Week One - Foundations of Counselling

Defining Counselling

Counselling is a 20th century invention; a social institution in the culture of modern societies. Definitions emphasise exploration and understanding, and stresses the idea of the professional relationship and importance of self-determined goals.

Counselling can only happen if a person wants it to, and must be understood in a social and cultural context.

Counselling allows permission to speak, respect for difference, confidentiality, and affirmation (a positive judgement).

Follows the core values of honesty, care, and integrity (consistency of actions and values).

The Outcomes of Counselling

Resolution: understanding, acceptance, solving the problem

Learning: acquire a new understanding, skills, stategies for the future

Social inclusion: to stimulate energy and capacity of person to contribute to well being of others and the social good

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Diversity and Theory of Practice (Core Approaches)

Psychodynamic (focus on insight)

Person-Centered (aim to promote self acceptance and personal freedom)

Cognitive-Behavioural  (concerned with management of behaviour and dealing with irrational beliefs)

Eclectic and Integrative (combined ideas and techniques of the above) - the best or most appropriate ideas from a range of theories to meet the needs of the client.

Aims of Counselling

Insight                           Relating with others            Generativity of social action

Self acceptance        Problem soving                        Self actualisation or individualisation             

Education                    Cognitive change                    Acquistition of social skills

Self awareness         Enlightenment                       Empowerment

Restitution                 Social/behavioural/systematic change

Counselling encompasses a set of competing theopretical perspectives, and a wide range of practical applications and meaningful inputs from different areas (philosophy, science, arts)

Counselling is a form of helping focused on the needs and goals of the person.

Week Two - An Historical Perspective

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Origins of Counselling

Traced back to the beginning of the 18th century. Problems used to be dealt with from a religious perspecitive, at a local family level. The Industrial Revolution brought about change. Religious values became replaced by science.

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The Shift from Traditional to Industrial Societies

People that used to live in the land moved to the city. Communities and families became fragmented, and could not care for their relatives. Mentally ill people were placed in asylums, built and run by the state. They would "contain", not help. 

After public outcry of the ethicacy of implemented practices, the medical profession eventually took control.

Invention of Psychotherapy

Sigmund Freud developed the technique of psychoanalysis - a set of techniques for exploring underlying motives (past experiences) and treating mental illnesses.

Freud believed that therapy was for everyone, not just the insane. Psychoanalysis was eventually introduced in the USA, allowing counselling to become more available. Freud's thinking had to be 'americanised' first. Writers, including Carl Rogers, in the 1950s had to interpret Freud's thinking in terms of their own cultural values.

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Carl Rogers

Founder of client-centered therapy - the client detemines the focus and process of each session.

He emphasised method rather than theory, individual's needs, was not interested in the past, valued independance and autonomy (people taking control of their lives).

Counselling in the 20th Century

Counselling came of age in the 1950s. It was offered as a class in schools and colleges. Counselling was offered outside of medical establishments.

Growth of Counselling

Individuals became aware of choices around identity and self

People in caring professions did not have time to listen

Counsellors were selling their services - must have been for high class people

Counselling recieved publicity in the media

Many people lacked social and emotional support

Counselling Theory

Theories provide tools for understanding. It is important that each counsellor develops own approach. Theories continually undergo reconstruction to reflect social and developmental issues. A theory is a set of ideas used to make sense of some dimension of reality. A theory gives a counsellor something to hold on to, for structure in the face of chaos.

Karasu (1986) found more than 400 approaches to theory.

Depending on the approach, a person can be viewed as an organism, a machine, a social being, or a spiritual being.

Successful Therapy

Successful therapt is due to the employment of specific theraputic strategies, support, a good client-therapist relationship, insight, and behaviour change.

Week 3 - Regulation of Counselling, Training, and Supervision

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Psychotherapy and Counselling Federation of Australia (PACFA)

Establish recognised standards of training, and regulate theraputic practice.

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Overlap and Differences in Counselling and Psychotherapy

Counselling - focus on specific problems or changes in life adjustment

Psychotherapy - focus on restructuring personality or self, individuals have more complex problems, clients are seen frequently and longer

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Counselling Training

Equips counsellors with theory, includes models of counselling, basic psychological theories, an introduction to psychiatric terminology, and an introduction to aspects of sociology.

