Counselling psychology

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What is counselling

the term ‘counselling’ is used in different ways - usually referring to giving advice

• e.g. debt counselling, religious counselling, marriage counselling, etc

What is the difference between therapeutic counselling and counselling

“work with individuals & with their relationships which may be crisis support, psychotherapeutic guiding or problem solving”

How do counsellors and psychotherapists help us

• Play a crucial role in improving the health and wellbeing of our society

• They help people to talk about their feelings

• Think about their choices or their behaviour

• Help to bring about positive changes

• The counselling professions include a range of different titles and specialisms

Difference between counselling and psychotherapy

• A psychotherapist working in a hospital is likely to be more concerned with severe psychological disorders than a colleague working in private practice

• Counsellors working in voluntary agencies deal mainly with everyday problems but may be qualified to offer psychotherapy in any other context

What happens in counselling

• Short term process

• Support the patient to perform day to day activities in a normal and efficient manner

• Address issues in a less in-depth manner

• Deal with patients who are fit enough to think rationally and find solutions to their problems by themselves

What happens in psychotherapy

• Long term process

• Uncover the foundation of the problem and address it in the most efficient manner

• Address issues in a very deep manner

• Involve individuals who are dependent on the psychotherapist to gain control over their personality, mind, emotions and behaviour

What are the seven effective outcomes of counselling

1. Focus on affect and expression of emotions and feelings, rather than on cognitive factors

2. Exploration of attempts to avoid distressing thoughts and feelings

3. Identification of patterns and recurring themes in emotions

4. Discussion of past experience with a developmental focus

5. A focus on interpersonal relations

6. A focus on therapeutic relationship

7. Safe exploration of fantasy life (day dreaming)

What are the four happiness interventions

1. Gratitude visit – provides a meaningful opportunity for client to express their appreciation to someone who has made a positive differences in their life, fostering connection and gratitude between client and contact

2. Three good things – acknowledge and appreciate 3 good things, no matter how small

3. Your peak self – imagine a time when you were at your best.

   • Reflect on the personal strengths that were in use at that time

4. Character strengths – identify strengths and commit to utilising them in a new way each day for one week

What are the benefits of counselling across modalities

• Increased skills in interpersonal communication

• Improved interpersonal relationships

• Decreased depressive symptoms

• Decreased anxiety symptoms

• Reduction in pharmaceutical interventions

• Improved quality of life

• Clarity of behavioural contribution to well being

• Reduction of suicidal ideation

• Improvement in emotional self-regulation

• Reduction in substance misuse

What is counselling psychology? !!!

it is the application of psychological theory & research to therapeutic practice

• aims to improve well-being, reduce psychological distress & resolve crises

• it is relatively recent category of recognised applied psychologists

What was counselling psychology known as before in 1982 and 1994? !!!

• 1982 - a ‘special group’ within the BPS

• 1994 - a division of counselling psychology within the BPS - putting it on an equal footing with other professional areas

What is the difference between a counselling psychologist and a (psycho)therapist

• Counselling psychologist has Health and Care professions council (HCPC/BPS) approved training and qualifications

• Psychotherapist can be highly trained and have specialisms but not necessarily with a psychology background

  • Some ‘therapists’ have little training – it isn’t a protected title, make sure to check their background and if they have a HCPC

What is the difference between counselling psychology and clinical psychology

• Clinical psychology looks at mental health disturbances

• Whereas counselling psychology is about providing advice and guidance

• However, these lines have blurred tremendously over time, which is why it is becoming increasingly difficult to pinpoint the differences between the two fields

In clinical psychology diagnosis is not always accurate as it is often based on

subjective assessments

• which can be influenced

• so a diagnosis may not always capture the complexity of a person’s experiences or accurately reflect their symptoms or underlying causes

In clinical psychology diagnosis does not always lead to

effective treatment

• research has shown that many factors can contribute to a person’s mental health issues and these need to be addressed holistically

In clinical psychology, moving away from diagnosis can:

1. allow clinicians to focus more on the person’s strengths and resilience, rather than solely on their deficits and challenges

   • this approach can help people build their capacity to manage their mental health and improve

2. diagnosis can lead to people being defined by their condition rather than as whole individuals

What is the phenomenological model? !!!

a focus on a person’s subjective internal experience and how they understand their behaviour

What are the three principles of practice? !!!

