Counselling

Counselling is a wonderful twentieth-century invention. We live in a complex, busy, changing world. In this world, there are many different types of experience that are difficult for people to cope with. Most of the time, we get on with life, but sometimes we are stopped in our tracks by an event or situation that we do not, at that moment, have the resources to sort out. Most of the time, we find ways of dealing with such problems in living by talking to family, friends, neighbours, priests or our family doctor. Counselling is not just something that happens between two people. It is also a social institution that is embedded in the culture of modern industrialized societies. The term counselling includes work with individuals and with relationships which may be developmental, crisis support, psychotherapeutic, guiding or problem solving . . . The task of counselling is to give the client an opportunity to explore, discover and clarify ways of living more satisfyingly and resourcefully. Counselling denotes a professional relationship between a trained counselor and a client. This relationship is usually person-to-person, although it may sometimes involve more than two people. It is designed to help clients to understand and clarify their views of their lifespace, and to learn to reach their self-determined goals through meaningful, wellinformed choices and through resolution of problems of an emotional or interpersonal nature. A principled relationship characterised by the application of one or more psychological theories and a recognised set of communication skills, modified by experience, intuition and other interpersonal factors, to clients intimate concerns, problems or aspirations. It may be of very brief or long duration, take place in an organisational or private practice setting and may or may not overlap with practical, medical and other matters of personal welfare. It is both a distinctive activity undertaken by people agreeing to occupy the roles of counsellor and client . . . and an emerging profession . . . It is a service sought by people in distress or in some degree of confusion who wish to discuss and resolve these in a relationship which is more disciplined and confidential than friendship, and perhaps less stigmatising than helping relationships offered in traditional medical or psychiatric settings.

The relationship between counselling and psychotherapy

Counselling is provided under a variety of different labels. To employ a metaphor from the world of business, there are a range of competing products that offer the consumer or client more or less the same service. The upmarket version of the product is sold as psychotherapy, which is provided by practitioners who are usually very highly trained specialist professionals, often with a background in medicine. Psychotherapy can be a lengthy process. Although there is an increasing interest in forms of brief psychotherapy, which may consist of a series of ten or twelve sessions, it is probably fair to say that most psychotherapists would consider it necessary for clients to be in treatment for a year or more for beneficial results to occur. The most expensive and exclusive version of psychotherapy remains classical Freudian psychoanalysis Clear distinction can be made between the two, with psychotherapy representing a deeper, more fundamental or involved process of change with more disturbed clients. Others maintain that counsellors and psychotherapists are basically doing the same kind of work, using identical approaches and techniques, but are required to use different titles in response to the demands of the agencies that employ them. One significant difference between counselling and psychotherapy is that much counselling is conducted by nonprofessional volunteer workers, whereas psychotherapy is an exclusively professional occupation. However, both counselling and psychotherapy can be viewed as activities distinct from advice-giving, caring and teaching.

Counselling and other helping professions

There are several other occupational titles that refer to people who are practicing counselling. A term that is widely used is counselling psychologist. This refers to a counsellor who has initial training in psychology, and who uses psychological methods and models in his or her approach. This label explicitly imports the language of science into counselling, by associating it with a specific scientific discipline. There are also several labels that refer to counsellors who work with particular client groups: for example, mental health counsellor, marriage counselor or student counsellor. The distinctive feature of these practitioners is that they will possess specialist training and expertise in their particular field in addition to a general counselling training.

To summarize, it can be seen that it is no easy matter to define counselling. In some respects this can be frustrating for people seeking counselling, because it means that there are many situations in which it can be hard for them to know exactly what is on offer when they consult someone who labels himself or herself as a counsellor. On the other hand, the fact that counselling has been, and continues to be, influenced and shaped by so many different traditions and helping approaches gives it a great deal of its vitality and energy. The whole question of what is counselling? is discussed very fully by Feltham (1995).

