. The aim was to identify the purpose and outcomes that participants attributed to their counselling experience. The analysis identified four narrative forms that young clients used to describe counselling. These included ‘transformative’, ‘supportive’, ‘pragmatic’ and ‘disappointed’ narratives. Each narrative form constructed a different purpose and outcome for counselling. Engaging with clients' narratives about the purpose and intended outcome of counselling may allow counsellors to better match their expectations and approach to fit with their young client or to work with them to co-construct more flexible narratives that support helpful outcomes.     

Self-criticism and the therapeutic relationship

The relationship between self-criticism and the therapeutic alliance was examined in 169 clients attending counselling in a community clinic. Self-criticism was associated with lower client ratings of the working alliance, suggesting that clients with higher self-criticism had greater difficulties establishing and maintaining a therapeutic alliance. These findings extend previous studies on the working alliance and self-criticism from highly controlled clinical studies to a more ecologically valid community mental health setting. Regression analyses were conducted to examine the mediating effect of additional factors on the relationship between self-criticism and the working alliance. Sensitivity to a perceived subordinate role in therapy did not impact the working alliance, although a general resistance to subordination was related to self-criticism. Implications for counselling self-critical clients are discussed.     

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.     

Counselling problem drinkers: The realm of specialists. Alcoholics Anonymous or generic counsellors?

A study was carried out to investigate counsellors' attitudes and experiences in working with people with drinking problems and counsellors' understanding of Alcoholics Anonymous as a helping agent. Ninety-four counsellors responded to a questionnaire about their work with people with drinking problems and their knowledge of AA. Generic counsellors tended not to feel competent working with clients with alcohol problems. Feelings of competence increased with greater experience of the client group and, to a lesser extent, with more hours of specialist training. It was found that counsellors whose intake of alcohol amounted to more than eight units per week were less likely to take on clients with alcohol problems than were those who drank less. Counsellors usually had some knowledge of AA but had little understanding of the 12-step programme that forms the basis of recovery for alcoholics as described by AA. They were, however, in favour of clients attending AA as an adjunct to individual counselling     

Marriage guidance counselling: I. What clients think will help

Thirty-one first-time attenders for marriage guidance counselling were given a non-schedule standardised interview and a client questionnaire. The main aim was to identify the counselling and counsellor characteristics which clients considered would be most helpful in dealing with their problems. Traditional counselling skills such as the ability to be warm, supportive, understanding and a good listener were seen to be important by most clients. However, the vast majority of clients indicated that it would be helpful to receive the counsellor's opinion about their marriage, their personal problems and marriage in general: this is incompatible with a non-directive approach to counselling. Whilst clients may not know best how they should be helped, counsellors who fail to address their preconceptions risk mutual disappointment and premature termination of counselling.     

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.