Action and language: Contextual action theory in counselling

Contextual action theory is presented as a conceptual framework useful for grounding the recent work in counselling and career development called Life Design. Based on the premise of the goal-directed nature of human action, this approach has links to language in theories of naive action and attribution, and theory of mind. Contextual action theory has an associated research method that has been used to generate a range of research studies that have described actions and projects in the career development and counselling domains. The link that contextual action theory provides between research and practice allows the identification of five tasks for the counselling practitioner informed by this approach.     

Responding to unemployment and inequalities in income and health

This paper discusses the social and economic context in which counselling and psychotherapy are practised. The use of ‘outplacement counselling’ and personal skills training programmes for dealing with unemployment and redundancy is criticized. It is argued that they involve a form of psychological reductionism which fails to acknowledge socio-economic realities. Research showing a strong link between inequalities of income and physical and mental health is reviewed. It is suggested that counsellors and psychotherapists have a professional obligation to acknowledge the social and economic circumstances likely to contribute to clients' mental distress and avoid the dangers of reductionism.     

Creating a research agenda in career counselling: the place of action theory

After identifying historical and current problems in career counselling research, we propose a research agenda based on contextual action theory. This theory has been used as a framework for research in the career field and for general counselling practice. It is advantageous for several reasons including its conceptual basis, its detailed qualitative and quantitative research method, and the significant link it provides between research and practice. It is supported by the action-project method, an integrated set of procedures developed for conducting research. Contextual action theory and the action-project method can address major emerging issues in career counselling, for example the place of emotion and the use of narrative, and advance the research agenda in this field.     

Community Counselling in African Contexts

This article explores community counselling as a form of professional practice for psychologists, with a particular focus on practices that are relevant in African contexts. The discussion identifies and discusses various models of practice identified in community psychology, including an ecological perspective, a public health and community mental health framework, interventions that focus on promoting a sense of community, indigenous approaches to community counselling and a critical or social action framework. Examples relating to each of these models of practice are drawn from various African settings, providing practitioners with some insights into how theory can be operationalised into practices that are relevant to African contexts. The article concludes with a discussion on community research, with a particular focus on ethical considerations relevant to a community approach in African contexts. The latter discussion emphasises the importance of working with the community as partners, and suggests the possibility of developing a Code of Ethics aimed specifically at guiding community counselling practice in African contexts.     

An inquiry into the emotional impact of sight loss and the counselling experiences and needs of blind and partially sighted people

Background: The link between sight loss and depression is well documented. The UK Vision Strategy seeks to bring the emotional impact of sight loss into public awareness and improve access to emotional support for visually impaired people. However, dedicated counselling services for visually impaired people remain scarce, and research into the effectiveness of psychological interventions is predominantly anecdotal rather than evidence based. Aim: To explore the emotional impact of sight loss in four core areas (mood, self concept, social connectedness and loss), and to explore the counselling experiences and needs of blind and partially sighted adults. Method: Data were collected using the mental health and social functioning sub-scales of the National Eye Institute Visual Functioning Questionnaire-25 and semi-structured interviews transcribed and analysed using grounded theory. Results: Participants with a serious eye condition shared a common transition from sight to blindness, starting with diagnosis, coping with deterioration of sight, experiencing loss in different areas of life, experiencing changed perceptions of self in relation to society, experiencing others in a changed way and experiencing rehabilitation. A theoretical model describing the transition from sight to blindness is proposed. Participants reported negative perceptions of counselling and a lack of counselling opportunities in relation to their sight loss. Implications: The implications for policy and practice are discussed, particularly the need for counselling after diagnosis of visual impairment and the specific challenges facing those who deliver counselling to blind and partially sighted clients.     