The diversity of theory and practice in counseling

Karasu (1986) reported having come across more than 400 distinct models of counselling and psychotherapy. The fact that this whole field of study is of relatively recent origin it means that there has not yet been time for the explosion of new ideas that appeared between 1950 and 1970 to have become integrated into a unified approach. However, despite the movement in favour of theoretical unification and integration, it is widely recognized that the three core approaches of psychodynamic, cognitivebehavioural and humanistic represent fundamentally different ways of viewing human beings and their emotional and behavioral problem There also exists a wide diversity in counselling practice, with counselling being delivered through one-to-one contact, in groups, with couples and families, over the telephone and even through written materials such as books and self-help manuals. Counselling also has a place in the world of work. A variety of counseling agencies exist for the purpose of helping people through difficulties, dilemmas or anxieties concerning their work role. These agencies include vocational guidance, student counselling services and employee assistance programmes or workplace counselling provided by large organizations in industry and the public sector. Whether the work role is that of executive, postal worker or college student, counsellors are able to offer help with stress and anxiety arising from the work, coping with change and making career decisions. A number of counselling agencies have evolved to meet the needs of people who experience traumatic or sudden interruptions to their life development and social roles. Prominent among these are agencies and organizations offering counseling in such areas as marital breakdown, rape and bereavement. The work of the counsellor in these agencies can very clearly be seen as arising from social problems. For example, changing social perceptions of marriage, redefinitions of male and female roles, new patterns of marriage and family life, and legislation making divorce more available represent major social and cultural changes of the past century. Counselling provides a way of helping individuals to negotiate this changing social landscape. A further field of counselling activity lies in the area of addictions. There exists a range of counselling approaches developed to help people with problems related to drug and alcohol abuse, food addiction and smoking cessation. The social role of the counsellor can be seen particularly clearly in this type of work. It is also a social activity that has a social meaning, Often, people turn to counseling at a point of transition, such as the transition from child to adult, married to divorced, addict to straight. Counselling is also a culturally sanctioned means of enabling adaptation to social institutions. Counsellors are rarely managers or executives who hold power in colleges, businesses or communities. Counsellors, instead, have a more liminal role, being employed at the edge of these institutions to deal with those in danger of falling off or falling out.

The aims of counseling

Underpinning the diversity of theoretical models and social purposes discussed above are a variety of ideas about the aims of counselling and therapy. Some of the different aims that are espoused either explicitly or implicitly by counselors are listed: Insight. The acquisition of an understanding of the origins and development of emotional difficulties, leading to an increased capacity to take rational control over feelings and actions (Freud: where id was, shall ego be). Relating with others. Becoming better able to form and maintain meaningful and satisfying relationships with other people: for example, within the family or workplace. Self-awareness. Becoming more aware of thoughts and feelings that had been blocked off or denied, or developing a more accurate sense of how self is perceived by others.

 Self-acceptance. The development of a positive attitude towards self, marked by an ability to acknowledge areas of experience that had been the subject of self-criticism and rejection. Self-actualization or individuation. Moving in the direction of fulfilling potential or achieving an integration of previously conflicting parts of self. Enlightenment. Assisting the client to arrive at a higher state of spiritual awakening. Problem-solving. Finding a solution to a specific problem that the client had not been able to resolve alone. Acquiring a general competence in problem-solving. Psychological education. Enabling the client to acquire ideas and techniques with which to understand and control behaviour. Acquisition of social skills. Learning and mastering social and interpersonal skills such as maintenance of eye contact, turn-taking in conversations, assertiveness or anger control. Cognitive change. The modification or replacement of irrational beliefs or maladaptive thought patterns associated with self-destructive behaviour. Behaviour change. The modification or replacement of maladaptive or selfdestructive patterns of behaviour. Systemic change. Introducing change into the way in that social systems (e.g. families) operate. Empowerment. Working on skills, awareness and knowledge that will enable the client to take control of his or her own life. Restitution. Helping the client to make amends for previous destructive behaviour. Generativity and social action. Inspiring in the person a desire and capacity to care for others and pass on knowledge (generativity) and to contribute to the collective good through political engagement and community work. It is unlikely that any one counsellor or counselling agency would attempt to achieve the objectives underlying all the aims in this list. On the whole, psychodynamic counsellors have focused primarily on insight, humanistic practitioners have aimed to promote self-acceptance and personal freedom, and cognitive behavioural therapists have been mainly concerned with the management and control of behaviour. However, any valid counselling approach should be flexible enough to make it possible for the client to use the therapeutic relationship as an arena for exploring whatever dimension of life is most relevant to their well-being at that point in time.

Counselling as an interdisciplinary area of study

Most important ideas in counselling and psychotherapy have originated in philosophy. The concept of the unconscious had been used in nineteenth-century philosophy (Ellenberger 1970) some time before Freud began to use it in his theory. The concepts of phenomenology and authenticity had been developed by existential philosophers such as Heidegger and Husserl long before they influenced Rogers, Perls and other humanistic therapists. The field of moral philosophy also makes an input into counselling, by offering a framework for making sense of ethical issues Another field of study that has a strong influence on counselling theory and practice is religion. Several counselling agencies have either begun their life as branches of the church or been helped into existence by founders with a religious calling. Many of the key figures in the history of counselling and psychotherapy have had strong religious backgrounds, and have attempted to integrate the work of the counsellor with the search for spiritual meaning. Jung has made the most significant contribution in this area. A third sphere of intellectual activity that continues to exert a strong influence on counselling is the arts. There is a strong tradition in counselling and psychotherapy of using methods and techniques from drama, sculpture, dance and the visual arts to enable clients to give expression to their feelings and relationship patterns. In recent years psychodrama and art therapy have become well established specialist counselling approaches, with their own distinctive theoretical models, training courses and professional journals. There has similarly been valuable contact between counselling and literature, primarily through an appreciation that language is the main vehicle for therapeutic work, and that poets, novelists and literary critics have a great deal to say about the use of language. Specific literaturebased techniques have also been employed in counselling, such as autobiography, journal writing, poetry writing and bibliotherapy.

