23 Mar 2015
Counselling is an interactive learning process contracted between the counsellor and the client. The overall aim is to provide the client with the opportunity to work in self defined ways, towards living in more satisfying and resourceful ways as individuals and as members of the broader society [Hough 1998].
Clients need to feel safe and secure for them to explore and develop an insight to their issues and concerns. For the clients to explore and resolve their issues with the counsellor a strong therapeutic alliance based on trust, empathy, congruence and unconditional positive regard needs to be established. The counselling environment needs to be comfortable and well suited to a range of client types so that the client can feel safe. Making a therapeutic contract, setting goals and targets, discussing confidentiality issues can help the client feel safe. This essay will discuss the aims & purposes of counselling in some detail, followed by the importance and benefits of a safe counselling environment for the client in his or her exploration. Some limitations of the counsellor will be discussed and finally, referral issues will be considered.
The European Association for counselling [in Hough 1998] defines counselling and its aims and purposes in the following way:
'Counselling is an interactive learning process contracted between the counsellor and the client, be they individuals, families, groups or institutions, which approach in a holistic way, social, cultural economic and / or emotional issues. Counselling may be concerned with addressing and resolving specific problems, making decisions, coping with crisis, improving relationships, developmental issues, promoting and developing personal awareness, working with feelings, thoughts, perceptions and internal or external conflict. The overall aim is to provide clients with the opportunities to work in self defined ways, towards living in more satisfying and resourceful ways as individuals and as members of the broader society'
Further detailed aims and purposes of counselling as defined by McLeod  are:
Insight, relating with others, self awareness, self acceptance, self actualization, enlightenment, problem solving, psychological education, acquisition of social skills, cognitive and systematic change, empowerment, restitution, Generativity and social action.
Insight refers 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. Relating with others means becoming better able to form and maintain meaningful and satisfying relationships with other people: for example, within the family or workplace. Self-awareness allows a person to be 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 is important for 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, a core impetus of the person centred theory allows the client to move in the direction of fulfilling potential or achieving an integration of previously conflicting parts of self Enlightenment is helpful in assisting the client to arrive at a higher state of spiritual awakening. Problem-solving implies finding a solution to a specific problem that the client had not been able to resolve alone. Psychological education will enable the client to acquire ideas and techniques with which to understand and control behaviour. Acquiring social skills is related to learning and mastering social and interpersonal skills such as maintenance of eye contact, turn-taking in conversations, assertiveness or anger control. Cognitive change is also one of the aims of counselling. Cognitive change refers to the modification or replacement of irrational beliefs or maladaptive thought patterns associated with self-destructive behaviour and Behaviour change which is the modification or replacement of maladaptive or self destructive patterns of behaviour [McLeod 2003]. Person centred counselling focuses on the client. In person centred counselling, the counsellor does not direct or in any way manipulate the counselling it is all about empowering the client to find and choose the best way forward
Creating a warm and safe physical environment is an essential stepping-stone to building a strong therapeutic alliance. Paying attention to meeting, greeting and seating are all helpful in helping the client to feel safe. For counselling to be effective, the counsellor needs to work at building a relationship. This is very important especially in the early stages when the client may be feeling vulnerable and insecure, and bearing in mind that it is usual for the client to meet the counsellor on unfamiliar territory for example the counsellor's consulting room. Striving to keep the room neutral, in other words free from personal belongings such as books, ornaments and family photographs, is a positive step that counsellors can take to reduce the equality gap [Sutton & Stewart 2002]. Sutton & Stewart  writes that barriers such as desks should also be avoided, and chairs should be uniform and placed approximately three to four feet apart and slightly at an angle. Being in direct eye contact with the counsellor can leave some clients feeling very uncomfortable or embarrassed. Sutton & Stewart  mentions other details of the room for example, a small clock needs to be positioned where the counsellor can glance at it, and attention should be paid to the lighting, and room temperature. A box of tissues placed where the client can easily reach them is a must, and a vase of fresh flowers or a potted plant can add a touch of warmth and colour to the setting, and reflect something of your personality. With the client's permission, the counsellor may tape the sessions and this should be set up ready to use. However, it should be pointed out that emotional barriers are far more potent that physical ones. Even if all the physical surroundings are perfect, the client still might not feel at ease if the counsellor and client are not in rapport.
