Empathic interactional sequences and counsellor trainee effectiveness

Consecutive counsellor trainee and client statements from 12 audiotaped assessment interviews were coded to operationalize empathy as a sequential variable. For each two statement sequence the speaking order (counsellor to client, client to counsellor) was also coded, and the resultant matrix analyzed via loglinear statistical procedures for categorical data. For the speaking order client to counsellor, three empathy sequences (empathy enhancing, empathy diverging, empathy commencing) were found to be significantly related to counselling effectiveness. For the speaking order counsellor to client, only one sequence(empathy diverging) was found to be significantly related to counselling effectiveness. Implications for counsellor training and future research are discussed.     

Standard posture,postural mirroring and client-perceived rapport

The relationship between client-perceived rapport (as measured from a standardized client) and physical mirroring and the standard counsellor posture was investigated with interviews performed by 59 post-graduate students in counselling psychology. Videotaped recordings were used to code counsellor posture in the categories of: total postural mirroring, mirroring of the hands and arms, mirroring of the legs, mirroring of the torso, and the frequency of the standard counsellor posture across each minute of the interviews. These minutes were classified as 'high' in rapport or 'low' in rapport as measured by the standardized client. Results indicated that there was significantly more postural mirroring of the torso during high versus low minutes, but that the counsellor standard posture occurred significantly more frequently during low rapport minutes than in high rapport minutes. However, when examined over the entire length of the interviews, these data were able to be understood in terms of counsellor 'flexibility' of response rather than simply whether these postural behaviours were present or not. Implications for counsellor training are discussed.     

Private work in public places: Confidentiality and role tensions in a university counselling service

This paper aims to explore issues of confidentiality relating to working with undergraduate and postgraduate students in a university counselling service. The context of a counselling service within our institute of higher education has to be understood in its relationship to academic, administrative and managerial staff, to medical and psychiatric services personnel and to the wide range of other student support and welfare services in the organization whether run by university staff or the students' union. Some reflection will be given to the need for clarity in the range of roles counsellors have to play within the different functions of the university. The client-counselling relationship cannot be seen as a dyad but as a triad or an even more complex constellation of relationships when regarded in an institutional context. The central premise is based on understanding the conscious and unconscious dynamics in the institution and how these impinge on the relationship between client and counsellor in challenging or assuming the confidentiality held by the service. Such boundary issues are identified in consultation and referral, breaking confidentiality, referral of disruptive students, calls for help and holding confidentiality. The case material drawn on to illustrate these five areas is also described in terms of anxieties raised and how these are projected, introjected and contained.

Within the service client and counsellor contract to work together. It is made clear that counselling is a professional relationship with agreed boundaries and a commitment to confidentiality. This is crucial to the working relationship and is a means of providing the client with both safety and privacy. Any limitation on the degree of confidentiality offered may reduce the usefulness of counselling. Bound by his or her professional code of ethics the counsellor will reach an agreement with the client at the outset about the extent of confidentiality they are offering, take care not to disclose information given in confidence and, when possible, be able to negotiate any change in agreement with the client.

Exceptional circumstances which may occur and give rise to the counsellor's decision to break the confidentiality formerly agreed between him or herself and the client are those which give grounds for believing the client will cause serious harm to others or themselves or have harm caused to them. Reference will be made to the role of consultant supervision in such situations and how any breaking of confidentiality can best be minimized. Attention will be given to the relevant ethical codes to which counsellors adhere and the issues of confidentiality within the legal process as well as whether the requirements of providing counselling services for students in higher education impel us, logically and practically, towards certain policies in regard to boundaries.     

A study of Muslim Asian women's experiences of counselling and the necessity for a racially similar counsellor

A survey of four Muslim Asian women of varying ages was carried out, for whom the author had previously acted as a counsellor. The survey was designed to explore the extent to which client and counsellor racial similarity affected the therapeutic alliance, as the counsellor/author was of a similar race to all four clients. It was the author's belief that racial similarity in itself would not procure positive counselling outcomes, and hence this study attempted to explore the clients' perceptions of qualities extrinsic to race, including interpersonal skills, styles and approach to counselling of the counsellor, in order to duduce whether in fact these factors were more singnificant to the outcomes than race. The majority of clients did not feel racial similarity was an essential quality, although one client expressed cultural awareness as being a preferable quality. This has suggested that it is not essential for client and counsellor to be racially similar in order to achieve successul counselling outcomes.     

