SS3025 : Counselling

WEEK 2 : 8 FEBRUARY, 2011.

3 core approaches psychodynamic, cognitive behavioural and humanistic (person centred) All 3 involve the essential qualities of the counsellor -- unconditional positive regard -- empathic understanding -- warmth & genuineness All 3 core approaches stress adherence to the appropriate Code of Ethics 1

Counselling Approaches

All 3 approaches use a core of basic skills, in addition to which each approach will have some unique specific skills Basic skills include : postural cues; situational management; clear (concrete) expression; immediacy/spontaneity; setting a clear contractual agreement; good timekeeping; active and objective listening. Specific skills will be pointed out when each approach is covered on this module In all 3 approaches, adequate training; continuing professional development; and supervision are regarded as essential Evaluation 2

Ethical principles (BACP)

Fidelity: Honouring the trust placed in the Counsellor Autonomy: Respect for clients right to be self-governing Beneficence: promoting the clients well being

Ethics continued:

Justice: fair and impartial treatment of all clients Self-respect: promoting practitioners selfknowledge and care of self Non-maleficence: avoiding harm to the client

http://www.bacp.co.uk/ethical_framework/ethics.php
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The Nature of Counselling

COUNSELLING

IS A HELPING RELATIONSHIP

IS BASED ON THE PRINCIPLE OF EMPOWERMENT

SEEKS TO HELP PEOPLE IDENTIFY THEIR OWN RESOURCES

IS CONFIDENTIAL

Communication/counselling

Counselling is based on effective communication PLUS A knowledge base in at least one theoretical approach Adequate qualifications and supervision Self and other evaluation, and retraining/CPD Adherence to an appropriate ethical code NB communication is 2 way.
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Barriers to communication
PERCEPTUAL

PSYCHOLOGICAL

PHYSIOLOGICAL

BARRIERS
PRESENTATIONAL ENVIRONMENTAL

INTELLECTUAL

LINGUISTIC

Counselling
The essential skill for all approaches is LISTENING : Use your eyes! Be on the watch for preconceived ideas Listen! Permit silences. Dont leap in.
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Some basic skills that Counsellors use:

Active listening Observing Attending RespondingReflecting Paraphrasing Summarising

Good Listening (1) General approach : interest, attention, immediacy. Posture : SOLER Attitude: Voice : Environment:
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Good Listening (2)

Keep client focussed on the point :Id like to hear more about ---, what was it you were saying about --- Ask for more info when something is unclear or incomplete Dont rush in with solutions. what do you think you want to do about it? rather than this is what you should do about it Many client situations may be insoluble they want to be heard, not have superficial solutions offered

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Good Listening

In general, these are not appropriate: Very probing why questions shoulds and oughts Suggesting blame in a situation Not accepting the clients feelings.
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SS3025 class 2 Class exercise : video of 3 counselling approaches 1. Key features of each. 2. Communication ; verbal; non verbal; silences(?) 3. Ethical features.

Recent years have brought a stronger emphasis on evaluating practice

It is unacceptableto continue to provide therapies which decline to subject themselves to research evaluation. Practitioners and researchers alike must accept the challenge of evidence-based practice, one result of which is that treatments which are shown to be ineffective are discounted.
Psychotherapy Services in England as quoted in Winter (2003))

(Parry and Richardson, (1996), Review of Strategic Policy on NHS

An example:

Westminster Pastoral Foundation, the largest provider in the voluntary sector of psychodynamic counselling in England agreed to an independent study into its effectiveness Two studies were conducted the latter into the effectiveness of Kensington Counselling service and 21 affiliated counselling centres

Sample:

Divided into 2 groups disadvantaged and nondisdadvantaged

(Disadvantaged defined as those people finding it difficult to access statutory mental health services)

1059 clients 70% female 30% male Age range15- 81 years old Mean number of sessions: 26 Clients asked to complete pre-counselling, postcounselling and follow-up questionnaires

Disadvantaged group included:

Older people (greater than 50 years old = 26.8% of disadvantaged group) Black people and those form ethnic minority groups (14.3%) Gay and lesbian people (7.1%) People with chronic illness or physical disabilities (10.7%) People with learning disabilities (3.6%) People from socially disadvantage backgrounds (as defined by the Social Exclusion Unit people from neighbourhoods of poverty, low income, being on benefits for more than 6 months, being in local authority care in childhood, living below half the average income, people struggling with social integration using drugs or being involve in crime =

522 clients from disadvantaged group and 537 from non-disadvantaged group completed pre-counselling questionnaire; a smaller number complete post-counselling questionnaire ( 151 and 232 respectively) Follow up questionnaire sent at 6-12 months after counselling

Key findings:

Clients problems more severe in the disadvantaged group than non-disadvantaged group in terms of both clients and counsellors rating. 78% in both groups - considered their problems had been more than a year long. Evidence of very significant reduction of clients problems in the post-counselling survey. No significant changes in post-counselling results and follow-up results . However some indications that gains made by the disadvantaged group are less well maintained.

Key findings:

Duration of counselling between two groups - no significant difference. Clients who showed greatest change in counselling are those with most severe problems. The two groups rated factors in the counselling differently. Disadvantaged group rated counselling relationship, counsellor being un-shockable and knowledge of counsellor could cope as more important than the non-disadvantaged group. Both groups rated as 1 and 2 respectively trust in counsellor & opportunity to talk. The demographic characteristics (i.e. gender, age and culture/religion) were considered of little importance. Effectiveness of psychodynamic counselling demonstrated in this and earlier study and benefits generally maintained at follow up stage. Clients problems were similar to that shown in clinical populations

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Limitations:
They were not able to use a control group for comparison either uncounselled group or alternative form of treatment group (however CORE measures should allow this) Response rate- high attrition rate at post counselling and follow up. It was not possible to tape counselling sessions to minimise intrusion (standardisation)

Winter, D., Archer, R., Spearman, P., Costello, M. Quaite, A. & Metcalfe, M., (2003) Explorations of the Effectiveness of a Voluntary Sector Psychodynamic Counselling Service in Counselling and Psychotherapy Research Vol. 3, No. 4