Counselling - a brief and informal guide (2024)

Counselling – a brief and informal guide

Rob Bray Ph.D.

Preface

This short book is aimed at adults who are interested in finding out more about Counselling. No prior knowledge or experience is needed. Reading this book will not make you a Counsellor or enable you to carry out Counselling, but it should help you to know more about what Counselling is about, what it tries to achieve, who does it and in what contexts. Equally importantly, it will explain what Counselling is not about (because there is a lot of misunderstanding about that). It should also give you some idea about the skills needed to carry our Counselling and the characteristics a Counsellor needs to develop to be effective – these are called the ‘three core conditions of Counselling’: Empathy, Congruence and Unconditional Positive Regard. These terms are fully explained in Chapter 2. You will also be introduced to three on the main theories that underpin different approaches to Counselling: Person-Centred, Psychoanalytic and Cognitive-Behavioural (CBT).

This book was developed following my teaching of a course ‘Introduction to Counselling’ in Scotland. It is, therefore, written from a British perspective (for instance the examples and spelling conform to British usage). I hope that if you are from a different country or culture you will still find that most of the content is relevant – Counselling is increasingly international.

Above all, I hope you find this an interesting and enjoyable read. Counselling is a fascinating subject and whether you are approaching it just out of casual interest or with a view to making it your career, there is huge amount that is relevant to all of us.

Rob Bray, July, 2024.

Counselling - a brief and informal guide,by Rob Bray

2^nd edition, July 2024

Published by Rob Bray, Argyll, Scotland

© 2024. This work is openly licensed viaCC BY-NC-SA 4.0

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International

https://creativecommons.org/licenses/by-nc-sa/4.0/

Contents

Preface. 2

Counselling – a brief and informal guide. 3

Chapter 1 Introduction. 7

1.1 What’s this book about. 7

1.2 Who is this book for?. 7

1.3 Counselling and Counselling Skills. 8

1.4 How to approach this book. 9

1.5 Contents. 10

1.6 Why has Counselling has become so popular. 10

Chapter 2 What is Counselling. 14

2.1 What is counselling – the basics. 14

2.2 What Counselling isn’t. 14

2.3 What Counselling is. 18

2.4 Counselling Aims. 21

2.5 Who is it for?. 22

2.6 Where does it happen? Who does it?. 23

2.7 Psychotherapy, Psychology and Psychiatry. 25

2.8 The Core Conditions. 25

2.9 Summary. 29

Chapter 3 Counselling Skills. 30

3.1 Introduction. 30

3.2 Active listening – attending. 31

3.3 Paraphrasing. 32

3.3 Reflecting. 34

3.4 Summarising. 35

3.5 Using questions. 36

3.6 Body language - Non-verbal Communication. 37

3.7 Using silence. 40

3.8 Focusing - 40

3.9 Summary. 41

Chapter 4 The stages of the Counselling Session. 42

4.1 Introduction. 42

4.2 Openings. 42

Confidentiality. 44

4.3 The Middle – Discussing issues, exploration. 45

4.4 The End – Action Planning. 46

4.5 The End - Closing. 46

Chapter 5 Approaches to Counselling: The three main theories. 48

5.1 Why are there different approaches?. 48

5.2 The three main approaches. 49

Chapter 6 Person-Centred (Rogerian) Counselling. 51

6.1 Carl Rogers view of Counselling. 51

5.2 The Incongruent Client. 52

6.3 Conditions of Worth. 53

6.4 The role of the Counsellor. 53

6.5 Necessary and sufficient conditions. 54

6.6 Self-actualisation. 55

6.7 Implications for Counselling process. 56

6.8 Summary and Key Ideas. 57

Chapter 7 Psychoanalytic approaches. 58

7.1 Introduction. 58

7.2 The main ideas of Psychoanalysis. 58

7.3 Sigmund Freud and his work. 59

7.4 The Psyche. 59

7.5 The structure of personality: 61

7.6 Development. 64

7.8 Transference. 66

7.9 Summary and key points. 67

Chapter 8 CBT: Cognitive Behavioural Therapy. 68

8.2 Systematic desensitisation. 69

8.3 Ellis and the ABC model 70

8.4 CBT in practice. 71

8.5 Summary and Key points. 72

Chapter 9 Integrative Methods. 73

9.1 Comparing the three main approaches. 73

9.2 What is the Integrative approach?. 75

9.3 Other approaches. 76

Chapter 10. Role-Play. 80

11.2 Tips: Giving and getting feedback. 81

Chapter 11 Ethics and evidence. 84

11.1 Ethics. 84

11.2 Evidence. 86

Chapter 12 Finishing up: What next? Courses, training, 89

12.1 What next. 89

12.2 Counselling Training. 89

12.3 Volunteering. 90

12.4 Counselling in another professional role. 90

12.5 Other forms of study. 91

12.5 Final words. 91

Organisations. 92

References. 94

Index. 95

1.1 What’s this book about

At first look, the idea of Counselling looks obvious – two people sit in a room, one talks about their problems and the other listens. But as you look more into what is going on in the Counselling relationship, the more complicated it gets. It will start to lead us into fascinating questions about how human beings think and feel, communicate and develop.

1.2 Who is this book for?

This guide is aimed at the beginner – someone who hasn’t got experience or knowledge of Counselling yet but wants to get a quick overview before deciding if they want to investigate it further.

You might just have heard about it and want to find out more. Or you might be working in a job where you find yourself doing some sort of Counselling, without much or any training, and want to see if what you’re doing is on the lines of how professionals do it. For instance, people who work in jobs with a lot of people contact often offer social support, which can be very much like Counselling.

Or you might be a trained professional who uses some Counselling Skills but wants to learn more.

If you are in any of these groups you might have thought about becoming a Counsellor yourself. This can be a personally rewarding – but also demanding – job. Reading this book may help you decide if you want to take look further into what it involves.

If you do decide that you want to do some further training in Counselling then there are a range of options discussed in chapter 12. While there are some good on-line courses it would be best to do a course that involves face-to-face learning. This is because such a course will involve some actual practice in developing your Counselling Skills – you will try out using them in short simulated situations, building up your confidence and getting plenty of feedback as you go along. Eventually one of these short sessions – probably about 10 minutes will be observed by an experienced tutor and form part of the assessment for the course. This really the only way to learn how to do Counselling – a course that is purely on-line just can’t do that. After all, you wouldn’t expect to learn to play a piano instrument from on-line without ever touching a musical instrument. On-line courses aren’t accepted as leading to respected Counselling qualifications.

Chapter 12 explains the sort of courses that are available but a good starting point will be an ‘Introduction to Counselling’ course available at many Further Education colleges in the UK. In Scotland it’s often called ‘Counselling – an Introduction’. Courses run usually for between 8 and 12 weeks and involve classes in both theory and practice. This brief guide may help to support students who are taking such a course. To help those students, there is a ‘Key Ideas’ label on those parts of this book that link most to the Introductory courses

As an alternative to all the above reasons for reading this book, you might be thinking about using Counselling yourself, and want to find out more about it before committing yourself. What are letting yourself in for, what should you expect?

1.3 Counselling and Counselling Skills

Before going any further, we should say that while there are relatively few people who are full-time professional Counsellors there is a much larger number of people who use Counselling skills. This group will include nurses, social workers, carers, paramedics, doctors, teachers, careers advisers, personnel workers – in fact anyone whose professional role involves working with people in some sort of supporting function may find themselves doing Counselling at some point - whether they realise it or not. So being able to use Counselling skills and developing them isn’t something that should be left just to those who want to undertake the long, difficult and quite expensive training to be a Counsellor. Just about anybody can benefit from learning to develop some of those skills.

1.4 How to approach this book

That’s entirely up to you, of course.

However, if you are doing it as part of a course in Counselling – or thinking about doing a course in the future – I would suggest that you discuss some of the ideas in this book with other people. Some of us like to learn on their own for sure, but we often get the most out of learning when we share ideas with others and get their feedback. Some of the Counselling Skills practical exercises can only really be done with two people, so if you can enlist a friend it will all go much better!

Whether or not you are reading this book while taking an Introduction to Counselling Course, it’s hard to learn such a practical activity just by reading about it. Watching videos is a good way of getting a better idea about what goes on in a Counselling session. Go onto YouTube, for example, type in ‘Counselling’ and you’ll find dozens of examples. But you need to use care. The quality of these videos, like everything else on the Internet, is very uneven and some of them are terrible. Also, even the best of them are simulations – that is, they are not actual, real Counselling sessions as it would not be ethical to show these publicly. Some of the simulations are good with competent, professional commentaries. Others are awful and downright misleading. Because of these issues I don’t recommend that you spend too much time looking through endless videos of Counselling unless you are very sure of the quality, but I have put up some recommendations at the end of the book to particular sites that I would regard as being worthwhile to see.

1.5 Finding your way around this book

After this introductory chapter, chapter 2 explains what Counselling is and, perhaps just as important, what it isn’t. It looks at what it tries to achieve, who it is for and where it takes place. This chapter contains a lot of material that is important for students taking ‘Introduction to Counselling’ courses (indicated as ‘Key Points’).

Counselling is a practical activity so the next chapter (3) looks at the skills that you need to be able to do it, such as using body language, asking appropriate questions and summarising. Chapter 4 looks at the stages of a Counselling session and focuses on the tricky opening and closing parts – they’re usually quite short but are important.

As well as having practical skills, Counsellor needs to have an understanding of how people think and feel, and how Counselling can work. There are several different Counselling theories or approaches which are important to know about. These are introduced in chapter 5 and then chapter 6 looks at Person Centred Counselling, 7 is about Psychoanalysis and 8 about CBT. Chapter 9 compares the three approaches and looks at attempts to try to combine them into what is called an Integrative approach. It also looks briefly at other approaches.

Chapter 10 looks at how role play is used in Counselling training and how it can develop skills. The next chapter looks at important ethical issues – what is acceptable and unacceptable for Counsellors to do – and also at some evidence on the benefits of Counselling. Finally chapter 12 discusses courses and training if you are interested in takes Counselling further and also recommends some further reading. At the end of the book there is a list of Counselling Organisations and references.

1.6 Why has Counselling has become so popular

This section provides a little background about why Counselling has become so popular. It isn’t essential so you might want to skip it and proceed straight to chapter 2.

Not that many years ago most people would never consider going to see a Counsellor. Many people would regard it as an admission of weakness, something. Now attitudes – in Western Industrialised countries at least – have changed. It is seen as quite acceptable to go and see a Counsellor for a huge range of everyday problems, which we’ll look at in more detail in the next chapter. So how did this change happen? After all, human beings seem to have got on pretty well for thousands of years without any form of Counselling – so why the sudden need at the end of the 20^th century?

One explanation is that modern society has lost the traditional support networks that supplied the same function as is filled by the Counsellor. According to this line of thinking, a century ago more people lived in close communities and in big extended families where grandparents and great-grandparents would hand out wisdom and support for younger generations. Religion was also more important then, and the local priest (or equivalent) would often fulfil many of the same roles as the modern day Counsellor.

Another change that has taken place in the last century is that life might be more complex and have more psychological stresses in it. This might not be so convincing - after all those of our ancestors who lived through devastating wars had to put up with poverty, diseases, a lack of healthcare, poor sanitation and of course the terrible death-toll of war – all of which was stressful enough. But some think that the modern world of social media and zero-hour contracts is uniquely stressful and that this explains the great rise in the number of cases of anxiety and depression that we are seeing now.

One final explanation for the current interest in Counselling is that as we as a Society become more materially well off we increasingly focus on our psychological needs. In other words, whereas our ancestors had to worry about how to pay for a doctor or whether they had enough food to eat, most of us don’t have those anxieties so have more time and energy to think about ‘higher’ needs – such as ‘self-actualisation’ – that is, becoming a fully rounded person(we’ll look in a later chapter in Maslow’s Hierarchy of Need’s idea which backs this up).

Why is any of this important? Because, whichever explanation you accept, it looks like Counselling is here to stay and it’s not just some passing fashion. Indeed, all the evidence suggests that there is a growing demand for Counselling that far outstrips the supply of trained Counsellors.

All over the world more and more people experience mental health problems. In 1990 there were an estimated 416 million people suffering from depression or anxiety globally, but that number had grown to 615 million by 2013.[1] But not enough people get the help they need. In the UK with an underfunded and under-pressure NHS, only 15% of those you try to get ‘talking therapies’ (like Counselling and Psychotherapy) get the full range of services they should do[2]

This puts more strain on other services and on other professionals to use more Counselling skills. Whichever way you look at it, we need more, and better, Counselling. I hope that reading this book will encourage people to contribute to do that in some way.

Notes about sources material and footnotes

To make it easy to read I’ve not included a lot of references to original source material. Where I have done, it’s in footnotes at the bottom of the page. If you go on to study Counselling in a College or University you will find this is done in a more formal and thorough way.