Clients' suitability for counselling: The perception of counselors working in general practice

This study investigated the attitudes of 112 counsellors in general practice towards various factors concernig the selection of clients. Response indicate that counsellors are influenced, not only by diagnostic criteria, and other factors relating to the client, but also issues relating to the counsellor and the setting in which she or he works. The diagnostic critreria whcih seem to be considered most important are desire for change, motivation for therapty and evidence of psychopathology, althoug there is no clear consensus about the criteria overall. Importance varied according to the age and sex of the counsellor, but not by the experience, training, model of working, desire for further training, or number of sessins available.     

The three worlds of the counselor

The counselor is seen as one who is personally involved as he deals with his client, but in much of his counseling he cannot escape dealing with himself as well. Three dilemmas of the counselor are analyzed: Can he enter the value world of his more youthful client in order to deal with such questions as respect for authority and learning from the past without compromising his own values? Can he “care” for the client and still show concern about what the client does? Can the counselor grow as a person and at the same time achieve professional success?     

Distance Guidance: Careers Advice by Post

Careers guidance is traditionally carried out face-to-face. Use may be made of facilities such as job-information leaflets and computer programs which the client uses on their own (perhaps at the suggestion of the counsellor), but the core of the guidance process is generally the careers interview. Issues examined include: is it possible to provide adequate guidance without face-to-face contact between client and counsellor? what might be lost or gained by the difference in approach? what are the circumstances in which distance guidance might be appropriate and how is it best provided?     

Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

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.     

Computer-based counsellor training

The use of computer-assisted instruction and simulation models of client or counsellor behaviour in counsellor training programmes is discussed. It is argued that computer-based training will increase the effectiveness and sophistication of counsellor training practices.     

A qualitative study of client experiences of working with novice counsellors

Aims: This paper reports on a qualitative analysis of written accounts by clients who participated in a counselling relationship with beginning-level trainees. The purpose of the study was to explore how clients experience the process of counselling with novice practitioners. Method: Consensual qualitative research was used for data analysis. Findings: Three general thematic categories were identified – client perceptions of self in counselling; client perceptions of the counsellor; and client perception of the counselling process. Conclusions: Overall, the findings suggest that these clients saw the interpersonal qualities and skills of the counsellor as major contributors to their experience. Implications: Clinical training of novices should start by developing the interpersonal and collaborative skills of trainees.     

Effects of counsellor interpretations and client reactance on social influence and the working alliance

These two studies investigated the main and interaction effects of client reactance and counsellor interpretation discrepancy and style on counsellor social influence and the working alliance. Undergraduate students who were divided into high and low reactant pups listened to low, moderate, or high discrepancy interpretations given by counsellors who used a tentative or absolute interpretation. Contrary to the hypotheses, results showed only one interaction effect for reactance, interpretation discrepancy, and interpretation style. Low reactant participants rated the working alliance higher with tentative interpretations while high reactant participants rated it higher with absolute. High reactant participants consistently tended to perceive the counsellor less positively than low reactant participants. There were unexpected gender differences, suggesting that females saw the counselling more positively in the low discrepancy condition while males did in the moderate. The results were not supportive of an interaction among reactance, discrepancy, and style, but are in line with macro-results in the counselling and psychotherapy literature indicating the primary importance of client variables.     

A narrative social constructionist approach to therapeutic empathy

The concept of empathy has been a centrol conceptual element in approaches to counselling and psychotherapy that emphasise exploration of meaning in the context of a facilitative relationship. However, the existing literature on therapeutic empathy lacks theoretical coherence. a narrative social constructionist perspective represents a theoretical approach that enables the integration of diverse strands of clinical observation and research into the creation of empathic understanding in counselling. From a social constructionist position, therapeutic empathy can be understood as a relational process, a step-by-step co-construction by counsellor and client of the life-narrative of the client. In this paper, the Barrett-Lennard (1981) cyclical model of empathy is used as a fremework for examining the counsellor and client actions, strategies and tasks that constitute empathic engagement around the task of emploring and re-authoring life-narratives. Constructionist analysis of the cultural origins of the concept of empathy suggest some limitations of this way of conceptualising what happens in therapy. The implications of these ideas for theory, training and research are discussed.     

Client perspectives on counselling: Before,during and after

This four‐year study investigated the under‐researched area of first‐time users’ perceptions of counselling and how these evolved over time. Research participants were drawn from six settings within university counselling services, the voluntary sector and primary care. Using an interpretive hermeneutic framework based on thematic analysis, 30 interviews were carried out. Results revealed that before counselling, participants were uncertain about the nature of counselling and what to expect, described stigma associated with peer influence and varying levels of confusion about specialist language. During counselling, participants experienced some level of positive change. At the same time, divergences of counsellor and client perception highlighted theoretical issues concerning counsellor approach and the exploration of emotions. Post‐counselling interviews revealed further positive change, and practical issues with implications for counsellor training and practice in terms of client assessment, preparation for counselling and the influence of cultural assumptions on theory and practice.     

