Spontaneous Self‐Practice of Cognitive Behavioural Therapy (CBT) by Aboriginal Counsellors During and Following CBT Training: A Retrospective Analysis of Facilitating Conditions and Impact

Previous cognitive behavioural therapy (CBT) training studies have suggested that therapists who practice CBT strategies on themselves during training may experience professional and personal benefits. However, it has also been reported that some CBT trainees are reluctant to engage in self‐practice. The present study reports an incidental finding from a CBT training study with Aboriginal counsellors: all five counsellors reported that they practiced CBT techniques on themselves without specific encouragement by the trainers to do so. This paper therefore posed three questions: (a) Why—in contrast to some other trainees—did this group choose to apply CBT to themselves? (b) How did they apply it—with what purpose, in what contexts, and which skills? (c) What was the impact of CBT self‐practice? Data from the group's reflections were qualitatively analysed by two of the researchers, and “member checked” by the remainder. Results indicated that the counsellors were motivated to practice CBT on themselves for two principal reasons: the value they placed on CBT, and their personal need resulting from the high number of crises experienced while living and working in their communities. The counsellors reported practicing CBT in a wide variety of contexts as part of their learning. As in previous studies, the impact of CBT self‐practice was that it increased their confidence and competence as therapists. It also appeared to be a valuable burnout prevention strategy. If the results are generalisable, they suggest that self‐experiential training in CBT may be a culturally responsive and adaptive way for Aboriginal counsellors to enhance their learning of CBT skills.     

An exploratory study of psychodynamic therapists’ working with people with multiple sclerosis

There is little published on working psychodynamically with chronic illness and even less on the clinical insights of therapists working with people with multiple sclerosis. The objective of this study was to consider therapists’ reflections on the impact of multiple sclerosis on the internal worlds of clients with multiple sclerosis. I would also like to think about the challenges multiple sclerosis presents and how these challenges are worked with therapeutically. Finally, the impact of my multiple sclerosis diagnosis upon the research interviews was considered. Twelve counsellors / psychotherapists who had experience of working with clients with multiple sclerosis were interviewed. Data was analysed thematically and the findings revealed a number of significant themes. Denial appeared significant both for those with multiple sclerosis and those therapists working with them. Therapists also identified that people with multiple sclerosis hold a range of conscious and unconscious feelings in relation to their multiple sclerosis. Also, the meanings and impact of multiple sclerosis are broad and idiosyncratic. Therapists also faced a number of challenges in their work with people with multiple sclerosis: powerful countertransference feelings which could disable the therapy, embodied countertransference, the tendency to make generalisations, the physical reality of multiple sclerosis and its impact upon continuity, therapists’ unconscious phantasy and associations which if unaddressed could impact their ability to work with illness and the pressure multiple sclerosis placed on therapeutic boundaries. Therapists within the study recognised the need to work with both the physical reality of multiple sclerosis, as well as its psychological impact while at the same time keeping themselves open to powerful countertransference feelings and using them in the service of the therapy. The study has implications for theory, practice and future research.     

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.     

Theoretical orientation and reported practice: A survey of eclecticism among counsellors in Britain

There is an increasing trend for counsellors to report that their practice is based on a combination of methods and approaches, rather than being grounded in a 'pure' model. However, there has been a lack of research on the proportion of counsellors in Britain who define themselves as eclectic or integrative in orientation. This study reports on a survey of eclecticism and integrationism in counsellors and other therapists in Britain. Results indicate that as many as 87% of counsellors can be regarded as taking a 'non-pure-form' approach of some kind. Issues in interpreting data on counsellors' self-reports of orientation are discussed, and implications for training and further research are outlined.     

Experiential Tasks and Therapist Bias Awareness

All therapists have values, assumptions, and beliefs about groups of people who are different from the dominant culture. How the therapeutic process is shadowed by therapists' assumptions and attitudes toward ethnic minorities is discussed. The author provides experiential techniques such as visualization, role playing, role reversal, family sculpturing, and a written assignment as a vehicle to heighten a family therapists' awareness of underlying assumptions and biases toward clients of an ethnic minority.     

Language matters in counselling diversity

The paper presents a personal view of some issues around therapeutic conversations involving difference and minority experience. Language, discourse and mother-tongue are explored from different theoretical standpoints and considered alongside concepts of difference, otherness and the unvoiced. Intercultural counselling offers a framework for unpacking the meaning of decolonising practice in conversations with clients or counsellors from ethnic or other minorities undertaking counselling or supervision. I discuss possibilities for practice informed by existential and hermeneutic phenomenology, including gestalt therapy interventions to bring in the body alongside discourse, and phenomenological empathy as a non-colonising resource in working across difference and diversity.     

Hypnosis as a counselling tool

The history of hypnosis is outlined, with particular reference to recent developments. The main current theories are expounded briefly, and applications in short-term therapy and counselling are discussed As therapists from a wide range of systems of psychotherapy and analysis are increasingly incorporating hypnosis into their practice, the hope is expressed that counsellors will take more advantage of training opportunities and extend the use of hypnosis in their own work.     

Therapeutic practice in multi-racial Britain

Service planners and providers of mental health services (including therapy and counselling) claim that their services are being restructured so as to become more sensitive to the needs of users—irrespective of race and cultural background. This paper is one step towards that goal. It aims to (i)challenge assumptions and beliefs held by mainly white, mainstream therapists and counsellors; (ii) question the therapeutic practice which is based on white, middle-class ideology; (iii) raise awareness of a ‘black’ perspective in therapy and counselling and (iv) provide some practical guidelines for transcultural counselling.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.     

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.     