2.1 What is counselling – the basics

At its simplest, Counselling involves two people, sitting in a room (a ‘safe space’), talking. One person – the Client – has a problem or issue that they want to resolve, confront or otherwise get help with. The other person – the Counsellor – has some form of training that enables them to do this role. The process will be time limited – each session probably won’t last for more than an hour or so. The Counselling sessions will usually take place on a regular, scheduled basis, say once a week for several weeks[3].

During that time, the Client will do most of the talking and the Counsellor will spend most of the time listening. The Counsellor may, or may not, suggest that the client does some activities or tries out some exercises. The Client isn’t under any obligation or compulsion to do those activities.

So, what’s the big deal about all this? Can such a low-key activity really make any sort of difference to the Client’s life? And why is this process different from any other in which two people sit in a room and talk.

Perhaps the easiest way to explain this is to look at activities that seem similar to, but actually quite different to, Counselling.

2.2 What Counselling isn’t

There are many activities that are similar – but significantly different to – Counselling. One of the first aims of this brief guide will be to make it clear what makes Counselling unique.

Counselling isn’t, for instance, the same as being a good friend and supporting someone when they‘re in trouble. Providing support in this way might involve some of the skills used in Counselling (we’ll look at Counselling skills later) but there are some important differences between the two activities of being a supportive friend and being a Counsellor.

Let’s look at an example. First, Andrea has relationship problems and is upset. She goes to meet her friend Gabby in a bar.

Later, Andrea goes to see a Counsellor- Lucy. After the Counsellor makes some brief Introductory remarks she asks “So what brings you here today Andrea”

The two conversations are, of course, very different. I’m not suggesting that one is better than the other. Everyone might want a friend like Gabby – warm, supportive, lively, she may be just what Andrea needs, taking hold of her life for her and pushing her in one direction, all with the best intention, based on a long friendship.

(Incidentally, these fictional encounters have clearly been exaggerated to highlight the important features. Please edit and amend them for your own relevant cultural context!)

But then again, Gabby’s approach might not always be what Andrea needs most. Andrea might wake up the next morning with a hangover and a feeling that she’s been railroaded into a course of action (for instance, of kicking Pete out of her flat) without really thinking it through. She may feel that she gave up control of the situation to her friend.

In contrast, the Counsellor doesn’t offer Andrea advice but let’s her explore her feelings in all their complexities and contradictions. The extract above would be the start of a much longer session (or sessions) in which Andrea could search her own feelings and review her life before coming to any sort of decision.

So Counselling isn’t friendship. What else is Counselling different to?

There are many jobs in which people offer others some form of social support or ‘Psychological helping’. It’s the sort of informal help that people may look for at times of stress or when they are experiencing personal problems. People can provide this type of support either as an essential part of the job or as a by-product of their main role.

Examples of the first type would include carers, nurses and social workers. Examples of the second type include, perhaps surprisingly, taxi drivers and hair stylists[4].

In these Social Support situations there is sometimes something going on that is like Counselling, for a short while at least. But it’s not ‘real’ Counselling – because other activities are going on as well that are as or more important. In ‘real’ Counselling, the only activity going on is Counselling – the Client has come to the session expecting Counselling and nothing else. The Counsellor – usually a trained professional – will be focused on that single task.

More informal Counselling may happen during a huge range of other activities – including for instance a carer looking after a patient, a hair stylist working with a customer. Without either party really quite knowing how they suddenly find they’ve slipped into Counselling mode – in fact they may never be aware of it. But one person will be needing support and the other will provide it, using a variety of the Counselling Skills that we’ll be talking about in this book.

Of course, they may not be – probably won’t in many cases – be trained in those skills. So, they just try their best. Some people just pick it up as they go along and others may have some natural aptitude[5]. Sometimes they get some basic training in Counselling skills during their professional qualifications (for instance Social Workers). Sometimes this is enough and the support they give is good – but sometimes it isn’t. Sometimes, even with the best intentions, this type of social support may not be helpful, or might even – unfortunately – be damaging.

That is why learning about Counselling Skills is so important for those of us who work with people in many different roles that might involve giving some social support, Even if you don’t intend to ever train as a Professional Counsellor who will probably find yourself giving Social Support and having developed Counselling Skills wills give you the confidence to do that better and more effectively.

Counselling isn’t Social Support – but Social Support using Counselling Skills

Before we move on to nail down what Counselling actually is, let’s just run through a few more things that it isn’t.

It’s not:

• advising, informing, telling, coaching, disciplining
• Telling clients “you should … I would” – that is, encouraging the client to behave as the Counsellor would (the client is a different person with different needs)
• Imposing one’s own values or beliefs on the Client
• “Being told what to do” “The answer” “Being told you’re wrong” “Being judgemental” “Fixing people” “Patronising”
• Alternative or Complementary medicine

2.3 What Counselling is.

Having looked at various things that aren’t Counselling perhaps it’s about time to be clearer about what it is.

A group of students carried out an exercise where they ‘brainstormed’ some of the ways they thought about Counselling. Before having a look at their responses you might try it out yourself, coming up with as many ideas as you want:

These were the students’ responses:

You can look up formal definitions used by professional organisations.

2.4 Counselling Aims

What is Counselling trying to achieve? That is, what are its aims?

Again let’s start with you jotting down some of your own ideas. You might want to do it just from what you have read so far or try to do some further reading by searching the internet

Let’s compare your thoughts with those from students who took part in our brainstorming session. They came up with these ideas:

2.5 Who is it for?

I hope you will have got some idea by now of what sort of people could benefit from Counselling. You could also do further research on this by looking at what local organisations are offering Counselling services and what sort of people they are offering them to. If you go into a Doctor’s surgery, library, Citizens Advice Office or other Public Building and you will often see many leaflets about dozens of services. Some of these will be offering Counselling. You could also the Internet to look at Counselling services available more widely. This is a good way of finding out about the range of services that are available. Having done this, write down sort of problems and issues that Counselling services are available for.

It’s a useful exercise to come up with your own list, and link it with specific service providers, but these are examples:

The list of who Counselling is for might seem endless, so it might be useful to think about who counselling isn’t for.

First, it’s isn’t for people who don’t really want it. That may sound obvious, but if someone gets ‘sent’ for Counselling – for instance by parents, or employers - without wishing to, it’s not likely to be of much use. One thing that is clear about Counselling is that it does need the Client to be actively engaged in the process – to be motivated to tackle whatever issue brings them there. Counselling has to be done on the Client’s own terms, not imposed on them.

Secondly, some people may look to Counselling to solve dilemmas, particularly if they face stark, one-off, irreversible choices. ‘Should I get married?’ ‘Should I leave home?’ ‘Should we emigrate?’ There may be all sorts of issues underlying these dilemmas that could be usefully explored by Counselling, but too often the client wants the Counsellor to make the decision for them.

In the same way, Counselling isn’t particularly helpful for people who just want advice. ‘What job should I be looking for?’ is a perfectly reasonable question that a Career Guidance Counsellor should be able to help with but the answer to the question has to come from the person asking it, not from the Counsellor. So the Counsellor might help the Client explore their motivations, interests, values and so on; the ultimate decision about what to do has to be theirs.

2.6 Where does it happen? Who does it?

From the previous section you’ll have a good idea of what sort of organisations and settings providing Counselling services:

You’ll see that some of these are services run by statutory and public bodies such as (in the UK) the National Health Service, but a lot are run by charities and other voluntary organisations. In all these cases, though, Counselling is usually free, and this reflects the fact that most people who need Counselling in these situations will not usually be able to pay for it. Unfortunately, there are not enough Counselling services, either public or voluntary, for the growing demand, so that people often find that there’s a waiting list and they might not get as much Counselling as they want.

For those who can afford it there are plenty of private counsellors. Most of these will have undertaken a full professional training and you can check exactly what sort of training someone has had before you start going for Counselling with them (see chapter 12). One complication is that, as we’ll see in in section 2.8 below, and also in later chapters, there are various theoretical schools or approaches in Counselling. People looking for Counselling (potential Clients) may not be aware of this and chose a Counsellor whose theoretical approach doesn’t really suit them or help with the problem that they want to deal with. Private Counselling is expensive: each session, usually of about an hour will cost between £10 and £80, with an average of about £50; some Counsellors may have reduced rates for students and others on reduced incomes.

Counselling is usually done on a one-to-one basis and face to face (in person). However, telephone Counselling is becoming increasing popular, as is Counselling using the Internet (for instance Skype). Sometimes people attend group Counselling sessions, where several clients meet with one Counsellor at the same time.

2.7 Psychotherapy, Psychology and Psychiatry

Counselling and Psychotherapy – what’s the difference? You may often see these two terms used interchangeably and there is a lot of overlap between the two. But Psychotherapy tends to be a longer-term process than Counselling – it can go on for years - whereas Counselling will typically involve only a few one-hour sessions. Psychotherapists also undergo a longer, stricter training.

Psychiatry is the branch of medicine that deals with Mental Illness. The treatments it uses includes both ‘talking cures’, such as Psychotherapy, as medication. All Psychiatrists have to train first as medical doctors before specialising in Psychiatry.

Psychology is the study of human thinking and behaviour. It uses Scientific methods to test out theories. Psychologists aren’t medically trained but do have degree and post-graduate qualifications from Universities. Applied Psychologists work in schools (Educational Psychologists) and with people with Mental Health Problems (Clinical Psychologists).

Where does Counselling fit in? It’s a practical activity but is backed up by a good deal of written theory. It’s not a fully regulated as some professions – so it’s hard for Clients to be sure there’s getting a fully trained Counsellor – but as you can see there is a well recognised training route that most Counsellor follow, which uses a lot of ideas from Psychology.

2.8 The Core Conditions

Counsellors may vary in their theoretical training but they are all good at building strong relationships with their clients. This relationship building depends on what is called three Core Conditions: Empathy, Unconditional Positive Regard and Congruence.

The idea of Core Conditions was developed by Carl Rogers and is the cornerstone of his Person-Centred (Rogerian) Therapy, which we’ll look at in chapter 6. Although the idea of Core Conditions is linked particularly to Rogerian Counselling, most Counsellors would agree that they are important, because they allow Clients to feel able to explore their feelings without fear of being judged.

Empathy.

This is being able to understand the how the Client sees and feels from the inside – from their point of view and not from your own. Sometimes it’s described as ‘walking in their shoes’; or ‘seeing the world through their eyes’.

Empathy is not sympathy, which is feeling sorry for someone. Empathy involves understanding but also sharing thoughts and feelings. It’s also important that the Counsellor is able to communicate their empathy back to the Client.

Sometimes trainee Counsellors become concerned about whether Empathy can be learned, as there are some who claim that people are either born with empathy – or not. This is a controversial area. It seems to be true that there are a very small number of people – psychopaths – who have poor empathy along with antisocial behaviour. Psychopathology is partially inherited and partially caused by upbringing. It wouldn’t be easy for someone with Psychopathy to learn Empathy. There are also some people who are the opposite and may have naturally enhanced Empathy. This condition – called Mirror Touch Synesthesia – is not very well understood. But most people – about 98% of us – don’t fall into either of these categories. For us, learning Empathy may not be especially easy but is certainly possible.

Unconditional Positive Regard

Unconditional Positive Regard is also referred to in a number of other ways that you might see, such as Warmth, Respect, Prizing and having positive feelings. To be technically correct we should call it Unconditional Positive Regard but this is a bit of a mouthful so in this section we’ll refer to it UPR.

UPR is about valuing the Client, having good positive feelings about them and not allowing anything they say to change that. In other words, it means valuing and accepting the Client as a person no matter what they’ve done. This is what the ‘Unconditional’ part of the term means – the Counsellor isn’t valuing the Client on condition that they behave in a certain way.

“I will like and approve of you if you behave in this way; I won’t like you or approve of you if you behave in another way” is an example of conditional approval, not UPR. UPR accepts and values the Client as they are ‘warts and all’

In UPR that liking and warmth is unconditional. (We’ll see in chapter 6 why this was so important to Carl Rogers, who developed the idea).

If the Client feels that the Counsellor is showing them UPR then they (the Client) will feel free to fully express themselves, to be totally honest with themselves and the Counsellor.

It may well have occurred to you that UPR might sometimes be very difficult to do. What if a Client tells the Counsellor about something they did that the Counsellor would regard as deeply immoral and hurtful to someone else? How could the Counsellor still show warmth towards the Client? Here we have to distinguish between warmth towards the Client even while we might dislike something they have done. All the same it isn’t always easy to maintain UPR and, as well see in the next section, it may not be easy to maintain congruence.