Sutton & Stewart  argue that addressing clients by their first name can go a long way towards helping them feel comfortable and accepted. Introducing yourself by your first name can help to break down the barriers of inequality. However, do not assume that because you are feel comfortable being on first name terms that all people are. Ask the client how they want you to address them. The counsellor's opening sentence should be empathic and your posture should demonstrate to the client that you are ready to listen: Some clients who seek counselling have been badly let down, hurt or abused by other people, and trust may therefore be a major issue. Trust is something that has to be earned by the counsellor and it can be hard work. However, developing the skills of active listening; accurate, sensitive responding; reflecting feelings; empathy; genuineness; and demonstrating that you are fully present for the client can help to establish a solid foundation of trust. Indeed, the more the counsellor invests in the relationship, the stronger the trust and bond grows between client and counsellor. Trusting the counsellor will help the client feel safe and will aid him or her in self exploration and insight.
Establishing clear boundaries [the ground rules for counselling] is another important stepping stone to building the therapeutic alliance and helping the client feel safe. Boundaries may include agreement over such things such as the duration of counselling, length of counselling sessions, limits of confidentiality, appropriate touching, number and duration of phone calls, sending and responding to emails, or strategies for managing episodes of self-harm or suicidal thoughts. The terms on which counselling is being offered should be made clear to clients before counselling commences; These may be agreed verbally, or they may be set out in a formal written contract between counsellor and client, and signed by both parties. Subsequent revision of these terms should be agreed in advance of any change. Clear contracting enhances, and shows respect for, the client's autonomy [Sutton & Stewart 2002]. A contract helps to ensure the professional nature of the relationship and may, in addition to the ground rules already mentioned, include:
Venue, fees, frequency of sessions, how counselling will be evaluated, process of referral, if and when necessary, broad details of the counselling relationship, duties and responsibilities of each party, details of the counsellor's supervision, goals of counselling, means by which the goals will be achieved, the provision and completion of 'homework', the setting of boundaries and expectations, the terms of the therapeutic relationship, provision for renegotiation of contract [Sutton & Stewart 2002].
It is important to end sessions on time. This helps the client feel safe. When a session is nearing an end, it can be helpful to say something like:
'We have about 10 minutes left of this session. Perhaps it would be helpful to summarise what we have talked about today.' It can often prove beneficial to let your client summarise what has been discussed during the session. Something like, 'What will you take away with you from today?' helps the client to summarise. Your closing sentences need to be clear, and should indicate that it's time to end the session [Sutton & Stewart 2002].
Just as a safe environment is important for the client to explore and share his or her issues, a strong therapeutic relationship based on trust, empathy and unconditional positive regard is as important. The counsellor must unconditionally accept the clients as whom they are in order for a trusting relationship to establish. Empathy and understanding is shown through careful listening. Egan  explains the importance of empathic listening and says that 'a helper cannot communicate an understanding of a client's world without getting in touch with that world through empathetic listening. Therefore empathy centres on the kind of attending, observing and listening'. Rogers defines empathic listening in the following way:
It means entering the private perceptual world of the other and becoming thoroughly at home in it. It involves being sensitive, moment by moment, to the changing felt meanings which flow in this other person, to the fear or rage or tenderness or confusion or whatever he or she is experiencing. It means temporarily living in the other's life moving about in it delicately without making judgments' [Rogers p142 in Egan 1986 p88].