Counselling is in many respects an unusual area of practice in that it encompasses a set of strongly competing theoretical perspectives, a wide range of practical applications and meaningful inputs from a number of contributing disciplines. Thorne and Dryden (1993) have edited a collection of biographical essays written by counsellors on the ways in which they have used early training in disciplines such as ecology, theology and social anthropology to inform their counseling practice. The field of counselling and psychotherapy represents a synthesis of ideas from science, philosophy, religion and the arts. It is an interdisciplinary area that cannot appropriately be incorporated or subsumed into any one of its constituent disciplines. An approach to counselling that was, for example, purely scientific or purely religious in nature would soon be seen not to be counselling at all, in its denial of key areas of client and practitioner experience.

A user-centered definition of counseling

Previous sections of this chapter have introduced some of the more widely adopted definitions of counselling, and have highlighted the complex ways in which counselling is located within contemporary society. However, while it is important to be able to appreciate the diversity that exists within counselling theory and practice, and the various ideas, values and traditions that have been emphasized within the literature on counselling, there is also a danger in getting lost in complexity, and losing sight of the essential simplicity of counselling. This book seeks to offer an introduction to counselling that will allow those who read it to appreciate not only what is common to all approaches to counselling, but also the value of specific approaches. One of the essential common features of all counselling is that it can only happen if the person seeking help, the client, wants it to happen. Counselling takes place when someone who is troubled invites and allows another person to enter into a particular kind of relationship with them. If a person is not ready to extend this invitation, they may be exposed to the best efforts of expert counselors for long periods of time, but what will happen will not be counselling. Counselling must also be understood within its social and cultural context: counsellor and client are social roles, and the ways in which participants make sense of the aims and work of counselling are shaped by the culture within which they live. How many of us have grandparents who were counsellors or psychotherapists, or who would even have known what a counsellor or therapist did? In many ways, counselling is a product of late twentieth-century modernity (see Chapter 2). The remaining chapters of this book are informed by a user-centred, socially oriented understanding of counselling. This way of making sense of counseling begins with the wish or intention of the client, and can be summarized in the following terms: Counselling is an activity that takes place when someone who is troubled invites and allows another person to enter into a particular kind of relationship with them. A person seeks such a relationship when they encounter a problem in living that they have not been able to resolve through their everyday resources, and that has resulted in their exclusion from some aspect of full participation in social life. The person seeking counselling invites another person to provide him or her with time and space characterized by the presence of a number of features that are not readily available in everyday life: permission to speak, respect for difference, confidentiality and affirmation. Permission to speak. This is a place where the person can tell their story, where they are given every encouragement to give voice to aspects of their experience that have previously been silenced, in their own time and their own way, including the expression of feeling and emotion. Respect for difference. The counsellor sets aside, as far as they are able, their own position on the issues brought by the client, and his or her needs in the moment, in order to focus as completely as possible on helping the client to articulate and act on his or her personal values and desires. Confidentiality. Whatever is discussed is confidential: the counsellor undertakes to refrain from passing on what they have learned from the person to any others in the persons life world. Counselling is a form of helping that is focused on the needs and goals of the person. The popularity of counselling reflects the strain and fragmentation of life in contemporary society.

 There exist many definitions of counselling, each of which emphasizes different aspects of the counselling role and process. Counselling is similar to, and also different from, other forms of helping, such as psychotherapy, social work and psychiatric nursing. There are many competing theories of counselling, and a variety of settings for counselling practice. The diversity of counselling is also reflected in its roots in disciplines such as philosophy, religion and the arts, as well as psychology and psychiatry. The diversity and heterogeneity of counselling can be seen as a strength, reflecting the sensitivity of counselling to the enormous variations in human experience. The common elements within the great diversity of counselling provision can best be understood by defining counselling from a socially oriented, user focused perspective.