It’s worth noting that UPR may also be more difficult if the Counsellor and Client have very different values or cultural backgrounds. How easy would it be for a devout Christian Counsellor to have UPR for a transgender woman (or the other way around). A vegan Counsellor for a Client who valued blood sports? A Moslem woman Counsellor with a client who was Islamophobic These are difficult areas and require the Counsellor to carry out a lot of work on their own personal development during their training.

Congruence

Congruence is also called Genuineness and sometimes realness. It means that the Counsellor isn’t acting or ‘hiding behind a mask’, or pretending in any way, but being themselves. Congruence involves being honest and open about ones feelings and emotions.

The word ‘congruence’ means ‘compatible’ or ‘consistent’. So the idea here is that with Congruence in Counselling there is consistency between how the Counsellor looks and acts and how they are really feeling and thinking – there isn’t any inconsistency between them.

The Counsellor is “himself or herself in the relationship, putting up no professional front”[9]. In other words the Counsellor is open about their feelings – the Client “can see right through” the Counsellor.

The Counsellor is fully aware of their own emotions and feelings and isn’t holding anything back from themselves, either.

Congruence has to come from being a well-developed, caring person – it’s not just a matter of how to learn the skills of how to look congruent. That is why training to be a Counsellor is long and involves a great deal of work on personal development.

You can see that maintaining all three of the Core Conditions at the same time may sometimes to be hard. For instance, for a Counsellor working with a Client with very different values to is talking about activities that were very damaging to other people it may be hard to be warm (i.e. show UPR), empathic and genuine. Nevertheless that’s the ideal which many Counsellors would try to aspire to.

2.9 Summary

In this chapter we’ve tried to outline what Counselling is (and isn’t), what it tried to achieve, who it’s for, who does it and where.

Counselling involves meeting the three core conditions (section 2.8 above), understanding one or more of the basic approaches (chapters 5 -9), adopting appropriate ethics (chapter 11) and learning Counselling Skills. The main skills that Counsellors need to develop to be able to build relationships with their clients will be covered in the next chapter.

3.1 Introduction

Counselling skills can be learned from reading, practicing, observing others (live or on video) and getting feedback from practicing it yourself in role plays (see chapter 10).

We’re going to focus on eight of the most important basic skills used by professional Counsellors and all those who use Counselling skills:

• Active listening. This involves attending carefully to what the client is saying, both the facts but also the emotional content. Active listening involves showing the client that the Counsellor is paying attention. Most of Counselling involves listening: sometimes it’s said that Counsellors should be listening for around 80% of the time and talking for only 20%.
• Paraphrasing– rewording what the client is saying and ‘playing them back’ – this shows that the Counsellor understands what the Client is saying and gives them a chance to correct or add to it.
• Reflection- this is similar to paraphrasing but is more about the Counsellor ‘playing back’ the emotional content of what the client is saying, rather than just the factual content.
• Summarising– this is a combination of paraphrasing and reflection but involves summing up a larger chunk of the Counselling session – for instance summarising may occur at the end of a half hour session and pull together an overview of all the issues that the Client has covered.

You can see that Paraphrasing, Reflecting and Summarising are similar – they are all about the Counsellor saying the Client in the Counsellor’s own words a shorter version of what the Counsellor thinks the Client is saying. The table below explains the differences:

• Using questions– open and closed. The Counsellor will usually use more open questions.
• Body language- Non-verbal communication. The way that the Counsellor looks and behaves will communicates a lot about them to the client.
• Using silence- sometimes silence is essential.
• Focusing- deciding with client which issue among many to concentrate on.

Let’s have a look at each of these in a bit more detail.

3.2 Active listening– attending

Why is this called ‘Active Listening’? To contrast it with the sort of listening that most of us do, most of the time – passive listening, which is where we aren’t really paying much attention or putting a lot of effort into following what is being said. Like having the TV or radio on in the background, we’re only partially aware of it. After all, most conversations are quite predictable and often we’re wrapped up in our own thoughts too much to be really that interested in following the other person in detail. (If you think this is very cynical, have a go at monitoring your conversations during the course of a day. A lot of Psychologists find that many conversations follow routine patters without a lot of in-depth listening going on).

But in the Counselling situation it has to be different – here the Counsellor’s main job is to listen. That means that while all the Counselling skills we’re going to look at in this chapter are important this one – Active Listening - is probably the most important of all. Without active listening you really can’t have effective Counselling.

One of the first things the trainee Counsellor realises, when you start doing role play during training, is that attending to the Client is in fact more difficult than it might seem – you’re in a stressful situation, there are all sorts of distractions and you have a whole number of things to remember at once. As well as having to make sure to listen to the content of what the Client is saying – to follow their story – you also need to be watching their body language and think about what it might be telling you about their emotional state. At the same time you need to be expressing your attention – using a variety of nods, verbal responses or non-verbal positive grunts – called ‘minimal encouragers’ – to show the Client that you are following them. All the while, while remembering to be yourself (being congruent), trying to ‘walk in their shoes’ (empathising) and value them as individuals (showing Unconditional Positive Regard), you also have to think about the other skills in this list and when to deploy them. It’s no easy task and that’s why the training takes so long! When you start off doing it don’t be surprised if it’s not as easy as it might seem as first. Sometimes, like riding a bike, it takes a few sessions before the novice gets into ‘the zone’ – when active listening seems like a natural and not impossibly difficult activity.

A good way to think about this is to try active listening is everyday conversations that you have with members of the family, friends or work colleagues. Try to concentrate fully on what they are saying and how they seem to be feeling while saying it. Does this feel different to how you normally listen? Does the listener notice a difference?

3.3 Paraphrasing

Paraphrasing is rewording or rephrasing what the client is saying and ‘playing them back’ This shows that the Counsellor understands what the Client is saying and gives them a chance to correct or add to it

Paraphrasing is a responding skill – it’s about the Counsellor saying back to the Client the main points of what they (the Counsellor) thinks the Client is saying.

It’s important because it shows to the Client that the Counsellor is doing active listening. is It’s also important for the Counsellor to make sure that they do understand the Client’s story properly. It can also be important to help the Client clarify their own thoughts – when they hear them played back in this way they may realise that they haven’t explained them properly, or aren’t clear in their own minds.

It’s important that the Counsellor tries to do this in their own words – not just repeat the Client’s words or re-arrange them. This ‘mirroring’, ‘parroting’ or ‘echoing’ is tempting to do when you begin Counselling: it is sometimes much easier to do than find you own words, and it’s given rise to all sorts of jokes about how bad Counselling can be, for instance:

Although this is a ridiculous example, there are occasions when repeating back a few words that the Client has spoken, especially the last few words, can be useful in keeping the flow going, or to highlight to the Client key parts of what they are saying:

But that isn’t Paraphrasing, which is where the Counsellor uses their own words, not the Client’s.

Here is an example of paraphrasing, taken from the situation we started Chapter 1 with

In this example the Counsellor’s rephrasing is shorter that the Client’s but picks out the most important facts, but here it doesn’t deal with the emotional aspects (see Reflection below)

Try rephrasing the following statements without significantly altering their meaning.

Ruth, an older person:

“I never see anyone. I can’t walk very far and the weather terrible, so I just sit here with the telly. The carers come, but they’re just in and out, they never have any time to stop and chat. And my children don’t bother, they’re always busy ….”

Jim, middle aged office worker:

“the job used to be interesting but it’s been the same old, same old for years now. Perhaps I should have moved departments years ago. I was working on a big project, what … about 7 years ago. Everyone thought it would be huge and for a while it was really exciting. I got to lead a small team and it felt like we were going somewhere. But there were some technical problems and then the senior management changed and the new people seemed to lose interest. And since then, well to be honest, it’s like we’re just finding things to occupy our time.”

3.3 Reflecting

While Paraphrasing relates to content, reflecting relates to feelings. Reflecting is the ability to pick up and play back the emotional content of what is said, rather than the factual content.

Let’s look at how Andrea’s Counselling session continues:

You could also try to go back to the examples of Ruth and Jim in the section on Paraphrasing and try to Reflect the emotions of what they’re saying.

You’ll see that reflecting emotions is often harder than paraphrasing facts because Clients usually aren’t so clearly stating their emotions. They may not say “I’m sad” or “I’m feeling really stressed”. You have to infer their emotions from what they say and how they are behaving. Sometimes you have to guess – ‘fill in the gaps’ – a little and because you might get it wrong you need to be quite tentative. It’s useful sometimes to use reflect using questions as Lucy does in the example: “And perhaps you resent Pete for not understanding that?” This gives Andrea the chance to disagree if Lucy has misread what she’s saying, and then to explore what her emotions actually are in more exact detail.

3.4 Summarising

Summarising is a combination of paraphrasing and reflection but involves summing up a larger chunk of the Counselling session – for instance summarising may occur at the end of a half hour or hour session and pull together an overview of all the issues that the Client has covered. Or it may start the next session as a way for the Counsellor to remind the Client on what was covered previously.

In any event, when Summarising the Counsellor has to pick out the main, essential features of the Counsellor-Client interaction and leave out all the unnecessary detail. It’s not easy to do – to say what is essential and what is unnecessary detail. It’s also important to remember that Summarising isn’t about the Counsellor ‘telling’ the Client, but rather the Counsellor offering their own picture for the Client to comment on, amend or even reject.

3.5 Using questions.

Counsellors will ask questions to help the Client explore issues in more detail and also for the Counsellor to understand the Client’s situation and emotions more clearly. There are two types of questions: Closed – where there are only a very limited range of answers possible (such as: ‘are you working?’, ‘how old are you?’) and Open questions, which usually require much fuller answers (such as ‘how did you get on with your dad?’ or ‘what was school like for you?’

Open questions keep the conversation going and encourage the client to talk more, while closed questions usually close it down and make it sound more like an interview or an interrogation. Open questions usually begin with ‘Who…..?’ Or ‘How ……?’

But the Counsellor also needs to care using either sort of question because they take control away from the Client. By asking a question the Counsellor is steering the conversation in a particular direction, which isn’t necessarily the one the Client wants to go in.

An example of a Counsellor’s questions steering clients away from their issue

Here the Counsellor is steering Alan to just one aspect of the problem – his school performance – while he seems more concerned about his overall relationship with his parents.

Unless there’s a good reason for steering the Client in this way, the Counsellor needs to use questions very sparingly, mainly to clarify their understanding:

Here the Counsellor needs Alan to clarify – John is obviously an important person in his life but he seems to be taking it for granted, wrapped up as he is in his story, that the Counsellor knows who John is.

A useful exercise is turning closed questions into open ones. For instance

Try turning these closed questions into open ones.

1. Are you very angry?
2. When did you lose your job?
3. What’s the name of your husband’s new girlfriend?
4. Don’t you feel lonely?

3.6 Body language- Non-verbal Communication.

Non-Verbal Communication includes all the ways in which we give out messages about ourselves without the actual use of words. It includes our appearance, how we may use of touch (such as handshakes), how we speak (our tone and volume) and our Body Language.

The tone, volume and speed of our speech is important: to give a provide a relaxing, warm and supportive environment for the Client it is important not to speak to quickly or loudly. No shouting!

Body Language says a lot about us. We may not be really aware of it, but we are constantly giving out messages about ourselves through the way we stand or sit, the way we move, how we direct our gaze and hold our head etc.

The Psychologist Albert Mehrab suggests that when we first meet someone, the decision on whether we like them or not is 7% based on the words they say, 38% on the tone of voice they use to say it and 55% on their body language. The ‘Mehrabian rule’ of ‘7-38-55%’ suggest that words are less important than how one looks – at least when we first meet[10].

So the way that the Counsellor looks and behaves will communicates a lot about them to the client. Also we need to be aware that different cultures have different standards of non-verbal communication. In some, for instance it is normal to stand or sit much closer together than you might be used to, in others this would be regarded as extremely rude. We need to sensitive to cultural differences and our own assumptions about what’s ‘normal’.

There’s a checklist of things to remember about body language. The problem is that if you try to remember them all you won’t be at all relaxed and you’ll feel very self-conscious! But it’s a good way to learn to think about how you appear.

Gerard Egan, who developed this model, suggests that you don’t become too worried or self-conscious about these: use them as guidelines to develop your own, natural style that shows your congruence.

Finally on the topic of Body Language – as well as being concerned with your own body language you might want to think about what the Client’s body language is telling you. Is it consistent with what they’re saying? For instance, a client who said ‘yes everything is fine’ but was wringing their hands or tapping their feet agitatedly might be showing inner turmoil that you might want to (tactfully) explore.

Exercise – what might these examples of body language tell you about a client (these elements are from different clients – not from one client!)

Another useful exercise might be to (discretely) observe people’s body language – what can you interpret about them.

3.7 Using silence

Sometimes silence is essential. In normal conversations, silence can be embarrassing and we often rush to fill it by saying the first thing that comes into our heads. But in Counselling silence can be useful and important. Learning not just to tolerate silence but to actually welcome it is an important aspect of training.