The Skilled-Helper Model - Egan 1984, 1990

Emphasis on pronlem-solving, describe and explore current senario, articulate a preferred senario involving future goals and objectives, develop and implement action strategies for moving from the current to the preferred senario.

Work on Self (Counsellor)

Self awareness and self knowledge of the counsellor are essential. It enable the counsellor to share the pain, fear and dispair of the clients, and to be aware of their motivations for doing this type of work. It enhances professional effectiveness, provides insight into role of client, and heighens self awareness.

Counsellors need to be able to work with ALL clients.

Personal Therapy

Personal therapy of the counsellor has been criticised as it does not allow the client to choose the therapy, could lead to uncovering difficulties which may impact on trainee participation in course, mismatch between therapist and client but trainee may feel it necessary to continue, justify use of time of a highly qualified counsellor, financial cost.

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Professional Issues

Issues which require careful consideration in counselling training courses include ethical practice, power and discrimination, case management and referral, boundary issues, and professional accountability and insurance.

Supervision

Supervision is VERY important. It is aimed at assisting the counsellor to work as effectively as possible with the client. Hawkin and Shohet (1989) found the 3 main functions of counselling to be education, support, and management.

The modes of supervision include individual, group, and peer. Choice of supervisor depends on

personal preference, cost, availability, and agency policy.

Research Awareness

Trainees need to be able to read research papers and draw conclusions, have some training in research methods, be able to design and implement a piece of research.

Week 4 - The Counselling Relationship

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Clients identify relationship factors more important that use of techniques. The quality of the relationship is often the largest contribution of the value of therapy.

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Psychodynamic tradition - therapist as a 'container'

Client-centered approach - therapist as an 'authentic presence'

Cognitive behavioural - therapist as a 'teacher, coach, scientist, and philosopher'

Integrative approach - the 'all purpose therapist'

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All forms of therapy are built around goals, tasks and bonds. The relationship will probably experience challenge, and often an impasse is reached. The counsellor needs to repair the relationship.

Development of an Effective Theraputic Alliance

Agnew (1994) identified the following stages in repairing an impasse in the relationship:

aknowledgement, negotiation, exploration, consensus and negotiation, enhanced exploration, new style of relating.

The Concept of Boundary

A boundary marks the limits of a territory, defined in counselling around time, physical space, information, intimacy, and social roles.

The relationship can be measured by questionnaires.

The Process of Counselling

4 main meaning of process in therapy (process refers to a sequence of events, ingrediants that contribute to outcome, 'becoming')

Negotiating expectations - many potential clients have no understanding of counselling

Assessment - evaluation, providing information, testing

Establishing a working alliance - essential element in therapy

Ending counselling - consolidation and maintenance of what has been acheived

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The Process of Change

Assimilation of problematic experiences (problem is warded off, problem comes into focus, vague awareness of the problem, problem clarification, understanding problem, application/working through, problem solution, mastery).

Need: istening, seeking clarification, encouragement, caring, exercises, keeping a jornal.

Counselling response models:

Approval, information, direct guidance, closed questions, open questions, paraphrase, interpretation, confrontation, and self disclosure.

Client responses:

Simple response, request, description, experiencing, exploration of relationship, insight, discussion of plans, and silences.

Both client and counsellor monitor what they think, select what they say, attempt to control non-verbal communication.

The counsellor needs to be able to extend the repertoire when necessary, be aware of when to work hard at being empathetic, know when to move into problem-solving mode.

Week 5 - Skills and Qualities of the Effective Counsellor

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Skills vs Competence - Seven Competence Areas

Interpersonal skills, personal beliefs and attitudes, conceptual ability, personal soundness, master of technique, ability to understand social systems, and openness to learning and inquiry.

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Interpersonal Skills

Creating theraputic alliance, empathy, genuineness, acceptance.

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Personal Beliefs and Attitudes

Seeing the world in certain ways, having accurate self awareness, increase self understanding of what makes others tick, accepting contrasting position.