Psychodynamic perspectives on teacher stress

Melanie Klein's concept of projective identification is now in common use by counsellors and psychotherapists. Julia Segal describes her own hypothesis about the way it works as well as her use of it in her practice, working as a counsellor for people with multiple sclerosis, members of their families and professionals working with them. When a person cannot bear to feel an emotional state they can evoke the feeling in someone else, not only a therapist or counsellor but also others within the family. Segal describes the way powerful emotions can be evoked in the counsellor; in particular the feeling that a certain idea cannot be shared with a client. She also describes working with clients who are on the receiving end of such projected feelings, sometimes evoked by illness within the family. She also points out that unresolved emotional states suffered in childhood can leave adults unable to bear certain feelings. If the feelings threaten to re-emerge in adulthood, perhaps triggered by their own children reaching a certain age, parents sometimes attempt to rid themselves of the emotional state by projective identification and in the process, evoke a version of the feelings in their own children. This may, for example, exert pressure on parents to divorce just as their own children reach the age they were when they themselves lost a parent.     

The challenge of prejudice: counsellors’ talk about challenging clients’ prejudices

This paper considers the implications for training and practice of counsellors’ responses to the notion of challenging clients’ prejudices. It explores tensions in counselling discourse between social responsibility, responsibility to the client and responsibility for one's self as counsellor. Three focus groups of counsellors were asked whether a counsellor should challenge clients’ prejudices. Responses were categorised as challenge, not-challenge or exit responses. Discursive themes identified in the responses are: managing congruence and being non-judgemental; self-care and self-respect; and social responsibility. Strategies for managing the discursive conflicts identified in responding to counsellor-identified client prejudices are summarised.     

Client and counsellor narrative accounts of congruence during the most helpful and hindering events of an initial counselling session

The role of congruence in establishing and maintaining a therapeutic alliance has been emphasized by theorists within the humanistic/person‐centred tradition. However, there appears to be a lack of research that explores the processes occurring during moments of congruence or incongruence. The main objective of the present study was to gather qualitative data about congruence based on both participants’ narrative accounts of their subjective reactions during the most helpful and the most hindering event of an initial counselling session. Client and counsellor recollections of their experiences during these two events were stimulated through the replay of a video‐tape after the session. The event identification came from the client through a Brief Structured Recall interview. During the hindering event, both participants were incongruent. There was a mismatch between what they were feeling and what they were expressing verbally and/or non‐verbally. At the same time the client was feeling criticised and offended by counsellor's confrontation. By contrast, during the helpful event both participants were congruent. The counsellor was experiencing empathic understanding toward his client and the client was feeling accepted and understood. The implication of these findings are discussed in terms of how congruence might affect the construction of significant events during the therapeutic hour.     

Interpersonal counsellor qualities: Their effect on client improvement

Recent analyses of client improvement suggest that it is related to three inter-personal counsellor qualities: (a) empathy — the ability of the counsellor to grasp the meanings, needs and hierarchies of the client's world as if it were his own; (b) genuineness — honesty and openness; and (c) non-possessive warmth — a care for and valuing of the client, functioning to preserve the client's dignity. These three core conditions are examined, and their implications for counselling research and practice are discussed.     

Examining process constructs of narrative career counselling: an exploratory case study

The present article examines how the five process constructs of reflection, connectedness, meaning making, learning and agency are operationalised in a constructivist approach to career counselling, specifically a storytelling approach. This article reports on an exploratory case study of a Black South African female university student. The case study provides examples of how a career counsellor enacts these constructs and facilitates their development in a client, as well as examples of how they are evident in client dialogue and action. Insight into the process of a storytelling approach to narrative career counselling is demonstrated, from which tentative suggestions are made about how to facilitate the process constructs of reflection, connectedness, meaning making, learning and agency.     

Development and field-testing of a procedure for coached clients to assess rapport during trainees' counselling interviews

Procedures for using coached clients to assess the degree of rapport between client and counsellor, as experienced by the client during counselling interviews, were developed. Twenty-three interviews conducted by counsellor trainees were assessed at one-minute intervals by two coached clients using a five-point rating system. In addition, the Working Alliance Inventory was used to assess rapport at the end of the interview. Data indicated that the in vivo rating procedure of client-experienced rapport possessed good reliability and validity.