Bearing in mind that the Client is doing most of the talking (the 80/20 rule mentioned earlier), silence will occur when the Client stops. This may be because they need time to think about what they’ve been saying or feeling, or to deal with the resulting emotions. It’s important for the Counsellor to give Client time to collect their thoughts before going on.

3.8 Focusing-

Focusing is deciding with the client which issue among many to concentrate on.

After the Client has spent some time explaining their situation to the Counsellor it may become clear that there are several different issue going on in their lives. There may be an immediate crisis that has prompted them to come to Counselling right now, but other underlying problems going back years or decades. How does the Counsellor start to address this? Which issue or issues should they concentrate on?

For instance, we started off looking at Andrea who might be breaking up with her boyfriend Pete after she finds he’s having an affair. Underlying this is the fact that she has thrown herself into a new job that she really enjoys – but perhaps he resents. And it may be that there are issues further back in Andrea’s past, about insecurity and feelings of underachievement at school, or perhaps feelings about her parents.

There are several ways that the Counsellor can negotiate with the Client about how to tackle this. It might be important to look at the most urgent issue first. It might also be useful to help the client set a number of goals about how they are going to look at each issue.

In Andrea’s case, the Counsellor might say something like:

“It looks like there are quite a few things going on here Andrea. You’ve got the immediate problem of what to do about your relationship with Pete, but also how you feel about your career, and underlying all that you’ve been telling me about difficult times you had at school and at home, which might be important too. Where do you think we should start”.

3.9 Summary

Counselling skills can be learned like other skills – by practice and by getting feedback from experts. It’s also useful to use ‘critical reflection’ – that is, having an honest conversation with yourself – an assessment of your own performance. As you do this it is important to be neither too self-critical nor overly complacent – there’s always room for improvement.

Developing these Counselling skills during training you will probably find that some come easier than others. In fact, you might already have well developed skills in some of these areas, while in others you’ll need to start from scratch. Whatever stage you’re at, these are skills most people can learn if they are motivated and willing.

Most importantly, you will find after a while that you can put the skills together without having to think about them. As with riding a bike (or driving a car) – at first each part of the process needs a lot of attention and when you start to think about one, you forget about the others! But with practice you’re able to integrate all the processes into one operation, almost without thinking about it. However, unlike riding a bike or driving a car, Counselling should never become an automatic process – each Client is unique and deserves the Counsellor’s undivided attention.

4.1 Introduction

The French film maker Jean Luc Godard said “ A story should have a beginning, a middle and an end, but not necessarily in that order.” It was probably true of a lot of his films, which are famously influential but not always easy to follow.

But it isn’t a good idea in Counselling, which definitely should start with a beginning, go on to have a middle and then finish off with an end!

This chapter will have a quick look at what these three stages involved in a typical Counselling session and the different skills that the Counsellor needs in each one.

The standard Counselling session, which is face to face, will last an hour or so. Half hour sessions aren’t uncommon.

The beginning of the Counselling session – the Opening – is usually quite short. However, if it is the first time that the Client and Counsellor have met it has to be significantly longer as there are some significant issues that need to be covered in this first session. So we need to distinguish between the ‘first opening’ and ‘later opening’.

The middle of the Counselling session – the filling in the sandwich if you like – is where the main business of the Counselling relationship takes place.

The end of the Counselling session is important and shouldn’t be hurried. It often involves two parts: first an Action Planning element and secondly a Closing.

We’ll have a look at each of these in more detail.

4.2 Openings

As we’ve said above, we have to distinguish here between the opening of the session in a series of sessions that already started (so that the Counsellor and Client have already met) – the ‘Later Opening’ - and an Opening which is the first time the two have met – the ‘First Opening’.

The First Opening

If it’s the very first session then there are a number of issues that need to be covered before actual Counselling can start. This amounts to forming a ‘contract’ between the Counsellor and the Client – and it’s essential that the Client understands and agrees with it. The detail will depend on the Organisation in which the Counselling is being delivered, but it will usually include the following:

• Ethics and Confidentiality - this is probably the most important – see below.
• Health and Safety – for instance, where to go if there a fire
• Theoretical Approach – some Counsellors will want to explain at the beginning what sort of Theory/Approach they use and what this means in practice
• Timing and frequency of sessions
• Cost and payment method (unless it’s free)
• ‘Housekeeping’ – (toilet location)

Because all of this can take a very long time to explain properly, when the Client might be quite anxious and not be in a very receptive mood to take in a lot of detail, it’s good practice to deal with as much as possible beforehand (for instance when setting up the initial appointment) and back it up with a written document). Otherwise far too much of the first session will be spent going through all this stuff before the Client even gets a chance to talk at all – very off putting for them!

A Counselling session is a form of contract between the Counsellor and Client, so it’s vital from the very beginning that the Client understands clearly what they can expect (and what they can’t expect). This first session is also a time when the Client can make decisions – mainly, whether or not they want to actually go ahead with the Counselling at all – it’s important that they feel they have a real choice here.

Ethics

Ethics. Professional Counsellors sign up to a Code of Ethical behaviour and its important that they give the Client an idea of this, without overwhelming them with the detail, so the Client has confidence in them. We discuss the whole issue of Counselling Ethics in a little more detail in Chapter 11, but what is important her is that the Counsellor communicates the essential parts to the Client.

Confidentiality

In particular, it’s important to say that Counsellor’s respect confidentiality and explain what this means – that anything that the Client says will ‘stay in the room’ and not be repeated outside to anyone. But it’s also important to explain that there are very rare exceptions to this, if in the Counsellor’s judgement there is a risk of harm to the Client or to someone else.

It’s important, of course, to put this in language that’s appropriate to the Client and check that they do understand.

Scripts

Should the Counsellor have a prepared script to read from? Because there a lot to say in these openings it’s useful to have some sort of script, to make sure you cover all the points. But reading out from a piece of paper isn’t a good idea – it seems very dull to listen to. Just remembering chunks of speech like an actor can also come across as quite artificial (as so not Congruent). Because first impressions are so important here, it’s better to try to be natural and maybe just have a checklist of the above which you explain in your own words.

It’s also important to try to make sure that the Client is following what you’re saying and is happy with it, and this is a good chance to start building a relationship through the use of appropriate Questions, such as “Is that OK?” or “Are you happy with that?”.

Later Openings

Opening of a session which is one in a series establishes the purpose of that session. It should also review the previous session and any goals that were set.

The Counsellor may start with something like the following. They may make a little small talk – about the traffic, or the weather, while they’re getting settled and then

Lucy - Counsellor: Hi Andrea, it’s nice to see you again. Last week I remember we talked a lot about your relationship with Pete and that’s obviously upsetting you at the moment. But we also touched on your feeling about work.

‘Permission to talk’ remarks

Whether it’s a first or second opening, once these initial remarks are over the Counsellor needs to hand the discussion over to the Client. Up to this point they’ve been doing most of the talking – now they need to signal to the Client that it’s their turn. So in the case of Andrea above, after the summary the Counsellor might leave it open to Andrea to talk or prompt her about which issue she wants to discuss first today (see focusing in chapter 2).

In the case of a first session, the Counsellor may use remarks such as the following:

This will then lead on to the next stage of the session – the Middle.

4.3 The Middle – Discussing issues, exploration

This is the main part of the Counselling process, the essential element. The skills of how to develop the Counselling relationship have been discussed in chapter 3 and the different overall approaches discussed in chapter 5 to 9. It’s really what the rest of this book is about so we don’t need to discuss it any more here.

4.4 The End – Action Planning

Timing is an important skill for the Counsellor. Without being too obviously watching a clock (or worse, constantly looking at their mobile phone!) it’s important to keep track of the time so the session doesn’t over-run. Normally, about 5 or 10 minutes before the scheduled finishing time, it’s useful to draw the client’s attention to this, at a suitable break in the discussion, and then to move to the closing.

If the Counsellor is using an approach such as CBT that uses ‘homework’ then this is a good point to review what that will involve. It is also a good point to look at any actual behaviour that the Client wants to do before the next session. This is termed Action Planning and involves setting concrete, feasible goals.

4.5 The End - Closing

Recording and keeping notes

This is a good place to say that, in general, the fewer bits of paper the Counsellor has the better. The key to Counselling is the direct relationship between Counsellor and Client - and paperwork gets in the way. Apart from anything else , if the Counsellor is looking at some notes they are losing that vital eye contact with the Client. Taking notes while a Client is talking can look like the Counsellor is making some sort of (secret) judgement about them. For some types of Counselling, such as CBT (see chapter 8), there may be exercises that the Counsellors gives to the Client as homework and needs to explain in the session. Also, for some organisations it may be a requirement that there is some record keeping at the end of a session (although that might be done by the Counsellor after the Client has left). But for many Counsellors, bringing out a diary at the end of a session to note down the next appointment is the most paperwork that they will do.

Closing may also involve a final summarising of the whole session (see section 3.4 in chapter 3) – this is important as it reflects the Counsellor’s overview of the session.

Finally it’s worth noting that there will eventually be a final ending – that is an ending of the last Counselling session after which the Counsellor and Client won’t see each other again. This represents the end of this relationship and it may require a little more time to say all that is needed.

4.6 Egan’s 3 stage model

Confusingly, you may come across another way of looking at stages of the Counselling process, called Egan’s 3 stage model. Gerard Egan is an influential figure whose booked ‘The Skilled Helper’ was first published back in 1975 but is still regarded as a key book, well worth reading. His three stages don’t necessarily refer to the parts of an individual Counselling session but to the whole process of working with a Client, which may extend over many session. The stages are:

Stage 1 “The Present Scenario” Understanding - what is going on?

Stage 2: “The Preferred Scenario” Exploration - are there different ways of looking at the issues, or different ways of coping? This stage may involve challenging the client.

Stage 3 “Getting There” Action Planning – what is the way forward.

The Egan model is widely referred to and is often used as a way of thinking about the aims of Counselling (section 2.4)

5.1 Why are there different approaches?

We have now, I hope, identified what sort of thing Counselling is, and decided what sort of things definitely aren’t Counselling. But it probably won’t come as a surprise to find that there are many different types and varieties of Counselling. If you start reading about these different approaches you may face a bewildering number of different theories, each with their own methods and ways of working. We’ll look at the three main, most popular approaches in chapters 6-8. (A theory is a system of ideas that explains something, while an approach includes theory and its practical implications to practice).

You might expect the sort of people who work in Counselling to be essentially well-meaning, peaceful and amicable types who get on well with each other. By and large they probably are. But that doesn’t stop them falling out with other in a serious fashion, quite regularly, about how to go about their work. If you go on to do a professional training you’ll read about – and even possible join in - bitter disputes, rivalries and disagreements between different schools of thought. Perhaps it’s like any area where people believe passionately in what they do and where there are many ways in which to do it, it’s inevitable that there are going to major disagreements between strong minded individuals who think they know best.

The practical implications for the beginner, at this stage, is that’s it’s important to hold on to the basic ideas of what Counselling is while appreciating that they can be interpreted differently by different practitioners. To take an example – one approach to Counselling, the Person-Centred or Rogerian, is essentially non-directive. That is, it does not believe that the Counsellor should tell the client what to do at all but that they should supply a safe space in which the client can open up and explore their feelings.[12] We’ll look at Person-Centred Counselling in detail in Chapter 6. But there are other approaches, such as Cognitive Behavioural Therapy (CBT - Chapter 8) which are routinely far more directive.

Which is the best approach? If you are a client looking for a Counsellor, you might make your choice depending on a personal preference for whether you want to be guided or not. But it might also be true, and there is some evidence, that CBT works better for some types of problem, while Person Centred Counselling is better for others (see section on evidence in chapter 11).

Similarly, if you were deciding to go on to do some training in Counselling Skills or even as a professional Counsellor you might be drawn to one of these theoretical approaches more than another, perhaps because its world view appealed to you most, or because you thought it was going to be the most popular, or because you think there is more evidence that it is effective.

All of this is fine and shows that there is plenty of room for individual preferences within the Counselling profession as long as everyone stays within the generally accepted framework, which we’re going to outline in this book. But just one final word on this topic – there is some evidence that effective Counselling does not depend so much on what theoretical model or technique is used, but on the personality and behaviour of the Counsellor. In particular, those who show the ‘Core Conditions’ of Respect, Genuineness and Empathy are more likely to be able to help their clients than Counsellors who don’t – whatever theories are used. That is why these Core Condition, that you’ll we discussed in Chapter 2, are so important.

5.2 The three main approaches

In the next three chapters we’re going to look at the three most popular and widely used approaches (or theories) to Counselling. These are firstly Person-Centred (also known as Rogerian), secondly the Psychodynamic approach (which includes the Psychoanalytic Theory of Sigmund Freud) and thirdly Cognitive Behavioural Therapy.