Addressing Urgent Community Mental Health Needs in Rwanda: Culturally Sensitive Training Interventions

Rwandan leaders in the health and educational sectors have begun to discuss the necessity for establishing culturally appropriate community-based mental health counselling services in Rwanda, especially trauma counselling. The need for a community psychology approach is anchored in the lingering effects of the genocide and the continuing post-traumatic stress symptoms suffered by many in the population. Capacity building in an effort like this would require the design of multi-level counselling curricula that are sensitive to the social structures within Rwandan culture. These curricular endeavours call for the development of a National Counselling Centre to serve as a structural mechanism for organizing community-based counselling initiatives. We consider the community health services needs in Rwanda here, along with associated challenges and strategies for effective mental health services in a country with a recent history of genocide. A community psychology approach to mental health would benefit Rwandan society by making trauma counselling and recovery services available and accessible to citizens throughout the country.     

A five‐year evaluation of the effectiveness of person‐centred counselling in routine clinical practice in primary care

Counselling is the recommended treatment for individuals with mild to moderate mental health problems of recent onset. In this evaluation of a primary care counselling service offering person‐centred counselling, the Core Outcome Measure (CORE‐OM) was administered at referral and at the beginning and end of therapy. A pre‐post therapy effect size for 697 individuals over a 5 year period was 1.2. This compares with a waitlist (between referral and pre therapy) effect size of 0.24 for 382 individuals over a three year period. The results indicate that person‐centred counselling is effective for clients with common mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate symptoms of recent onset, but extends to people with moderate to severe symptoms of longer duration.     

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.     

Towards an evidence‐base for student wellbeing and mental health: Definitions,developmental transitions and data sets

Against a background of huge changes in the world of university and college students since the turn of the millennium, together with a multitude of reports on student mental health/wellbeing, this article argues that the field of student mental health is hampered by the imprecise use of terms, a rush to action by universities in the absence of a robust evidence‐base, and a lack of overall coordination and collaboration in the collection and use of data. In response, we argue for clearer and more consistent use of definitions of, as well as differentiations between, student wellbeing and mental health, for a longitudinal approach to the student body that captures their developmental transitions to and through university, and a strategic and systematic approach to the use of bona fide measures in the collection of data on wellbeing and on the process of outcomes in embedded university counselling services. Such a coordinated approach will provide the necessary evidence‐base upon which to develop and deliver appropriate support and interventions to underpin and enhance the quality of students’ lives and learning while at university or college.     

Referral by clergy who counsel older adults

The purpose of this cross sectional study of clergy (N?=?493) was to examine the likelihood of referral to formal mental health providers by those clergy who counsel older adults. Responding clergy completed a brief questionnaire that included information on the amount of counselling they do with older adults, the Attitudes towards Older Adults and Mental Illness (AOAMI) scale, their relationships with mental health professionals, their knowledge of resources for referring people for additional help, and basic demographic data, such as race, age, years in the clergy, and education level. In logistic regression analysis, respondents with more education, those who felt less prepared to provide counselling, and those with more positive attitudes based on the AOAMI indicated that they were more likely to refer, and no differences were found based on their denominational affiliation race, relationships with mental health professionals, or knowledge of resources for referring people for additional help. We believe that public-private partnerships should be formed to help clergy recognise when referrals are appropriate, and to help improve relationships between clergy and mental health professionals.     

The impact of psychological distress and university counselling on academic outcomes: Analysis of a routine practice-based dataset

Whole university approaches to student mental health and well-being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE-OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE-OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study.     

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.     

Factors affecting self-referral to counselling services in the workplace: a qualitative study

The benefits of psychological support in the workplace (also known as workplace counselling) are well documented. Most large organisations in the UK have staff counselling schemes. However, it is unclear what, if any, factors affect employee decisions to use such schemes. This study has used a qualitative methodology to explore the reasons that make employees use workplace counselling. Eleven employees of a university in the north of England who had used the staff counselling service of their employer took part in the study. The employer had two schemes available: an internal staff counselling service and an external Employee Assistance Programme (EAP). A semi-structured interview was used with each participant and grounded theory techniques were used to analyse the interviews. The analysis resulted in the construction of a model of psychological help-seeking in the workplace. The main findings indicate that most participants were motivated to use their employer's counselling service by their prior positive experiences of similar or other type of mental health services. Other encouraging factors were: recommendation of service by others, a supportive environment and trust in the confidential ethos of the service. Conversely, negative preconceptions of psychological help-seeking and a perception of the employing environment as unsafe were shown to have been discouraging factors. The study concludes with suggestions for practice and for further research.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