Conceptual Ability

The counsellor needs to work with the client to arrive at their own understanding and decisions. Counsellor has to be competent at thinking about what is happening.

The counsellor should have a high level of emotional adjustment and capacity for self disclosure.

A range of techniques is beneficial, and counsellors should be familiar with a range of intervention strategies for different clients.

Counsellors should learn from clients, search for knowledge and understanding, engage in research findings, and use research evidence to inform practice.

The Counsellor's Journey

Five distinct and overlapping stages:

1) roles, relationship patterns and emotional needs established in childhood

2) the decision to become a counsellor

3) the experinece of training

4) coping with the hazards of practice

5) expressing creativity in the counselling role

Week 6 - Morals, Values, and Ethics in Counselling Practice

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Values in Counselling 

A value is an endsuring belief or mode of conduct that is preferable.

Kelley (1995) found counsellors to be HIGH in concern of welfare for others, self direction, and autonomy self expression, and LOW in power, and tradition.

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Four levels of emotional reasoning:

Personal intuition (a sense of what feels right),   

Ethical principles (autonomy, non-maleficience/no harm to the client, beneficience/human welfare, and fidelity/freedom of action),                                            

Ethical guidelines (PACFA),

General moral theories (e.g, costs and benefits).

Causes of malpractice

Include sexual conduct, treatment error, death of a patient, faulty diagnosis etc

There are many difficulties involved in ensuring compliances with ethical guidelines in counselling practice.

Agencies use informed consent proformas, pre-counselling leaflets, and complaints procedures with clients.

Week 7 - Politics of Couns: Empowerment, Control, & Differences

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3 Basic Aspects of Power

-power differences are universal

- power is socially constructed

- power is a combination of individual and structural factors

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Mechanisms of Social Control

- the language and concepts of counselling

- acting as an agent of social control

- control of space, territory and time

- different access to services

- corruption of friendships

Mechanism: the Language and Concepts of Counselling

'a professional language deficit' - Gergan, 1990

Inequality is expressed in laguage mannerisms during counselling

The term 'client' has social and political implications

Power is expressed in the technical terms used, as well as the 'way' counsellors speak to their clients.

Mechanism: the Counsellor as an Agent of Social Control

Attitude and approach of counsellor defined by external demands.

May not accept members of certain groups

Some counsellors reinforce social norms of rejection

Mechanism: Control of Space, Territory and Time

There is a control of space, territory and time in the counsellor's office

The apoointment should be kept to approx. 50 minutes

Sessions should be every 2 or 3 weeks, more if necessary

Number of sessions is controlled by the agency, regardless of the client's needs

Mechanism: Differential Access to Services

Access to services is highly correlated with power ands status

Most mainstream counselling services are staffed by white middle class heterosexual, non-disabled people who attract clients with similar social characteristics.

Mechanism: Corruption of Friendship
No matter how kindly the person is, the relationship between therapist and client is a professional one based on an equality of power.

Masson (1988) suggests that people need more kindly friends, and less professionals.

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Counselling with Economically Disadvantaged People

Services are most widely used by people in upper income and social class groups.

Economically disadvantaged people probably don't seek help as they don't have access, or are turned back.

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Homosexual people: Liddle (1996/97) found most professionals have overcome earlier prejudices, but there is still a minority that refuse homosexuals. 63% of homosexuals screen their therapist about attitudes before committing to therapy.

Counselling those with Religious Commitment

Johnson & Ridley (1992) found 4 sources of benefit to clients that can result from integrating Christian beliefs with counsleling practice:

- accomodating Christian beliefs and values within established techniques and approaches

- mobilising hope

- the use of spiritual health

- intervention by a divine agent

Anti-Oppressive Counselling Strategies can acheive an anti-oppressive practice.

These include:

- developing a critique of mainstream, 'majority' theory and practice,

- empowerment and emancipation as goals of counselling, and

- developing a user friendly approach to counselling.

Anti-Oppressive Counselling

Reimer's and Treacher (1995) formulated principles to adopt a 'user-friendly' style of operation: - ethical issues are of primary importance, therapy is a human encounter, power difference is recognised.