In each case we will start of by looking at the basic assumptions they make – about how the mind works, what drives us, what goes wrong when we become emotionally unwell and what can be done about it. Then we’ll look at the practical implications for Counselling practice and why some approaches may be better suited for some clients and their problems than others. In Chapter 9 we’ll look at attempts to combine the different approaches – these are called Integrative Methods. We’ll also talk about how these different methods came about and try to predict how they will develop in the future. Very briefly we’ll touch on some of the other approaches and theories that you might come across.

Because this book is titled ‘a brief and informal guide’ I’ve not gone into very much detail of any of these theories. This means that you can’t get a full picture of what they really have to offer in just a few pages. You may find yourself interested and attracted to one of the approaches more than the others and perhaps find that one doesn’t appeal at all, but if you do go on to study Counselling in more depth you’ll find there’s a lot more to them – so give them a second chance! They’ve all got something to offer and provide some fascinating insights into how the mind works and what we can do about it when it goes wrong.

6.1 Carl Rogersview of Counselling

The Person-Centred approach was developed by the American Psychologist Carl Rogers, and so is sometimes known as ‘Rogerian’. Since he first developed his ideas in the 1950’s and 1960’s it has become one of the most important and influential movements within Counselling. It is one of several Humanist Counselling approaches.

Rogers had an optimistic view about human nature: he thought that people were basically good and well-meaning. Problems arise in our lives, he thought, because of forces outside of ourselves, such as in their upbringing.. So, his approach to counselling and therapy is largely concerned with letting the individual person liberate themselves from ideas and beliefs that are imposed on them by others. This viewpoint was a particularly attractive one during the 1950s and 60s when many people were struggling against a narrow and socially conformist society.

Rogers became convinced that traditional approaches to therapy were often putting off clients, with therapists acting as remote authoritarian experts who talked down to their clients. He came to see that this approach was often unhelpful. In contrast he came to realise that:

“it is the client who knows what hurts, which directions to go, what problems are crucial, what problems have been deeply buried. It began to occur to me that unless I had need to demonstrate my own cleverness and learning, I would do better to rely upon the client for the direction of movement in the process”[13]

So, the key idea of Carl Roger’s approach is that the Client knows best – they are going to know more about themselves and the inner workings of their mind than any outsider ever will. It would be arrogant for the Counsellor to think, therefore, that they know better than the client, according to this approach.

If you accept this assumption – you have to ask, what then is the role of the Counsellor? If the Client knows best, why do they need the Counsellor in the first place?

5.2 The Incongruent Client

The reason is that people who seek Counselling – the Clients – have become disturbed or vulnerable in some way because they are incongruent. We talked about Congruence as one of the Core Conditions in Chapter 2 (section 2.8) and how important it is that the Counsellor is Congruent – that is they are quite open about their feelings and emotions, which are all consistent with each other. But in contrast, the Client is in a state of Incongruence - there is a discrepancy or inconsistency between how they feel experience a situation, for instance, and how they feel about it. So the Client’s mind is in some ways trying to hold two or more contradictory views at the same time – and it’s this that is making them anxious or vulnerable.

Let’s look at an example. Neil is a 50 year old man, married with three children, two of them teenagers. His wife is disabled and he is the main breadwinner in the family, but his job (he’s worked as a welder in a large Engineering firm for 15 years) is now under threat of redundancy. To outward appearances Neil is a strong, resilient and tough man, well able to look after himself and his family in these difficult times. But privately Neil doesn’t see himself like this at all, is in fact sensitive and vulnerable, and quite unable to see how he will cope if he’s unemployed. But he’s afraid of ‘letting the mask’ slip, of appearing weak. This is making him feel anxious and depressed. Neil can’t talk to anyone about this, of course, because he is ashamed to admitted these feelings.

6.3 Conditions of Worth

This incongruence might come about because the way we think of ourselves might be too much influenced by negative outside influences or Conditions of Worth. This refers to what you have to do to be approved of by the people who are important in your life (‘significant others’), such as parents.

Some obvious conditions of worth, familiar to many, are around conforming to social stereotypes or being successful at education. A person may feel that their parents don’t approve of them if they don’t do well at school, get a particular type of job or marry a certain type of person.

“Be a good boy and eat up your dinner”

“Your room’s a mess. You’re a terrible person”

These are the sort of messages that many people get from their parents – they are only worth something if they behave in certain ways – if they meet the conditions set my other people in authority (parents, teachers).

If they are unable to achieve any of these, they may feel failure – a big sense of incongruence between how they see themselves as they should be and their actual experiences.

The basic problem for such an individual is that this incongruence is coming from Conditions of Worth imposed by other people, not from themselves. They are not being true to their own self. Because of this they suffer feelings of guilt, doubt, self-hatred, depression, confusion: they are vulnerable and can’t find a way out.

6.4 The role of the Counsellor

The role of Person-Centred Counselling then is to provide the Client with the opportunity to look into themselves and discover what they really want and what they really are – to become more congruent by closing the gap between the idea-self and the self-image. It’s not the Counsellor’s job to do this – and in fact the Counsellor can’t do it because these are ideas within the Clients mind that only they have access to. But the Counsellor can create the right circ*mstances for the Client to explore their own feelings in ways they may not have done before. How does the Counsellor do this?

Roger’s suggested that the key to this process was the Core Conditions that we looked at in Chapter 2. It was Rogers who developed the idea of Core Conditions, which are now so central to Counselling generally. But whereas most forms of Counselling and Therapy are happy to merely say that the Core Conditions are important, Rogerian go further – they say that they are essential and even that they are sufficient!

In other words, just by being truly empathic, respectful and congruent the skilled Counsellor is providing the Client, maybe for the first time, the chance to free themselves from external conditions of worth. In particular, Unconditional Positive Regard is the key to helping the Client discover their true being. If the Client’s problem is that their sense of self has been distorted by the Conditions of Worth imposed by other people, then having a Counsellor who values them unconditional can be especially liberating. For once, maybe for the first time ever, the Client, meets someone who approves of them no matter what – no ifs or buts. The Client doesn’t feel the need to try to conform to any image that they think the Counsellor, or anyone else, wants them to be. Those damaging Conditions of Worth become less important as the Counselling continues and the Client can start to explore their true self.

6.5 Necessary and sufficient conditions

Based on these ideas, Rogers developed his idea of 6 necessary and sufficient conditions for ‘constructive personality change’, by which he meant vulnerable clients becoming significantly less vulnerable. What he meant by ‘necessary and sufficient’ was that you have to have all six of the following, but that’s all you need for this form of Counselling to be effective. The six conditions are:

1 The Client and Counsellor are in a Psychological relationship (a fairly obvious condition).

2 The Client is in a state of Incongruence (as we’ve discussed above)

3 The Counsellor is Congruent in the relationship

4 The Counsellor shows Unconditional Positive Regard for the Client

5 The Counsellor shows the Client Empathy

6 The Counsellor communicates their Empathy, Congruence and Unconditional Positive Regard to the Client

So the six conditions really just boil down to the Counsellor showing the Incongruent Client the three Conditions that we’ve talked about.

6.6 Self-actualisation

One of the key features of Person-Centred Counselling is that it isn’t just about solving problems – it also about making life better. An important part of Carl Rogers’ ideas was that humans were constantly trying to develop and improve themselves, to become better and more fulfilled people. Using Roger’s own terms this would mean that they became more congruent – open to their feelings and at ease with themselves.

This state of being is also termed self-actualisation. A popular theory which developed this idea is that of Abraham Maslow, a humanist Psychologist. Maslow’s idea is called his Hierarchy of Needs

According to this, all humans have a series of priorities. First of all, we make sure that we meet our Physiological Needs - these are the basic things that needs doing if we are to survive, such as having food and drink.

Next comes Safety and Security needs (such as freedom from violence), followed by Social Belonging needs – for intimacy, love, friendships and belonging. Next comes Self-Esteem – the need for achievement, respect, status and recognition.

The idea of the hierarchy is that people have to satisfy the needs at the lower level before they can start to work on the next level up. In other words, if you’re starving, you’ll focus on that and not be so worried about safety, but once you’re safe and well fed, you’ll want companionship and a family, and so on.

It’s only once a person has achieved all of the first four, lower levels and met their physiological, safety, Social and Self-esteem needs that, the theory says, they can start to work on Self-Actualisation.

The self-actualised person is ‘centred’ – fulfilled, creative, open to experience, and genuine. Incidentally the self-actualised person would make a good Counsellor!

Rogers also referred to something very similar to this as ‘the good life’ "The good life is a process, not a state of being. It is a direction not a destination". (Rogers, 1967, p. 187)

6.7 Implications for Counselling process

The Person-Centred Counselling Approach is non-directive: the client makes own decisions and client solves own problems. The Counsellor isn’t there to tell them what to do or how to do it. At most the Counsellor will guide the Client’s exploration of their own feelings, but mainly the Counsellor is there to provide the three Core Conditions of Unconditional Positive Regard, Empathy and Congruence.

This means that the Counsellor facilitates, but doesn’t try to diagnosis or interpret what the Client is saying as this would be imposing the Counsellor’s own viewpoint. It’s Non-judgemental, based on acceptance and trust.

Person-Centred Counselling is very dependent on the relationship between Client and Counsellor, and needs the Counsellor to be fully Congruent. It works well with clients who are motivated to discover themselves and experience positive growth.

It’s worth looking at some videos of Carl Rogers himself using his technique.

6.8 Summary and Key Ideas

Carl Rogers took an optimistic view of human nature and he assumed people are motivated to develop and become self-actualising. He also believed that each individual should be trusted to make the best decisions about themselves. They are in charge of their own destiny, so the client is the expert in themselves. Person-Centred Counselling is non-directive and is based on the three Core Conditions of Unconditional Positive Regard, Empathy and Congruence. It sees these as being necessary and sufficient – in other words all that is needed to help the vulnerable or anxious client, who is incongruent because they haven’t come to terms to their true self because of Conditions of Worth imposed on them by others.

7.1 Introduction

Psychoanalysisis the theory and practice of Psychotherapy developed by Sigmund Freud. The term Psychodynamics is used to include Psychoanalysis but also those approaches which followed on from Freud but deviated from his work in some ways.

Because Freudian Psychoanalysis is often very intense and goes on for a considerable time, it is often thought of as a form of Psychotherapy more than as a type of Counselling. But there are many Counsellors who do use Freud’s theory and methods in their practice.

7.2 The main ideas of Psychoanalysis

Freud believed that emotional and behavioural problems can be traced back to earlier difficulties, especially in childhood (such as relationships with parents). The memories of those difficulties often get buried and hidden in the unconscious, which we aren’t aware of but which affects our everyday life. Therapy helps uncover these hidden memories and this will often solve the present-day problems.

Freud also thought of our mind can be divided into: the id – which contains our basic biological drives; the superego – our sense of right and wrong, or conscience; and the ego – which is the rational part of the mind that works out compromises between the id and superego. This is stressful for the ego and may result in anxiety, leading to defence mechanisms of the unconscious including repression, denial and regression. These defence mechanisms can become unhealthy.

A third part of Freud’s theory relates to how children develop through psycho-sexual stages.

7.3 Sigmund Freud and his work

The ideas of Sigmund Freud really started off the movement that became what we now know as Counselling. His writing was hugely influential in the first half of the 20^th century and many ideas that we take for granted came from his work. But a lot of what he said is controversial and many Psychologists are highly critical of much of it. All the same, it’s still influences not only Counselling and Psychology but many other ways in which we think.

Sigmund Freud(1856-1939) developed his ideas while working as a doctor and Psychiatrist in Vienna in the late 19^th century. Most of his clients were well off and lived in a culture that seems so different from ours that many people wonder if his observations of patients can really apply to our times. But although some of his ideas seem bizarre, and some have been generally discredited, much of what he said is still powerful and provides a helpful way to think about how the human mind works.

His overall theory is complex but we need to get a sense of his basic ideas in order to judge how useful they might be for us in Counselling. Unfortunately they are often wrapped up in a great deal of jargon. We’ll try to explain the most important terms and you can also refer to the Glossary at the end for further detail. Also do have a look at the reference section if you want to read more. The basic principles are as follows.

7.4 The Psyche

The Psyche – which basically means the mind thinking – mental processes – has three aspects: the conscious, pre-conscious and unconscious.

• Conscious - what we are aware of now
• Preconscious- easy to access and bring into conscious
• Unconscious- deeply buried, difficult to access

This is sometimes portrayed as an iceberg, because everyone knows that you can’t see the 90% of the iceberg that’s under the water. The Conscious mind is the part of the iceberg you can see above the water; the pre-coconscious mind is the part under the water that you can just about see and the unconscious mind is the ide that’s far too deep down to see – it’s hidden and by analogy mysterious.

