The contribution of anxiety and depression to fatigue among a sample of Australian university students: suggestions for university counsellors

Responses to the Zung Self-Rating Anxiety Scale (SAS: Zung, W. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12, 371–379), the Self-Rating Depression Scale (SDS: Zung, W. (1973). From art to science: The diagnosis and treatment of depression. Archives of General Psychiatry, 29, 328–337) and the Fatigue Severity Scale (FSS) developed by Krupp and colleagues (Krupp, L.B., LaRocca, N.G., Muir-Nash, J., & Steinberg, A.D. (1989). The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123) were collected from 200 Australian university students to explore the links between these three disorders. Reliability data were satisfactory for all three scales and there were no significant gender or age-related differences between total scale scores. Factor analyses revealed a 5-factor solution for the SAS, a 6-factor solution for the SDS and a single factor for the FSS. There were 8 major and meaningful correlations found and these were entered into a regression of the SAS and SDS factor scores upon the single factor of the FSS. Fatigue factor scores were most powerfully predicted by psychomotor agitation, pain and resultant fatigue and cognitive and emotional arousal factor scores from the SAS and SDS. These data argue for an arousal/anxiety-fatigue-depression progression in disease that may be developmental or accumulative, with extreme levels of psychomotor arousal, resultant muscle fatigue and pain, plus concurrent elevated emotional state and cognitive arousal contributing to an eventual depletion of physical resources, leaving the individual in extreme fatigue. Implications for diagnosis and treatment by counsellors are discussed.     

Counselling — Why not? A qualitative study of people's accounts of not taking up counselling appointments

The aim of this research was to explore the reasons behind people's decision not to take up a counselling referral. A qualitative study was carried out, using semi‐structured interviews and written responses. The investigation was based in NHS primary care counselling services in a GP practice in the North of England. People who had been referred for counselling by their GP, but did not attend any counselling appointments, were interviewed or invited to submit written comments. Many people talked about the courage it took to ask for help. The referral itself was sometimes therapeutic as it legitimised their distress. The GP's response affected people's decisions. Waiting time and what happened during waiting was important. Some people had their own resources, which they used actively, seeking other sources of help; others were more passive, their lives changed around them. Other factors that contributed to non‐engagement were being referred in a crisis; lack of knowledge about counselling and mental distress; and concern about stigma and its impact on work. Perceived waiting time was the most significant factor for participants in this study, but most people had a combination of reasons for not engaging. Support from the GP, information about the service and being given a realistic expectation of waiting times, may help people feel better able to access counselling services.     

Can heterosexual counsellors or generic agencies help same‐sex couples? An exploratory study

Gay men and women were interviewed in single‐sex focus groups in order to learn more about the therapeutic help that could be offered to people in same‐sex relationships. Interviews were analysed using the constant comparative method. Among the various themes that emerged was the need to have their relationships valued and accepted and the damaging effects of living in a heterosexist and homophobic society. The need for men, in particular, to identify a set of developmental stages for gay relationships was important. Difficulties in seeking help from mainstream organisations are discussed and recommendations made for both counsellors and agencies.     

Counselling provision for staff in the National Health Service in England: A survey of patterns of provision

This paper reports the findings of a research project carried out in 2001, mapping the provision of counselling services for staff in the National Health Service in England. A postal survey was used to gather both quantitative and qualitative data in order to produce a picture of service provision in NHS Trusts throughout England. Analysis of information concerning the qualifications, experience and pay structure of counsellors, and patterns of service delivery, revealed significant variations across Health Trusts. Findings are discussed in relation to implications for policy, practice and future research.     

Working for free: A fundamental value of counselling

This paper challenges two myths about voluntary sector counselling, namely (a) that volunteer counsellors and voluntary sector counselling are the same thing, and (b) that standards of practice in the voluntary sector are significantly different from those elsewhere. The paper also argues that voluntary sector counselling nurtures a deeply felt commitment to respond to human need without monetary recompense. Drawing on evidence from a study of voluntary sector counselling in Scotland, we show that a substantial proportion of voluntary sector counselling is undertaken by paid workers, and that many counsellors who volunteer in one setting undertake paid counselling work in another setting. We demonstrate that the majority of voluntary sector counselling agencies in Scotland work within ethical frameworks developed by the professional bodies for counselling, and we argue that these agencies have been at the forefront of efforts to enhance the quality and safety of counselling services available to the public. We identify and illustrate three overlapping reasons why large numbers of highly qualified counsellors give their time and expertise for free: because of their desire to support the work of agencies through which the accessibility of counselling is extended; because volunteer counselling constitutes personally rewarding and meaningful work; and as an expression of their commitment to give freely of themselves. In conclusion we argue that voluntarism is central to counselling, but that parts of the counselling world are at risk of forgetting this core value.     

Five women talk about work‐related brief therapy and therapeutic writing

Therapeutic writing can play a valuable role in brief, workplace counselling. The present study explores the experiences of five women who used therapeutic writing in this context. Ethical and methodological dilemmas in carrying out this research are highlighted. The study also demonstrates the use of ‘fictionalist’ accounts as a way of overcoming some of the difficulties associated with the dual role of practitioner/researcher, especially confidentiality.     

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.     

The Function of Confession: A Study Based on Experiences

In Finland, confession has been an object of discussion within the Church for a long time. While people have demanded that its role be increased, it has almost solely been discussed in terms of quantity. This study examines people's experiences of confession on the basis of 200 letters. These experiences show that it is not the form of confession that is the central issue, but rather its function, that is, giving relief. Thus the artificial borderline between confession, pastoral counselling, and psychotherapy is blurred. The goal should thus be not to stimulate confession, but rather to stimulate ways of helping people. The starting point must be a person's distress and on the basis of this one should decide which form of help is the most relevant in any given situation.     

Integrating traditional and non‐traditional approaches to treat a client with a co‐occurring addictive and mental disorder: A case study

This paper presents a case study of a male client with co‐occurring addictive and psychological problems. The aim is to describe this client's treatment within an inpatient facility that provided integrated care for those diagnosed with both mental illness and substance abuse. The course of treatment from admission to discharge and follow‐up are discussed in an effort to provide a detailed account of the treatment modalities used to best help this client. Implications for counselling clients with similar issues and concerns are discussed.