- theraputic alliance is important

- client's stress and distress should be recognised

- treat client as an individual

- counsellors work with clients in a way that suits the client

- if therapist has difficulties, they should attend their own therapy

- training and professional development are important

- counsellor should acknowledge that therapy has limitations

- counsellor should challenge the client's attitudes and behaviour

Week Nine - The Role of Research in Counselling and Therapy

Good Research

- allows the development of a better understanding of events and processes

- enables practitioners to learn from each other

- promotes a critical and questioning attitude in practitioners

- helps practitioners improve the quality of service

Factors that Motivate People to Conduct Research

- test validity of theory        - funding                             - to resolve questions                 

- evaluate effectiveness      - monitoring work        - to get Masters or PhD                                                             - acedemic credability       - to share cases with collegues  

Research in Counselling

Quantitative - careful measurement of variables/researcher detatched

Qualitative - description and interpretation of what things mean to people/relationship with participant important

Outcome and Evaluation

How much does a particular intervention benefit the client

Scientist-Practitioner Model -  collect baseline data on level of problem, and monitor level throughout and follow-up.

Can be done through slf monitoring, self ratings, questionairres, observation, post therapy rating scales.

Research in Counselling

Quantitative - careful measurement of variables/researcher detatched

Qualitative - description and interpretation of what things mean to people/relationship with participant important

Outcome and Evaluation

How much does a particular intervention benefit the client

Scientist-Practitioner Model -  collect baseline data on level of problem, and monitor level throughout and follow-up.

Can be done through slf monitoring, self ratings, questionairres, observation, post therapy rating scales.

Evaluating Quality of Service

Service is often evaluated according to six critera:

- relevance           - equity           - acceptability           - efficiency         - accessibility        - effectiveness

Rules of research

Participants to be informed

Participants can withdraw

Information is kept confidential

Participants are not to be identified

Do no harm to participants

Process Research

- Concerned with identifying and measuring theraputic elements associated with change

- Client-centered perspective (recordings of therapy sessions/Q-sort)

- Psychodynamic perspective (core conflictual relationship theme-CCRT)

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The Events Paradigm

- concentrates on finding change events within therapy

- idenifies actions of counsellor to enable events to occur

- interpersonal process recall (IPR) (counsellors ability to perceive the thoughts and feelings of clients)

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The Process Experienced by the Client

- perspectives of the client, the therapist, and external

Research in Counselling: Case Studies

- Invaluable for development of theory and practice

- Can be behavioural, psychoanalytic, or integrationist (a mix)

Ethical Dilemmas

- disclosure of information

- revisiting painful feelings

- relationship with counsellor damaged

Reactivity

- when research interferes with counselling

- the effect of research on the counsellor

Ethics and Limitations

• Rule of conduct
• Conform to a code of set principles (relevant to your work)
• Take into account degree of inconvenience and emotional involvement
• Informed consent
• Potential risks (to participants and researchers
• Working with vulnerable groups (children, aged, disabled)
• General ethical responsibilities - nothing illegal/that causes concern
• Issues of anonymity and confidentiality

Ethical Decision Making Model

When a counsellor encounters an ethical dilemma, they are expected to carefull consider an ethical decision-making process. The client should be involved in the process as much as possible.

1. Identify the problem or dilemma

Gather as much informaion as you can and clarify the situation you are facing.

2. Identify the potential issues involved

After the information is collected, list and describe the critical issues and discard the irrelevant ones. Evaluate the rights, responsibilities and welfare of all those who are affected by the situation.

3. Apply the relevant ethics code

Once you have a clearer picture of the nature of the problem, review the code of ethics to see if the issue is addressed. If there are specific and clear guidelines, following them may resolve the problem. However, if the problem is more complex and a resolution is not apparent, you may need to employ additional steps to resolve the problem.

4. Know the applicable laws and regulations

It is essential to keep up to date on relevant state and federal laws. Know the current rules and guidelines of the agency or organistaion where you work.