Whether or not this image works for you, what’s important is that Freud thought that we had many ideas and memories that were hidden away and could not recall. He thought that often this might be because they were painful to remember, having started off in childhood with unpleasant experiences. What’s more, these memories [?] in the unconscious mind don’t always just sit there but are actively influencing our conscious thoughts and behaviour in ways we don’t understand. particularly in people with various emotional disturbances, these elements in the unconscious can influence the conscious mind in unhelpful ways, leading to distress or unwanted behaviour. That’s where the iceberg image doesn’t really work; a better analogy than the iceberg might be that the mind is like a dormant volcano – on the surface it might be fairly calm but deep underground great forces are moving that may lead to sudden eruptions!

The job of the Freudian therapist is to find out more about these deep, hidden forces. This is essential because Freud believed that once the origin of these maladaptive thoughts were uncovered the pathology itself would ‘crumble away. In other words, the therapist had to expose the hidden, unconscious thoughts because once exposed to the light of day they would lose their ability to affect the mind in damaging ways, so would stop causing psychological, emotional and behavioural problems.

But if the unconscious mind cannot be accessed by the conscious mind then how is the therapist going to find out what’s going on there? Freud believed that he found the answer to this riddle in that the unconscious mind was always leaving clues around about its activity, for instance in dreams or in slips of the tongue. Some Counsellors make the comparison with a detective, looking for subtle clues.

‘There are no accidents’

Freud believed that the unconscious, although hidden, was constantly influencing the way that we think and act. He believed that when we make mistakes these often reflect these unconscious thoughts. This is often interpreted as meaning ‘there are no accidents’. For instance, losing one’s keys when about to leave the house might reveal an unconscious desire to avoid going to work.

Similarly slips of the tongue are often taken to reveal our unconscious thoughts. Clues about what’s going on in the Unconscious may be given by these Freudian Slips. Some examples of Freudian Slips:

“Nice to beat you” instead of “nice to meet you”

“Sad to meet you” instead of “glad …….”

These probably aren’t the most revealing examples of Freudian slips, which usually involve reference to sex that the speaker did not intend to say. In order to keep this book available to all age groups, I’ll invite you to do an Internet search for Freudian slips if you want to explore this in more detail.

Dreams are also another way of revealing the Unconscious, and much Psychoanalysis is concerned with the Analysis of dreams and their meaning.

Sex is another distinguishing feature of Freud’s work. Freud thought that much of human behaviour was motivated by the drive for sex – some have said that all behaviour is basically sexual, but that is an exaggeration. When he wrote this society was much less willing to talk openly about sex than it is now, so it was enormously controversial and probably partly explains why he became so famous and influential..

7.5 The structure of personality:

A second important part of Freud’s ideas are that the mind is divided into three elements:

• Super-ego- rule based, ‘conscience’ ,
• Ego - practical, rational, (the ‘reality principle’),
• Id- instinctive drives (the ‘pleasure principle’), particularly the sex drive but also aggressive instincts.

The id is entirely unconscious – we’re driven by its desires but aren’t openly aware of them, according to Freud..

The super-ego is partly conscious and partly unconscious (having developed from a very young age from relationships with parents)

The ego is entirely conscious

These conflicts lead to stress on the ego. To reduce stress the Ego adopts ‘Defence Mechanisms’ . These are strategies of the unconscious that protect the ego from anxiety or unacceptable behaviour by distorting reality . Defence mechanisms are among the most widely known of Freud’s ideas and include:

• Sublimation. This is where the id’s energy is redirected into positive achievements. Freud believed that many high achievers were able to channel the id’s energy into creative fields in this way, so sublimation is seen as a healthy defence mechanism.
• Repression: where the id’s energy is pushed down into the unconscious, keeping dangerous thoughts away from our conscious minds. As with the analogy with the volcano, or perhaps ta pressure cooker is better, the energy will have to force itself out in some way that can’t be controlled and may be damaging to the individual: this is termed neurotic and is unhealthy. Repression is the basis of other unhealthy defence mechanisms
• Denial. Ignoring the problem and refusing to accept it existence.
• Projection- ascribe one’s own ‘unacceptable’ thoughts or desires to others
• Displacement- ‘kick the cat’, taking out your feelings, such as aggression, on somebody else (a substitute) other than the person it is really directed at
• Regression- going back to childish behaviour
• Reaction Formation- holding the opposite views to the unconscious beliefs

These also seem rather dry so let’s look at some practical examples of people displaying defence mechanisms. Try to identify which. Answers below.

1 Jim is a young man who is violently hom*ophobic. He constantly tells anti-gay jokes and expresses disgust about hom*osexual acts, which he talks about at some lengths. He is always suggesting that acquaintances are gay.

2 Jeff is a middle-aged married man who has become a passionate advocate for banning all p*rnography. He has been married for many years but once experimented with hard p*rn when he was a teenager.

3 Emma has started getting very angry at her teenage children and is constantly shouting at them. This has been going on for some months since she moved to a new job, which is stressful and where her new boss never seems satisfied with her work.

4 Kim has a demanding job that she enjoys and unwinds by enjoying alcohol. For the last year her friends have worried that her drinking has now got out of hand – she sometimes doesn’t remember how she gets home after a night out. Recently she has started having a quick drink before going to work. When her friends ask her, she maintains she’s ‘just a social drinker’ and gets irritated if they suggest it’s a problem.

Answers.

1 Reaction Formation and Projection

2 Reaction Formation

3 Displacement

4 Denial

7.6 Development

The third, and probably most controversial, aspect of Freud’s ideas that we’ll look at here is his theory of development.

The idea is that all humans go through five stages of development, called ‘psychosexual stages’ because in each stage sexual energy (the libido) is fixated on a different body part. So Freud believed that the infant from birth is at the Oral stage, where it receives the greatest sensual pleasure from sucking and eating, before moving into the Anal stage (roughly at the time of potty training) when the child is fascinated by the control of bowel movements, and then to the Phallic stage, where the child becomes focused on its genitals, This is where the greatest Psychological conflict can occur (such as the Oedipus and Electra Complexes, which involve sexual feelings for the parent of the opposite sex). After this, at around six years of age, the child enters the Latent stage, where sexual energy is repressed by the Superego (concerns about conforming to societal norms) and this continues until puberty, when the final Genital Stage appears.

You can see why this part of Freud’s theory has been controversial since it first appeared in 1905. And despite the fact the we think of ourselves as much more open to discussing sex than a century ago, modern concerns about children and their sexual exploitation by adults means that talking about their ‘psychosexual development’ is not an easy an easy topic to discuss. Also, this part of Freud’s theory has little empirical (that is, scientific) evidence) to back it up and this is the part of Psychoanalysis which is most often criticised.

You might of course, think that Freud’s developmental stages are worth exploring further and there has certainly been a huge amount written about them. But there are other, probably much better and more useful theories of child development which are also worth looking at, such as Jean Piaget’s. There are some references at the back if you want to follow this up.

Whether or not you reject the Freudian theory of Psychosexual development, you can still carry on doing Counselling following a largely Psychoanalytic approach. Although some strict Freudian’s may regard it as a type of heresy, his main theory – of the work of the unconscious and the role of defence mechanisms etc – doesn’t really depend on the development stage theory at all.

7.7 Implications for counselling and therapy:

The role of the Counsellor is Psychoanalysis is to find ways to probe the Unconscious mind. Rather like a scientist who uses various instruments to find out what’s going on deep within the volcano, the Psychoanalyst interprets clues using different techniques, such as:

Free Associationis a technique where the Client reports whatever words come into their mind, without interference from the Counsellor. This can be done in speech or writing and is intended to provide access to the Unconscious by short-circuiting the conscious mind.

Dream analysis

Projective techniques like the Rorschach test. This is a series of abstract images which the Client is asked to ‘explain’ or give meaning to. Their explanations are interpreted on the assumption that they reveal what’s going on in the Unconscious mind

One of the implications for Counselling is that classic, ‘proper’ Psychoanalysis might not really work in a Counselling situation. That’s for two reasons. First, Psychoanalysis requires a very lengthy and intense therapy – several sessions a week for several years isn’t uncommon (and for most clients this is of course very expensive!). Most Counselling is far briefer. Secondly, classic Psychoanalysis requires the therapist to act like a detective, as we’ve suggested. So they use all sorts of techniques that might seem quite odd to the client to unpick their conscious: free-association, dream analysis, Rorschach diagrams form instance. For someone going to Counselling with a particular problem, this might be off-putting. If a client is feeling depressed because their father died, or worried about their relationship, and a Counsellor starts off by showing them funny pictures and asking them about their dreams, they might want their money back. Clients usually want Counselling to be more straightforward and offer more obvious techniques.

However, that doesn’t mean that the Counsellor can’t use the Psychoanalytic approach even in quite a short number of sessions. First, they can look at the client using the Freudian framework – thinking that most current behaviour, especially if its neurotic, will have its roots in childhood and that it will be buried deep in the unconscious. The Counsellor can also be looking for clues as to the origins of these neuroses, not so much in what that client actually says (their conscious) but what they imply or even don’t say (so if they omit something obvious in telling a story that might indicate it was important). Resistancemight also be important – this is a Freudian term indicating that when a client refuses to acknowledge some issue it often has a special significance. The Psychoanalytically oriented Counsellor will also be aware of the various defence mechanisms.

In all of this , the counsellor won’t self-disclose, may not answer questions directly but respond with another question in attempt to help client link the past and present. The Counsellor’s main aim will be to uncover sources of ego conflict and bring material from unconscious into the conscious mind, to bring conflicts, impulses and feelings to the surface.

7.8 Transference

An important idea in Psychoanalysis is Transference. This is when a Client transfers their unconscious emotions from one person towards to the Counsellor. If for instance the Client has especially strong unresolved towards their father and then start to identify the Counsellor with their father, they may start to display anger towards him. Such transference can be useful in that it can reveal aspects of the Unconscious that would otherwise be hidden and open up ways for it be explored, but it might also present problems in that it interferes in the Counsellor – Client relationship.

Freud also observed that the Counsellor might develop an emotional response of their own to the Client’s Transference – he termed this Countertransference. Essentially this means that the Counsellor is becoming emotionally involved with the Client and is therefore something that the Counsellor should be aware of and guard against.

7.9 Summary and key points

8.1 The basis of CBT

Cognitive Behavioural Therapy developed from theories of Psychology about how we think and theories about how we learn. It really developed as a combination of two approaches – Cognitive therapy – which focused on thinking (cognition) and Behavioural Therapy, which emphasises what we actually do. CBT is more scientific and based on the academic discipline of Psychology than other approaches to Counselling

Behavioural therapy developed from a particular approach to Psychology called Behaviourism that was particularly popular in the middle of the last century. It taught that much human behaviour is simply learned as a response to our environment. So for instance, if when I was a young child I suffered a painful burn from accidentally touching the exhaust of a motor-cycle; ever since I have what seems to be an irrational dislike of motorbikes. Also, in the same way as we can train dogs to do tricks by rewarding them with treats, so we can train behaviour by using what are called reinforcement schedules – rewards for good behaviour or punishments for bad behaviour.

Some of the Psychologists who developed these ideas include Ivan Pavlov, a Russian Psychologist who studied learning in dogs, and J.B. Watson - experimented with fear responses in children. Perhaps the best known Behaviourist was B.F. Skinner -who invented the ‘Skinner Box’ used to study learning in rats and pigeons.

What all these people shared is a view of people that was very different from that of Freud or Rogers. They didn’t worry about unconscious motivation or incongruence; for them human being act in quite straightforward ways, almost mechanically, in response to stimuli in the environment around them.

8.2 Systematic desensitisation

To take an example of this approach, let’s look at a well-known and effective behavioural therapy called Systematic Desensitisation. It is used to treat various phobias and anxiety disorders. A phobia is an overwhelming feeling of fear about something, out of proportion to a realistic risk. For instance, many people are cautious around dogs, but someone who is phobic about dogs will – as soon as they see one - experience a number of unpleasant feelings, such as the heart beating very fast, breathlessness, nausea, dizziness, trembling and shakiness. However much the person tells themselves that they shouldn’t feel like this, that it’s not ‘rational’, they can’t help themselves. Phobias can be extremely unpleasant and debilitating. About 10% of people will have some sort of phobia during their lifetime. Agoraphobia, which is a fear of open spaces, crowded spaces and public transport is by far the most common and obviously makes ordinary life (and work) difficult.

Systematic desensitisation is a technique that tackles such phobias using three stages.

1 Create an Anxiety Stimulus Hierarchy: this means identifying all the things that start off the phobia and rank them in order of how bad the reaction is. For instance, for someone with a phobic reaction to dogs, is the reaction the same for all dogs? Does it depend on the breed, or the size? The hierarchy then creates a list starting with items that may create the least reaction (for instance, seeing a small dog a long distance away) and going up to the highest reaction (e.g. being close to a very large dog!).