Understanding the role of hope in counselling: Exploring the intentional uses of hope

In this paper we look at various conceptual models of hope and research evidence for the integral role that hope plays in counselling. We recognize hope as a dynamic process during which counsellor and client interact in ways that can be mutually influencing and we review research that explores this reciprocal process. A model for the intentional use of hope in counselling that recognizes both implicit and explicit approaches is offered. Metaphors for hope-work that position and re-position both counsellor and client in ways that may foster hope are explored. Finally, we provide suggestions for initiating conversations in which hope can be an explicit therapeutic focus.     

How are counselling and therapeutic services experienced by orthodox Jewish primary schools in North-West London? What are the cultural sensitivities,attitudes and beliefs of senior staff members in these schools?

This study investigates how Jewish senior staff at orthodox Jewish primary schools in North-West London experience therapeutic services such as counselling for their students and community. A qualitative approach using semi-structured interviews with seven female orthodox Jewish participants was employed. Thematic analysis was used to analyse data. Results highlighted six broad themes covering the school’s view of counselling and other therapeutic services. Uptake of counselling was often low. Negative parental attitudes, stigma, fear of local authorities and lack of culturally appropriate signposting were some of the factors determining whether counselling services were accessed or not, and why. The importance of the therapist’s own religion and the language used to describe therapy was also significant. Further research into increasing awareness of mental health needs for orthodox Jewish schools and to increase uptake of therapeutic services should be undertaken and has implications cross culturally.     

The well-being outcomes of career guidance

ABSTRACT

The potential for career guidance to impact on well-being has received insufficient attention in the UK. There are both conceptual and empirical reasons to expect that the impacts may be positive, but a lack of evidence directly testing this proposition. Career guidance has commonalities with therapeutic counselling suggesting analogous effects, and it promotes positive engagement in work and learning, which may be associated with health benefits. There are implications for services in reconciling health and employment objectives. However, the promotion of well-being need not imply quasi-clinical ways of working. A call is made for more research and debate in the career guidance community as to the extent and implications of the potentially important relationship between career guidance and well-being.     

Psychosocial response to COVID‐19 pandemic in India: Helpline counsellors’ experiences and perspectives

The COVID‐19 pandemic presents a threat to physical and psychosocial health of individuals. In lieu of the subsequent lockdown and containment measures, helpline counselling becomes a viable method of accessing psychosocial services during the pandemic. The present paper describes experiences of counsellors working with a special COVID‐19 counselling helpline initiated by iCALL, a national‐level technology‐assisted counselling service of the Tata Institute of Social Sciences, India, which aims to address the psychosocial impact of the pandemic and the lockdown. The paper is based on two focus group interviews held with 11 counsellors during the initial two months of the helpline's functioning. Findings of the study highlight the diverse profile of the callers, with individuals belonging to different strata of society and to marginalised communities. The nature of concerns presented by the callers were often a mix of psychological, relational and practical issues. The resultant distress emanated from an interplay of these factors with the relational contexts, their social locations and social structures the individuals were embedded in. This highlighted the need for conceptualising and responding from a psychosocial lens, whereby interventions involved traditional counselling approaches and strategies for addressing determinants of distress by connecting callers to required ground‐level resources. Counsellors’ engagement with this process impacted their professional and personal selves, necessitating the need for structured and continuous training, supervision and support. At a larger level, the counsellors’ narratives asserted the need for adopting a psychosocial paradigm for conceptualising and addressing mental health concerns in India.     

Counselling psychology in South Africa

The origin and development of counselling psychology in South Africa has been profoundly influenced by the country’s sociopolitical history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country’s mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentialising or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country’s health care and education systems.