“We are better and happier if we are inclusive.” Therapist perspectives on the importance of LGB cultural competence in a mental health setting

Lesbian, gay and bisexual people are more likely than their heterosexual counterparts to report dissatisfaction after accessing a counselling or psychological service. Greater dissatisfaction may result from therapists who focus on psychopathology without considering cultural context. Research has demonstrated therapists' cultural competence (attitudes, knowledge and skills) may influence effective service provision to LGB people. Counsellors and psychologists (N = 10) were interviewed to determine the sources of information influencing the cultural competence and LGB cultural competence practices used by therapists in their clinical practice. Three themes were developed from semistructured interviews: (1) the importance of multiple sources of cultural competence; (2) applying cultural competence improves the therapeutic process; and (3) ensuring visual cues of affirmation are affirming, not pathologising. Theme 1 highlighted that initial professional training, cultural competence training and lived experience could be triangulated to assist therapists in improving their cultural competence. Theme 2 highlighted that cultural competence improves the therapeutic process by ensuring therapists can demonstrate affirming attitudes, knowledge about LGB people and culturally affirming skills to work effectively with LGB clients. The final theme explored the need for therapists to create an inclusive space for LGB clients. Recommendations for improving clinical practices and tools to enhance cultural competence are discussed.     

Constructing and deconstructing psychotherapeutic discourse

This paper reviews recent work on the social construction of the self in counselling and psychotherapy, and argues that we need to attend to the ways in which the therapeutic self is fashioned (a) in relation to the ‘psy-complex' as the network of theories and practices concerned with psychological governance and self-reflection in modern Western culture and (b) in the context of ‘therapeutic domains' outside the clinic and academe, domains of discursive regulation and self-expression which then bear upon the activities of professional and lay counsellors. Therapeutic domains contain repertoires, templates and complexes within which counsellors and clients fabricate varieties of truth and story a core of experience into being. I then turn to describe and assess some of the various ways in which this kind of critical reflection on therapeutic discourse and counselling practice now already underpins the work of social constructionist ‘narrative' therapists. Some attention is given to the different pragmatic and deconstructionist approaches which make the discursive constitution of the problem into the problem, either by dissolving or by externalizing the account the client presents. Here I argue that the activities of social constructionist counsellors can be viewed as forms of deconstruction-in-process (a deconstruction of the discursive frames which have been constructed by the client), but that they should not be viewed as stepping outside the discursive conditions of possibility which ground their work. the psy-complex and therapeutic domains still function as relatively enduring structures which limit the degree to which we may construct and deconstruct psychotherapeutic discourse.     

Career guidance and therapeutic counselling: sharing ‘what works’ in practice with young people

Many young people in the UK and across the world, where austerity measures are biting deep, find themselves at a time of crisis and uncertainty in their lives. The assumptions previously held of clear and straightforward career paths are being challenged and ‘career’ has come to mean more than simply ‘work’ or ‘employment’. This has implications for career practice, where career advisers are engaging with a range of complex issues in their guidance interactions with clients. This article draws on research undertaken with therapeutic counsellors into ‘what works’ when counselling young people. It offers career practitioners the opportunity to reflect on four key emerging themes and to consider how the discipline of therapeutic counselling might inform guidance practice.     

Counselling older adults: Issues and awareness

This paper explores understanding and awareness among counsellors and counselling psychologists, of work with older people. The result of a piece of reasarch on this topic are presented. These tentatively confirm a relative lack of interest and insight into work with this age group and indicate that an age bias may exist among therapists. The reasons for this lack of awareness are explored and it is suggested that issue of the therapists' countertransference is crucial and that work with older persons may raise complex emotional issues for the counsellor. Possible future directions for research are discussed.     

Spiritual Dimensions in Counselling: Editor's Introduction

Contributors to the symposium experienced difficulty in finding appropriate language to express their understanding of spirituality and the essential nature of their work with clients. Nevertheless, a fascinating world emerges from which it is clear that many counsellors are now fulfilling the role of spiritual companion. The implications of this for therapists in general are examined, as well as what it means for clients to conceive of themselves as 'spirit'. The question of whether or not counsellors are taking over from the clergy as spiritual guides is explored.     

A solution-focused approach to working with clients who are suicidal

Self-harm and suicide are amongst the most challenging and frightening problems that therapists and counsellors can encounter in the course of their work. The risk of clients harming themselves in the course of treatment can debilitate the therapists from acting creatively and collaboratively, and make their actions defensive, focused solely on risk assessment rather than therapeutic change.Yet it is precisely a creative and collaborative response, such as that engendered by solution-focused therapy and other models, that is the most likely to facilitate change and re-empower clients to take back charge of their lives. This article describes a solution-focused approach to working with suicidal clients that can be used in conjunction with traditional approaches and which focus on establishing safety as well as assessing risk.Working from this model the clinician shifts to identifying client strengths and coping skills, to collaborating with the client to establish meaningful goals and to helping the client envision a positive future. Arguably, such an approach can increase collaboration between therapist and client and lead to a more client-centred safety plan.     

Guidelines for Counsellors Working with People of African Ancestry in a Sport Context

The objective this article is to describe five practice guidelines for counsellors working with people of African ancestry in a sport context. The practice guidelines pertain to counsellor training, counsellor perspectives, counsellor services, counsellor ethics and counsellor research. These practice guidelines can assist counsellors working with people of African ancestry in a sport context to focus on both personal development through sport and performance enhancement in sport. This will enable athletes not just to view sport in terms of their win-lose record, but to also strive for excellence in sport by becoming better people. In becoming better people athletes can contribute to building up Africa and her people.     

Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.