2 Learn a coping mechanism, such as progressive muscle relaxation PMR ( a technique of relaxing groups of muscles to reduce anxiety)

3 The Counsellor then works with the Client, going through the Stimulus Hierarchy, starting with the lowest (least anxiety producing) item, and using the coping mechanism – such as PMR – until the Client is quite relaxed and not at all anxious (the assumption here is that you can’t be anxious and relaxed at the same time). Once this has been done at the lowest part of the hierarchy, they move on to the next highest level, and so on to the highest level/ Eventually, then, the Client will be happily patting a Rottweiler!

We’ve gone into some detail about this method, because it shows some key features about CBT more generally. First, it’s grounded in Psychology theory. Secondly, it’s a very systematic method, involving a number of clear, organised steps. Thirdly, following from that, it needs the Counsellor it take the lead and direct the Client, showing them exactly what to do. Fourthly, again, following from that, it needs the Client to be committed and well-motivated to go through the whole process – it won’t work if they drop out half-way. Finally, it does seem to work, there is a lot of evidence to back it up.

Now that we’ve had a brief look at the ‘behavioural’ part of ‘Cognitive Behavioural Therapy’, we’re going to turn our attention to the Cognitive part.

8.3 Ellis and the ABC model

Albert Ellis developed Rational Emotive Therapy (RET), which was based on the ABC model of psychological disturbance and change. Ellis suggested that we can think about significant events or problems as involving:

A = Activating event

B = Belief and inference about the event (can be rational or irrational

C = consequences (emotional and behavioural)

That sounds obvious, but what made Ellis interesting is that he suggested that the Consequences (C ) depended on the Beliefs (B) as much or more as on the events that Activated the whole thing (A) in the first place.

That’s all very abstract so let’s give a concrete example. I go into the office where I work and say hello to a colleague, who ignores me. This is the activating event (A). I might believe that this is because I’ve done something to upset them. “Perhaps everyone’s talking about me behind my back? Maybe everyone hates me? I know I’m not popular so it’s not surprising people ignore me”, and so on. This is one set of beliefs, let’s call them B1. Alternately I might think that my colleague is distracted, or worried about something, or upset themselves, or simply having a bad day and not had enough coffee yet. Let call those beliefs B2. We can see that the two different sets of beliefs will likely lead to two very different consequences (C ). B1 may lead to me being hostile, or defensive, or withdrawn, or angry (C1), while B2 may lead to me being sympathetic, supportive, understanding and perhaps buying a coffee (C2). And we can see that in turn there will be further consequences from each of these outcomes, chain reactions may lead down very different paths.

While it might be the case that the B1 beliefs are true, it’s probably more likely to be B2. The B1 beliefs are an example of irrational beliefs, coming from ‘thinking errors’, which arise from, and further contribute to, low self-esteem.

Examples of ‘thinking errors’, irrational beliefs and Negative Automatic Thoughts (NATs):

Catastrophising: making mountains out of molehills. “This is going to be a disaster …”

All-or-nothing thinking: things are either wonderful and perfect, or terrible and couldn’t be worse. There are no shades of grey.

Fortune-telling - predicting the negative

Mind-reading - assuming others are thinking badly of you

Overgeneralising – thinking in terms of absolutes – “this always happens”, “it never works” thinking

Personalising - the world centres around oneself

CBT involves using a number of practical techniques that challenge these

8.4 CBT in practice

CBT is practical and problem-focused around particular issues, for instance

Phobias; Obsessive Compulsive Disorder (OCD); Eating disorders - such as Anorexia Nervosa, Bulimia; PTSD

It is also used to treat more generalised problems such as Anxiety; Depression.

There is evidence that is can be as effective in the short-term as medication. It is endorsed by the National Institute for Health and Clinical Excellence (NICE) the UK.

It involves using a number of Tools, techniques and strategies, such as

• Cognitive restructuring - reframing schemas (core belief frameworks)
• Pleasant activity scheduling
• Journaling / keeping a diary
• Scaling feelings
• Role play
• Modelling
• Relaxation procedures such as PMR

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8.5 Summary and Key points

9.1 Comparing the three main approaches

We can compare the three approaches we’ve looked at using this table. Then look at the answers underneath.

9.2 What is the Integrative approach?

An integrative approach combines different tools and approaches to fit the needs of the individual client. There are several different types of integrative approach, but they tend to share a view that Counselling should be tailor-made to fit the specific circ*mstances of the Client, as opposed to just having a ‘one-size-fits-all’ approach. Many, perhaps most, practicing Counsellors adopt some type of integrative approach.

There are obvious advantages to the Integrative approach: it’s flexible and focuses on the Client’s needs, rather than on the Counsellor’s preferences.

But it’s also got some disadvantages. Sometimes it can look like a “pick-and-mix” method – “if this particular technique doesn’t work straight away, we’ll try another”, and this can end up being superficial and failing to tackle underlying problems in a consistent manner.

Perhaps, as with all approaches, it has to be done well by a committed, skilled and well-trained Counsellor in order to work.

9.3 Other approaches

There are a number of other approaches or theories of Counselling that you might want to look in to, or at least be aware of. They include some that are particularly controversial. For instance, Neuro Linguistic Programming (NLP) is regarded by many Psychologists as “pseudo-scientific rubbish”[14]. But most of the following are within the mainstream of the Counselling movement, although less popular than the three main approaches that we’ve been looking at.

Psychodynamic Counselling

Psychodynamic Counselling includes Freud’s Psychoanalytic approach but also those of many of his followers who came up with rather different theories. These include the theories of Carl Jung, Alfred Adler and Melanie Klein. They all share the idea that mental disturbance is rooted in conflicts in the unconscious mind that developed during childhood.

Cognitive Analytic Therapy

This is a relatively new and exciting development. It’s directive and time-limited – so it’s meant to work after a relatively short number of sessions, and because of this is attractive to the UK NHS, which is so short of resources. CAT works to uncover chains of events – how a sequence of thoughts and emotions can lead to problems (such as self-harm, eating disorder or violent behaviour). There is growing evidence that CAT can be effective.

Family Therapy

Family Therapy works with the whole family and explores the relationships between all of its members. In working with the family in this way the Counsellor hopes to help the family develop stronger and healthier relationships between themselves.

Hypnotherapy

Hypnotherapy uses the technique of hypnosis to produce a deeply relaxed state. The idea is that during this hypnotic state the Client’s unconscious is more open, and so the Client is more receptive to suggestions about changing their behaviour, such as stopping smoking or breaking bad eating habits. Hypnotherapy is sometimes classified as a form of Alternative or Complementary Medicine. There is some disagreement about whether it works or not.

Neuro-Linguistic Programming (NLP)

NLP is a controversial approach, based on the idea that individuals create ‘internal mental’ of the world maps. NLP has many followers who claim that it can help in personal growth, but also many critics who call it a ‘pseudoscience’.

Relationship Counselling

Relationship Counselling is sometimes called ‘couples counselling’ (and once, when social conventions decreed that you had to be married to be in a relationship: ‘Marriage Guidance’). It involves Counselling sessions for both members of a relationship to help improve communication and work on any problems or issues.

Solution-focused brief therapy (SFBT)

Solution-focused brief therapy is short (as the name suggests) and focused on the Client’s strengths, achievements and particular goals without being concerned about how problems arose in the past. The Counsellor focuses on the Clients’ answers to specifically designed questions to guide the process. It leads to goal setting for positive changes. This approach is recognised by the UK NHS as being an effective form of therapy and is likely to become more popular in the future.

Gestalt Therapy

Gestalt Therapy was particularly popular in the 1950s and 60’s and was popularised by the book of that name by Fritz Perls, published in 1951. It stresses personal responsibility and the importance of living in the ‘here and now’. It often uses the Empty Chair Technique – where the Client is encouraged to talk to an empty chair as though it was another person (for instance a parent, or spouse).

9.4 So which approach to choose?

Reading about the many different approaches to Counselling can be confusing and begs the questions: – why so many? Why can’t they agree? And perhaps most importantly for someone considering becoming a Counsellor – how do I choose which one to follow?

Why so many? Although there seems to be an endless list of approaches, they do really all come into three main categories:

1 first the Psychoanalytic/Psychodynamic (the oldest) which emphasise the Client’s history (and especially their childhood);

2 then the Humanist approaches, which includes Rogers’ Person Centred Counselling and also Gestalt Therapy, emphasising emotions;

3 and finally the group that is currently most popular, which are all variations of the Cognitive-Behavioural method in some way, in that they are outcome focused and more concerned with results than underlying causes or theories (this includes CBT and SFBT). The other approaches mentioned above are either concerned with working with particular client groups (Families or Couples) or using very specific techniques (Hypnosis and NLP).

Why the differences?

There are many reasons for why these differences have developed – people have different priorities and different ways of looking at the world, they work in different countries and cultural contexts and want different things. The Psychoanalytic/Psychodynamic approach grew out medicine, the Humanist approaches grew out of a reaction against authority, the more modern approaches are practical and just want things to work. They each reflect, maybe, the rapidly changing world in which they developed.

How to choose?

That is up to you. If you decide to find out more about Counselling then you will plenty of opportunities to explore many different approaches. You might be drawn to some because their outlook on the world appeals to you – for instance if you have a sunny and optimistic disposition you might like the Rogerian optimism. On the other hand you might find a welcome antidote to such optimism in the darker, more mysterious and in some ways more fantastic – but fascinating – world of Psychoanalysis. Or of course you might just be a practical person who wants a technique that works – and can earn you a good living by working as a Counsellor.

We’ll look a little bit at the evidence of what works – and what doesn’t – in chapter 11.

What is role play?

Role-play is used in professional training to learn new skills. It involves a ‘make believe’ situation or scenario where participants pretend, for a short time, to be a different person.

This chapter will be particularly relevant if you are a student doing a course in Counselling that involves an assessed role play. This will mean that you will practice the Counselling Skills that you’ve been learning in a simulation of a real-life counselling situation. This chapter will describe how this usually happens, how to prepare and get the most out of it.

If you’re not doing a formal course but still want to practice Counselling skills you might still find this chapter useful as a way of thinking about practicing yourself with a partner.

As we’ve said earlier, Counselling is a practical activity that you can’t learn just by reading or talking about – you have to actually do it, practice it and get feedback in order to develop the skills and improve your overall capability. That’s what role play is all about.

This part of Counselling training is, in fact, not very easy for the beginner if you’ve never done anything like it before. Don’t be surprised if it all seems a little strange at first – you’ll soon be surprised how easy it does become.

Role-play in Counselling means that one person, for a limited period of time, takes on the role of a Client so that another can take on the role of Counsellor for them. So the two people are ‘simulating’ the Counselling situation.

At first, these sessions might just last for 5 or 10 minutes, but will gradually get longer.

At first these role-plays may just involve the two people – ‘Client’ and ‘Counsellor’, but later may be a triad where a third person acts as an Observer. This is useful as the Observer can provide more detailed feedback to the ‘Counsellor’ on their skill development. At some point in a Counselling course the tutor will act as an Observer so that they can assess the ‘Counsellors’ skills.

For the Person who is role-playing the Counsellor the task is straightforward – to use the Counselling skills that they’ve been learning about as best they can, bearing in mind they are in a ‘safe’ environment – that is, it isn’t a real Counselling situation so they don’t have to worry about ‘getting it wrong’.

For the person role-playing the Client, they are essentially helping their fellow learner by acting out the role of a Client. (And of course, everyone gets there turn to do both roles). But the role of Client isn’t easy at first. In some cases, tutors will supply detailed set scenarios that the ‘Client’ has to imagine themselves to be (there’s an example at the end of the chapter). In others, it’s just a sketch and the rest is left to the Client’s imagination (for instance:

“Jenny is a 43 married woman with two children who works in a shop. She feels dissatisfied with her life now her children are grown up…”).

Yet other tutors may let learners devise their own Client scenarios. If you do this, it’s important not to take a scenario that is too close to one own actual real problem or issue, as this might turn a role-play simulation into a real, live Counselling session. However it is organised, it is a good idea for the ‘Client’ to prepare for the role-play beforehand, making some notes and thinking through the likely questions that might come up and how they might respond.

The triad

This term just means that you’ll working in a group of three: one person takes on the role of Counsellor and another the Client, while the third is an Observer.

11.2 Tips: Giving and getting feedback

Counselling training is a serious business and you’ll be talking about deeply important matters. Triad role play can be stressful, especially for the student who is role-playing the Counsellor, who as a beginner has so many things to remember while being watched by two other people. Despite all this, role play is usually very enjoyable and rewarding. It can also be great fun – don’t be surprised of you find your triad erupting into laughter during the feedback – it’s a good way to get rid of the accumulated stress!