The expansion of counselling in the late twentieth century

Counselling, as a distinct profession, came of age only in the 1950s, and so an understanding of the history of psychotherapy is necessary to make the link between counselling and earlier forms of healing and care. Although in many respects counselling can be seen as an extension of psychotherapy, a way of marketing psychotherapy to new groups of consumers, there are also at least two important historical strands that differentiate counselling from psychotherapy: involvement in the educational system and the role of the voluntary sector. Counselling of various kinds came to be offered within the school and college systems in the 1920s and 1930s, as careers guidance and also as a service for young people who were having difficulties adjusting to the demands of school or college life. Psychological testing and assessment was bound up with these activities, but there was always an element of discussion or interpretation of the students problems or test results (Whiteley 1984). Counselling also has very strong roots in the voluntary sector. For example, the largest single counselling agency in Britain, the National Marriage Guidance Council (RELATE), was created in the 1940s by a group of people who were concerned about the threat to marriage caused by the war (Lewis et al. 1992). Similarly, other groups of volunteers have set up counselling services in areas such as rape, bereavement, gay and lesbian issues and child abuse

The social meaning of counseling

Counselling emerged in the second half of the twentieth century. To understand what counselling is, and what counsellors do, it is necessary to have an appreciation of the historical origins and development of this form of helping. In pre-industrial times, people with emotional problems were helped either by their priest or by other members of their community. In the nineteenth century, following the Industrial Revolution, and the increasing secularization of society, there emerged new institutions and professions devoted to problems of mental illness. During the middle years of the nineteenth century, mesmerism (hypnosis) was a widely used form of psychological therapy. Towards the end of the nineteenth century, Freud integrated many different strands of psychological, medical and philosophical thought into the first fully developed system of psychotherapy, known as psychoanalysis.

 Psychoanalysis remained a marginal activity until it was enthusiastically espoused by many sectors of American society in the 1920s and 1930s. The client-centred theory of Carl Rogers represented a more popular, accessible approach, that did much to bring counselling to the masses. The rapid expansion and popularity of counselling in the USA can be attributed to high levels of social mobility and consumerism, which produced a lack of meaning, or empty self, that therapy helped to fill. Other important strands in the evolution of counselling include vocational guidance in educational settings, and the voluntary sector.

It is important to recognize that counselling plays a role in society of promoting an image of the person as an intrinsically autonomous and separate being, and in supporting strategies for dealing with social problems at an individual level. Counselling is an activity that is inextricably bound up with the culture of Western industrial societies, and is therefore not necessarily relevant to the problems experienced by members of other cultural groups.

Counselling Theories
During the twentieth century, the development of counselling and psychotherapy came to be organized around a number of distinct theoretical models orapproaches. Historically, the most important of these approaches or schools of therapy have been psychodynamic, cognitivebehavioural and humanistic. However, these are merely the most popular of a wide range of theoretical orientations presently in use. The current situation in counselling and psychotherapy is one of great theoretical diversity and creativity. Just as quickly as new theories are spawned, new attempts are enjoined to unify, combine or integrate them. The proliferation of theories and approaches is often confusing for people learning about counselling, whether clients or students. The aim of this chapter is to make sense of theoretical diversity, and the role of theory in counselling. The topic is tackled by first establishing just what is meant by theory, then looking at the uses of theorizing in counselling (Why do we need theory? How is theory used in practice?). The discussion moves on to consider the factors that have contributed to the apparent diversity among counselling theories, and then shifts to an analysis of the underlying similarities between all counseling approaches. Theories of counselling and psychotherapy do not represent immutable truths, but are perhaps better regarded as providing tools for understanding. It is essential for each counsellor to develop his or her own personal approach,