5. Obtain consultation

It may be helpful to consult with a collegue to obtain a different perspective on the problem. Prejudices, biases, personal needs, or emotional investment can distort the perception of the dilemma. If there is a legal problem, seek legal counsel.

6. Consider possible and probably courses of actions

Brainstorm ass possible causes of action. Ask collegues to help think of potential causes of action. Evaluate each with reference to the potential consequences for all parties involved. Determine which of the GOOD options are suited to the situation.  It may help to decide on if you would be comfortable knowing your actions were to be published in the newspaper.

7. Explore the consequences of various decisions

Ponder the implications of each course of action for the clint, those who are related to the client, and you as a counsellor. You should discuss these with your client.

8. Decide on the best course of action

Consider the information you have recieved from various sources. Determine the outcomes of your action, and decide if any further action is required.

Week 10 - Counselling Organisations and Modes of Counselling

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Organisation and Management

Organisation and management impact on sessions, counselling approach, supervision & training, morale & motivation of counsellors, interview room, perceptions of client, security of confidential information, and cost of counselling.

Types of Counselling

Private Practice - client makes direct contact with counsellor, reimburse counsellor for each session, therapist has more freedom

Voluntary agencies - unpaid/minimal payment, central mission, budgets vary, have organisational structure

Types of Organisation (cont.)

Statutory agencies - philosophy vs. counselling approach, legal requirements, rivalry among collegues (includes probation and social services)

Large organisations - organisation values vs. counsellor values (includes police force and insurance companies)

Organisational Culture

Language and imagery - how client/counsellor address each other "a family" or " a team"

Social norms and rules - role conflict, paraprofessional or voluntary counsellor

Values and philosophy - the developmental history of the agency

Expectations - communicated by the culture

Organisational Stress and Burnout

Overworked, unplanned changes, poor working environment

Maslach and Jackson (1984) - 3 causes of 'burnout syndrome':

- emotional exhaustion

- persistant fatigue

- state of low motivation

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Prevention of Burnout

-support from colleagues                                                                 - realistic workloads

- clarity about job role and demands                                       - recognition  

- positive feedback from clients and management     - varity and creativity in job    

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Strategies: regualr effective supervsion, counsellor career development, and peer support.

Stability of Funding

The agency usually has little control of sources of funding.

Somtimes commitments from funding bodies are not renewed.

Grants and contracts from government departments carry strict guidelines, formal report procedures and other forms of control.

Modes of Delivery in Counselling

Time limited counselling - limited no. of sessions, referred to as 'brief therapy', requires careful training and supervision.

Telephone counselling - understanding, caring, listening, offering feedback, exhibiting a positive attitude, acceptance, focus on problem, giving suggestions | 'faceless helper' is perceived as ideal | client in position of power and control

Modes of Delivery in Counselling (cont.)

Internet counselling - good accessibility, the theraputic relationship & confidentiality may be an issue.

Murphy and Mitchell (1998) found that using the internet gives a permanent record of contact, typing is an effecive means of 'externalising problem', power imbalances reduced, and client can express feelings.

Reading and Writing as Therapy

Bibliotherapy - reading books and self-help manuals, no theraputic relationship, and the books assume the same techniques will be effective for all individuals.

Guided writing - writing on particular topics, journals, correspondance, poetry, autobiography, letter writing.

Group Counselling and Therapy

Interactions are more complex, facilitator needs to have a sense of what is happening to group as a whole system, distinctive ethical issues in groups, client can exhibit a broader range of interpersonal behaviour, counsellor presened with different information about the clients, and group members can help each other.

Yalom (1975) found that in group therapy, there is group cohesiveness, instillation of hope, universality, alturism, guidance, self disclosure, feedback, self understanding, identification, family re-enactment, and existential awareness.

Group processes may be HARMFUL - pressure to self disclose, take part in activities despite resistance, and reactions of others may be destructive.

Self-Help Groups

Meet without assistance of a professional leader. They find it helpful to talk to others with the same problems. Difficulties can arise if the group is dominated by one or two members. It is important to explicit ground rules.

Couples Counselling

Dominated by psychodynamic and behavioural approaches. Can go individually or together.