Giving feedback

The Observer’s role in the triad is to give detailed feedback to the ‘Counsellor’, This will often use a checklist of Counselling skills. When you first start working in triads there is a natural tendency for the Observer to give only positive feedback to the ‘Counsellor’. Everyone is often nervous and there is a feeling that they want to support each other. That is absolutely fine for the first session or so. However, as you get a little more experienced with the role-play situation you should find that you will want to give feedback that not only positive and supportive, but also includes suggestions for improvements and identifying particular issues that would be worth exploring. Your tutor will be able to able here, but it’s worth remembering that we learn from mistakes as well (or more) as from successes. So pointing out where something has gone wrong – or could have been done better – can be really helpful for your fellow learner, as long as it’s done in a positive and supportive manner.

The feedback sandwich is often recommended. It involves starting with positive feedback (praise, mentioning the good points) before moving on to areas which could be improved (‘constructive feedback’) and then finishing off with more positive feedback. This ensures that the ‘Counsellor’ is getting plenty of acknowledgement for what they did right while also getting pointers for those areas they can improve.

Getting feedback

It isn’t easy to take feedback. We can all feel defensive. Any sort of feedback that isn’t 100% positive can feel can criticism, and criticism can feel damning. Particularly in something like Counselling training, where you are exposing you inner self (being Congruent) and opening up about your feeling, you may feel very vulnerable. So it’s not surprising if sometimes even getting some mildly unfavourable feedback from an Observer, or maybe feedback that’s just a little clumsily put, can feel devastating. It’s important to try to remain positive here and listen to the feedback. Whatever it is, it usually isn’t that bad and isn’t something that you can’t put right fairly easily, and be a better Counsellor for doing so. Occasionally, of course, the Observer may be mistaken and you might want to disagree with their assessment. A good discussion about how to interpret a Counselling Skill in practice, for instance, can be really useful, as long as no-one becomes too stubborn in maintaining their point of view. Getting feedback is the key to learning. If in doubt, talk to your tutor.

11.1 Ethics

Trained Counsellors have to be members of a Professional body such as COSCA in Scotland or BACP (British Association for Counselling and Psychotherapy). These organisations have professional guidelines, to make sure that clients get a good standard of service and aren’t exposed to dangers of abuse from its members.

These guidelines are detailed documents. The BACP Ethical Framework for the Counselling Professions 2018[15], for instance, contains 94 points over 27 pages and trainee Counsellors will be expected to show that they “will fulfil all the commitments to clients within the Ethical Framework”.

The COSCA Statement of Ethics and Code of Practice 2014[16] is a little less daunting as it runs to just 14 pages. However, most of the points that both these documents make are both common sense and necessary to protect Counsellors and their Clients.

One of the key issues concerns boundaries – where is the line between acceptable and unacceptable behaviour? In the Counselling relationship the Client is in a vulnerable position that could easily be exploited, so it’s essential that the Counsellor avoids situations in which there could be such exploitation by crossing these boundaries.

One boundary concerns relationships between Counsellors and Clients. Having a relationship of any sort with the client outside of the Counselling relationship can lead to a conflict of interest and the Counsellor should avoid it. For instance, if the Counsellor has already met and worked with someone, or they are a casual acquaintance, then if they became a Client there would be a conflict of interest and a risk of breaching confidentiality. So Counsellors should keep their professional and private lives quite separate. Of course relationships between Counsellors and Clients should never be started. For the same reasons Counsellors shouldn’t have Social Media contact with Clients.

Another boundary concerns physical contact between Counsellor and Client. It may be tempting for Counsellor to offer a reassuring touch on the shoulder to a client who is in distress, or to hold their hand or even give them a hug. But generally this should be avoided. It can be misinterpreted and lead to an awkwardness that gets in the way of the relationship.

Confidentiality

This is of course one of the biggest issues. As we’ve discussed earlier, when talking about opening the Counselling session, it’s important to reassure the client that everything that is said will remain confidential and won’t be said to anyone else – it will ‘stay in the room’. But it is also important to explain the exceptions – if the Counsellor believes, from something that is said, that there is a risk to the client or a someone else then they may have to disclose. It has to be said that this is quite rare – but it does need to be said.

Respecting Diversity

Counsellors need to be especially aware of and respectful of cultural differences. They will be dealing with issues that will have very different meaning in different cultures. So Counsellors will need to be especially aware of the problems that can arise from misunderstanding between cultural expectations. And of course they should, as the COSCA guidelines state, not practise, condone or encourage unjustified discrimination or oppressive behaviour

Supervision

Finally in this section its worth noting that all Professional Counsellors have supervision – work with another counsellor to review their work. Counsellors should discuss any boundary issues, or other ethical problems, in supervision.

11.2 Evidence

Regarding evidence – does it work?

Does Counselling work – does it actually makes things better, achieve its aims, and – equally important - avoid making anything worse?

These are obvious questions, which you would think everyone would want to have answered.

But getting straightforward answers isn’t as easy as it might appear at first.

For a start, Counselling has had, traditionally, a difficult relationship with Science and Medicine. Many Doctors and Scientists regarded it at first with suspicion. In a response to that, many of the advocates of Counselling in the 60s and 70s reacted against the ideas of Science and didn’t believe that they had to justify their practice through rigorous research or using the Scientific method. Unfortunately, this meant that there wasn’t as much research done by academic Psychologists into Counselling as there should have been.

This situation has changed greatly in the 21^st century. Counselling has become more acceptable and accepted. There is a growing body of research that shows that some forms of Counselling produce some measurable benefits in some circ*mstances. The existence of such evidence is vital because it justifies the use of funds – for instance in the British NHS – to pay for Counselling treatment. But as usual, the devil’s in the detail. In other words, which forms of Counselling produce what benefits and in what circ*mstances. For instance , the National Institute for Health and Care Excellence, known as NICE, is a well respected part of the UK NHS which recommends treatments and procedures based on the latest research . In 2011 they published guidelines on ‘Common Mental Health Problems: identification and Pathways to Care’ that provided detailed recommendations on specific types of Counselling (such as CBT, Psychodynamic) for particular mental health problems.[17] But this type of research is still in its early stages and is inconclusive – there’s a need for much more.

‘First, do no harm’

When medicine was developing in its modern form in the 19^th century it adopted a set of ethics called the Hippocratic Oath (after the ancient Greek physician Hippocrates). The most well-known part of this oath, which is still taken by medical students today, is to promise to ‘do no harm’. In more detail, it states that given a particular problem it may be better not do something, or do nothing at all, rather than risk making things worse. This principle was especially important when medicine was starting out and hadn’t yet established an accepted method – much of the science of the 19^th century was controversial and many so-called cures were experimental and could be painful, dangerous and even fatal.

Why is this relevant? Because in some ways Counselling in the early 21^st century is a rather like early medicine. It seems to be on the right track and is growing in popularity, but we don’t really understand why it works or agree about the best methods. In fact some of the methods we’ve looked at in chapter 9 are probably not very useful; some might be completely useless and even harmful, especially if used with vulnerable clients who desperately need help but may not be able to make the best decisions about how to get it. Adopting the ‘do no harm’ principle’ seems especially important, therefore. At the very least, Counsellors should attempt not to guide, advise or otherwise lead their clients into activities which may damage them.

Yet this might be taken to mean that do nothing might often be the best policy. But non-action itself has its risks. For potentially suicidal clients, for the Counsellor not to act may increase the likelihood of the Client do themselves harm.

The role of the Counsellor

All of this goes to show that Counselling is, as we’ve come to see, a much more complex activity that it may first look. Two people are sitting in a room talking but incredibly complex processes are going on in the relationship between them. The Counsellor, particularly if they come from the Person-Centred approach, may look like they are taking a very passive role, barely talking. But in fact they are busy doing a huge number of tasks at the same time: actively listening, of course, to the client, following their narrative as it unfolds and empathising with them (which might be emotionally quite draining as well as involving a great deal of concentration in order to remember the details of complex stories and situations). The Counsellor also needs to be considering their own responses – both emotionally (how do they feel about it, important for maintaining congruence) and rationally (when will they intervene next; what that intervention will be: a question, reflection, summary etc). While all of this is going on the Counsellor will need to be considering any ethical aspects, maybe planning some action as the end of session approaches and keep their eye on the time! So the Counsellor is multi-tasking and constantly making decisions. No one should think that this is easy to do.

12.1 What next

If reading this far hasn’t put you off Counselling altogether then you may want to study it further and think about the training process to become a Counsellor. This chapter will describe some of your main options if you live in the United Kingdom. There are contact details for more information in the appendix. If you live outside the UK you’ll need to search for organisations in your country that can give you this information. Also be aware that things change! This is being written in 2019 so if your reading it much later then training and education procedures might have changed.

12.2 Counselling Training

Training in Counselling that is recognised by professional associations (in the UK, organisations such as the BACP and COSCA) usually involves three stages:

Stage 1 Introduction

If you’ve not yet done any studying or training in Counselling then the usual first step is an Introductory course, often called ‘Introduction to Counselling’ and often run in Further Education colleges. This type of course might run for 2 or 3 hours once a week, for between 8 and 12 weeks. It provides an overview to the subject and some practice in basic Counselling skills. In Scotland the course is often called ‘Counselling – an Introduction’.

This book is aimed at supporting students studying this type of course.

Stage 2 Counselling Skills Certificate

For instance COSCA recommends a number of courses but these combine stages 1 and 2 (that is they are for people who have no prior knowledge or experience). The COSCA courses involves 120 hours contact time and lasts 1 year part-time and involves considerable practice in using Counselling skills as well as exploring a number of theoretical approaches. There is usually a significant course fees but sometimes this may be paid for by bursaries.

Stage 3 Professional Practitioner Training e.g. Diploma usually 2 years part-time. These are intense courses, requiring a considerable commitment of time and energy. Students will usually be required to undertake a placement involving a considerable amount of Counselling (e.g. 100 hours) and attend Supervision session. There is often a considerable cost in terms of course fees (several thousand pounds).

12.3 Volunteering

There are a number of organisations that depend on volunteer Counsellors – that is, if they didn’t have people who Counselled clients on their behalf without getting paid, then they couldn’t operate. Some of these will, in exchange, train up their volunteers in Counselling, and this might be a good way to get training and qualifications if you can’t do the route identified in section 12.2 (because it is too expensive, for instance).

For example, in Scotland, Cruse Bereavement Care offers bereavement Counselling. It takes on volunteer Counsellors and provides a free training.

Other organisations with similar arrangements include the Samaritans and Relationships Scotland Couples Counselling. Local Organisations that provide support for drug addiction and alcohol abuse might also take on volunteers.

12.4 Counselling in another professional role

As we talked about earlier, there are many occupations which routinely involve some form of Counselling, or at least the use of Counselling skills. Social Workers and social care workers are obvious examples. Nurses may also use counselling skills (although in an increasing over-stretched NHS in the UK they may feel they don’t often have enough time). Other occupations in the category include Careers Guidance advisers, Teachers and Lecturers, and Human Resource professionals.

12.5 Other forms of study

It might be that you find some of the topics we’ve discussed in this book interesting in their own right and would like to study them further. In particular, a lot of what we have talked about overlaps with Psychology and you might be interested in finding out more about courses in that subject. Further Education Colleges run courses at all levels and there is also the Open University, which has extremely high quality courses and specialises in qualifications for adults who are returning to education after a long break and have few or no qualifications to start with. Although courses do have fees you will often find that you don’t have to pay these if your income is below a certain amount (for instance, if you live in Scotland in 2019 and want to study part-time for an Undergraduate degree then you probably won’t have to pay anything for fees as they will get paid by the Student Awards Agency for Scotland (that’s not a loan - you don’t have to pay it back) .

12.5 Final words

Counselling continues to be a growing and developing profession, offering great rewards for those becoming Counsellors and valuable help for their Clients. But it needs to become more widely available, more professional and better funded. There are many ways to become involved in this worthwhile and evolving field; I hope that reading this book will help identify some of them.

British Association for Counselling and Psychotherapy BACP

BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire LE17 4HB https://www.bacp.co.uk/

COSCA (Counselling & Psychotherapy in Scotland)

16 Melville Terrace Stirling FK8 2NE

01786 475140 info@cosca.org.uk

http://www.cosca.org.uk/

The National Counselling Society
19 Grafton Road
Worthing, West Sussex
BN11 1QT

Tel: 01903 200666

https://www.nationalcounsellingsociety.org/

The Open University

Walton Hall, Milton Keynes MK7 6AA

www.open.ac.uk

01908 274066

BACP 2019 C3 Information Sheet https://www.bacp.co.uk/media/1917/bacp-choosing-counsellor-psychotherapist-c3.pdf Accessed 28 July 2019