consistent with his or her own life experience, cultural values and work setting. There are some key ideas that run through this chapter, and inform the book as a whole, in relation to the role of theory and the difference between competing schools or approaches within the field of counselling and psychotherapy: from the point of view of the client, the experience of counselling is much the same, no matter which theoretical orientation is being used by the counsellor; there is little evidence that any one theory of counselling is more valid, effective or true than any other; being able to offer a secure, confidential relationship, hopefulness and some kind of structure for exploring and resolving problems in living, and becoming more connected with other people, is more important than theory; it is essential for effective counselling that the practitioner has a coherent framework for understanding what he or she is trying to achieve; in multicultural, pluralist democratic societies, it is inevitable that competing value systems and cultural traditions will generate different ideas about human personality and the proper aims of counselling some degree of theoretical diversity and debate is healthy and necessary; the current fragmentation and proliferation of counselling and psychotherapy theories is a result of (a) the current state of development of the profession, and (b) social and economic factors; the prevailing movement within counselling is in the direction of increased theoretical convergence and consensus. It is essential, also, to appreciate that theories of counselling and psychotherapy reflect the ideas and concerns that are most pressing for individuals at any particular point in history. Theories of counselling and psychotherapy are continually undergoing reconstruction to reflect prevailing social issues and developments Theory as a structured set of ideas The obvious way of looking at a theory is to think about it as a set of ideas or concepts that are used to make sense of some dimension of reality: for example, Einsteins theory of relativity is a set of ideas that explain the relationship between time and space. A theory is different from everyday, common-sense ideas in that it is stated formally, with clearly defined terms, has been tested or critically evaluated in some way and is consistent with other scientific ideas. In relation to theories of counselling, it is essential to acknowledge that the set of ideas that makes up a theory is not only all of these things (useful, clearly defined, critically tested etc.), but is also structured. In other words, a counseling theory operates at different levels of abstraction, and the implications for a counsellor of using any particular theory depend a great deal on which level of abstraction he or she is employing. Three levels to any theoretical model used in counselling and therapy. First, there are statements about observational data. Second, there are theoretical propositions, which make connections between different observations. Third, there are statements of philosophical assumptions, or metapsychology. Rapaport and Gill (1959) looked at the theoretical structure of psychoanalysis, and came to the conclusion that statements about, for example, defence mechanisms such as projection or denial were fundamentally simple observations of behavioural events. Psychoanalytic concepts such as anal personality, on the other hand, went beyond mere observation, and made inferences about the connectedness of events separated by time and space. For example, the idea of anal personality implies a link between childhood events (potty training) and adult behaviour (obsessionality), and this association is inferred rather than directly observed. It can be seen, therefore, that learning and using a theory of counseling involves different kinds of tasks and challenges. On the one hand, to become familiar with a theory it is necessary to learn how to detect or label observational phenomena such as defences, transference, empathy, irrational beliefs and so on. On the other hand, it is also necessary to become immersed enough in the underlying image of the person or philosophy of a theory to appreciate what is meant by the unconscious, self-actualization or reinforcement. Finally, there is the task of understanding how observational and philosophical concepts are brought together in the form of specific theoretical propositions. All this is made even more difficult because few theories of counselling and psychotherapy are ever formulated in a manner that allows their structure to be clearly identified. For example, writers such as Rogers or Freud conveyed their ideas through case studies, through essays on specific topics and (in Rogers case) in research papers. The structures of therapy theories are often more clearly explained not in therapy and counselling books, but in personality textbooks such as those by Monte (1998) and Pervin and Johns (2000). There are several implications of a social perspective that are significant for understanding how theory is created and used in counselling. First, the oral tradition is always broader than what is written about it. Writers such as Freud and

Rogers were influential because they were able to put into words, better than anyone else at the time, the ways of understanding and working with clients that were being generated in their oral communities. But, even in their cases, there was always more that could be said. Both Freud and Rogers struggled, throughout their careers, to find the best ways to articulate in words what they knew at an implicit level. Some of the apparent theoretical debates and differences in counseling and psychotherapy can therefore be viewed not so much as arguments over the substance of what is happening in therapy, but as disputes around the best language to use in talking about these happenings. Another key implication is that, much of the time, it is more accurate to talk about counselling approaches rather than theories. The idea of an approach is a reminder that there is more to way of doing counselling than merely applying a set of ideas: an approach embraces philosophical assumptions, style, tradition and tacit knowing. The third, and in some way most important, implication of a social perspective is to suggest that in many ways a theory is like a language: psychodynamic theory is the language used by one group of practitioners, cognitivebehavioural theory is a language used by another group and so on. The idea of theory as language is a fertile metaphor. It does not imply that one theory is right and another one is wrong. However, it does admit the possibility that it is easier to talk about some things in certain languages rather than others. Learning a language involves knowing about formal rules, acquiring everyday idioms and practising with other speakers. And it also introduces the issue of translating between different languages, in order to communicate with colleagues in other communities: to be able to translate, practitioners need to know about different theories, rather than remaining monolingual. There is also the question as to whether it might ever be possible, or desirable, to develop a common language for all therapies (a kind of counsellors Esperanto?), as suggested by Ryle (1978, 1987). Finally, by regarding a theory as a language-system, it becomes easier to appreciate how processes of power and oppression can occur in counselling. If, for example, a theory does not contain language for talking about homosexuality in positive terms, then gay and lesbian counsellors and clients are silenced and excluded. If a theory does not include words to describe spiritual experience, then it becomes much harder to talk about that dimension of life in counselling or supervision. In fact, both homosexuality and religion/spirituality were largely suppressed in the language of mid-twentieth-century therapy, and it has been a long and hard struggle to allow these voices to be heard.