• insight:

  • promote client’s insight into the origin & maintenance of their problem

• self-awareness:

  • promote client’s self- awareness of their thoughts and emotions

• self-acceptance:

  • help client to become more accepting of themselves and develop a more positive view of the self

What are the four key frameworks that inform practice? !!!

• humanistic perspective

• psychodynamic perspective

• systemic perspective

• cognitive-behavioural perspective

Self-actualising in the client requires… - humanistic perspective? !!!

• Self-actualising in the client requires:

  • Unconditional positive regard – acceptance and love regardless of behaviour

  • Geniuses – individual is able to express their own sense of self

  • Empathy – individuals interact with people who understand the world from that individual’s perspective

What therapy is used and what skills is required of the counsellor in the humanistic perspective? !!!

• Person-centred therapy

• Three key skills of the counsellor:

  • Empathy towards client, i.e. enters their frame of reference and communicates this to client

  • Unconditional positive regard – therapist accepts client and shows warmth (regardless of behaviour/attitudes)

  • Congruence of therapist’s feelings & behaviour toward client – allows trust to be built

What are the main general counselling skills in the humanistic perspective? !!!

• Listening & observing: verbal & non-verbal behaviour (Egan, 1986)

  • Linguistic: words, phrases, metaphors

  • Paralinguistic: timing, volume, pitch, accent, pauses, fluency

  • Non-verbal: facial expression, gestures, touch, body position & movements, proximity, eye contact

  • Use non-verbal communication to communicate empathy, unconditional positive regard (gestures, posture, etc.)

  • Paraphrasing – repeating back to client a summary of what they have said; demonstrates active listening and ensures understanding

  • Reflection of content and feeling of client – build trust; also helps enter client’s frame of reference

What is the psychodynamic perspective based on? !!!

based on Freud’s theories than an important part of our mental functioning is unconscious

What does the psychodynamic perspective explore? !!!

explores association between early experiences and how they might be related to current distress

What are the aims of the psychodynamic perspective? !!!

aims to bring unconscious thoughts/feelings/memories into conscious so links can be made

What are the three rules of therapeutic relationships? !!!

1. Rule of abstinence: holding back from responding

2. Rule of anonymity: reveal nothing of self to client to allow ‘transference’ & ‘counter-transference’

3. Rule of neutrality: neutral stance so client learns to understand self, rather than told by therapist

What is transference? !!!

client treats the therapist as if they were someone else in their life

What is counter-transference? !!!

as a result of transference, the therapist responds to the client as if they were the other person; this can provide insight into the relationship between client and this ‘other person

The systemic perspective believes problem behaviour may (serve, reflect, result)… ? !!!

• Problem behaviour may:

  • Serve a function within family

  • Reflect a family’s inability to function properly

  • Result from inter-generational transmission of dysfunction behaviour (nature/nurture)

What are the 3 different schools of family systems therapy? !!!

• multigenerational family therapy (Bowen, 1966, 1976)

  • Considers at least three generations, inter-generational transmission of relationships/behaviours

  • E.g. ‘ use’ two family members to stabilise a relationship

• structural family therapy (Minuchin, 1974)

  • Understands the structure/organisation of a family through the interactions of family members

  • E.g. an individual’s problems used as a diversion from wider family problems

• strategic family therapy (Haley, 1973)

  • Focus on solving current family problems, rather than considering/resolving issues from the past

  • Will often involve development of problem-solving and coping skills

What does the cognitive-behavioural perspective focus on? !!!

focus on link between how people think (cognitions, assumptions, beliefs) and their behaviour

What are the aims of the cognitive-behavioural perspective? !!!

• aims to help client understand their thinking & how it impacts on emotions and behaviour

• aims to help them change their thinking in order to change their behaviour

How long does CBT last? !!!

• Typically 8-12 sessions, lasting 3-6 months

What is the structure of CBT? !!!

• Structured intervention, rather than free talking

• Setting goals to work towards

What is the process of CBT? !!!

• Identify negative thoughts

• Explore alternative ways of thinking

• Use of homework

What are the techniques in CBT? !!!

• Keeping a diary of events & associated thoughts

• Understanding source of cognitions associated with a distressing behaviour

Do the interventions work? !!!

• The problem with having a number of approaches and no dominant perspective is that it can be hard to know what intervention works best

• Choice of approach best driven by the approach the client feels most comfortable with

• Good fit of approach & client likely to lead to better outcomes