Week 11 - Multicultural and Philosophical Counselling

Culture: the way of life of a group of poeple.

Kinships, rituals, mythology, and language. Historical roots. Cultures are complex.

Counsellors need to be cautious about the cultural reality of a client.

Underlying Cultural Aspects

The concept of reality - mind and body vs. physical, mental and spiritual

The sense of self - individualist vs. collectivist

The construction of morality - guided by principles vs. embedded in stories

The concept of time -  future vs. past

The significance of place and land

External observable cultural aspects

Non-verbal  behaviour: touch, eye contact, gestures, proximity

Verbal behaviour: linguistics

Kinship patterns: size, composition, marriage, children

Gender: identity and roles

Emotions: what is acceptable

Healing: scientific knowledge vs. supernatural beliefs

Culture in practice

Cultural flexibility   

Consider social and political realities

Be aware of prejudices and needs of minority groups

Draw on resources

Philosophical Counselling

4 main groups of philosophers:

- classical Greek philosophy

- enlightenment philosophers

- critics of modernity

- non-western philosophical traditions

Existential Psychotherapy

To understand the experience of 'being' - the relationship with self and the physical world.

Humans exist in time, to be human is to exist in an embodied world.

Anxiety, dread and care are central to everyday life.

Aims to enable people to become truthful with themselves, to owiden their perspective on themselves and the world around them, and to find clarity on how to proceed into the future while taking lessons from the past and creating something valuable to live for.

Philosophical Counselling

Each individual has their own personal philosophy which represents the totality of their views of self and the world.

No specific techniques are used.

4 stages in philosophical counselling - free floating, immediate problem resolution, teaching as an intentional act, transendence.

Post Modern Theory

Modernity associated with replacement of religious beliefs and values with those of science and rationality.

Concerned with individualism, scientific theories and progress.

Focus on relationships.

Many different identities - at home, work, different life stages

Conceptual Analysis for Counsellors

Examines the meaning of ideas or concepts

The interpretation of concepts - self/mental illness

The evolution of meaning.

"Conceptual analysis consists primarily in breaking down or analyzing concepts into their constituent parts in order to gain knowledge or a better understanding of a particular counselling issue in which the concept is involved"

Week 12 - Overview of Theraputic Approaches to Counselling

Psychodynamic approaches - insight

Experimental and relationship-orientated - feelings and subjective experinece

Cognitive behavioural approaches - action oriented

Integrative approach - concepts and techniques from various approaches

Psychodynamic Approaches

Provided a foundation for other theories, with Freud the main contributor.

Personality development based on dealing with psychosexual and psychosocial stages of development.

Experimental and Relationship-Oriented Approaches

The therapist develops quality relationship with client.

It is based on the assumption that clients can be the experts of their own lives.

The client uses own resources.

Includes existential, person-centered, and gestalt approach

Experimental and Relationship-Oriented Approaches 

Existential Approach - we define ourselves by our choices, we are the authors of our lives.

Person-Centered Approach - emphasis on client resources for becoming self aware, and on resolving blocks to personal growth.

Gestalt Therapy -  individuals and their behaviour must be understood within the context of the present environment. The therapist facilitates client's exploration of their present experience.

Cognitive Behavioural Approach

CBT emphasises how thinking influences emotions and behaviour. Action will bring about change.

Behaviour therapy - focus on observable behaviour, current determinants of behaviour, learning experiences, and assessment and evaluation of behaviour.

Cognitive therapy - cognitions are major determinants of how we feel and act. It assumes internal dialogue of clients play a major role in behaviour

Rational Emotive Behaviour Therapy (REBT) - thinking, evaluating, analysing, questioning, doing, practising, and re-deciding are the basis of behaviour change. It assumes individuals are born with potential for raional thinking BUT accept irrational beliefs.

Integrative Approach

Based on concepts and techniques drawn from various theoretical approaches.

Based on the recognition that no single theory is comprehensive enough to deal with complexities of human behaviour.

Each theory has its strengths and weaknesses.

An integrative approach is the product of a great deal of reading, study, clinical practice, research, and theorising.