Counsellors face limitations in their profession as well as during the therapeutic process. Sometimes, the practitioner may feel a strong urge to help the person, by listening to their story and perhaps trying to help them to come to terms with what has happened. This is a very caring response, but there are times when it may not represent the best course of action. If a person has been assaulted in childhood, the resulting sense of lack of trust, and perhaps self-hatred, may permeate many aspects of the person's life. Talking through all of that may take a long time, may involve strong emotions, and requires a great deal of persistence and consistency on the part of the counsellor. Any practitioner faced with such a situation needs to consider whether they are capable, in terms of the time they can give, and their confidence and competence as a counsellor, to accompany their client on such a journey. Starting on such a journey, and then pulling back, clearly has the potential for hurt. At the same time, ignoring what the client has said about their abuse, for fear of 'getting in over my head' also has the potential for hurt or harm [McLeod 2007]. Another set of issues around counsellor competence arises from what might be described as temporary impairment. For example, a counsellor who has recently experienced the loss of a close family member is unlikely to be much help to someone with a bereavement issue. A counsellor who is burnt out, stressed or tired is unlikely to be in a good position to offer ongoing help to someone. Being aware of one's limits as a counsellor is very important in these regards [McLeod 2007]. Counsellor competence, ability and experience are clearly some main limitations. A counsellor will be trained and experienced in psychodynamic or couple counselling but may not be able to help with a client suffering from recurrent depression or any other psychological problem, which is why counsellors need to have a list of contact to refer the clients should they need to.
There are specialist agencies working in the areas of mental health, marital distress, eating disorders, sexual abuse, and many others. If the counsellor cannot help a particular individual, he may refer them on. There may be various reasons for referring on. It may emerge that someone's problem would be better addressed through couple counselling or in group therapy.
It may become very clear that the client wants a particular kind of therapy. The counsellor may think of a colleague whose experience and/or orientation closely matches the needs of the client. The counsellor may feel that a counsellor of the opposite sex, or someone older, or someone who can speak another language may be more appropriate for the client. For example, the client may have clear signs of an obsessive-compulsive disorder, and the counsellor may realize that medication and behaviour therapy may be appropriate for the client than psychodynamic counselling. A woman client may tell the counsellor that she is being beaten by her husband and the counsellor may suggest that she seeks a refuge. Since some people perceive counselling as a kind of befriending; the counsellor may have to refer this kind of person on to a befriending scheme. Some people, on the other hand, may be afraid of doctors and believe that counselling is what they need. The counsellor may have to encourage them gently to see a doctor [perhaps helping them to explore their fears but without trying to substitute for medical attention]. A client may not be able to afford services for very long and the counsellor may not offer a free counselling service [Dryden 2006]. In all of the mentioned circumstances, the client may be referred to an appropriate agency
Being willing and able to refer individuals to other sources of help is an essential competence for any practitioner who is offering counselling. McLeod  mentions some reasons why referral would be important
'the client may be referred if he or she needs more time than the counsellor is able to give or more frequent meetings; is primarily looking for practical information and advice, rather than an opportunity to talk things through; describes problems in living that the counsellor believes are beyond his or her capacity to work with; might gain a lot from making use of a specialist agency where there are practitioners available who have a wealth of knowledge and experience in relation to the type of problem the person has described; is involved in a prior relationship with the counsellor that would be incompatible with the creation of a secure and confidential counselling space' [McLeod 2007].
When the counsellor is aware of his or her own particular strong feelings in the counselling situation, this may indicate feelings that the client has difficulty recognizing or dealing with, or the feelings may belong to the counsellor. The counsellor may need to work through his or her own issues and may need to refer the client on.
Another reason why the client may be referred is because of avoiding dual roles and relationships. Dual relationships occur when counsellors assume two [or more] relationships simultaneously or sequentially with a client. Dual relations can be exploitative and do serious harm both to the client and to the professional. For example, becoming emotionally or sexually involved with a current client is unethical, unprofessional, and illegal. Forming dual roles and relationship is harmful as there is a potential for misusing power, exploiting the client and impairing objectivity. Therefore if the practising counsellor is in another relationship with the client, the counsellor will refer the client to another counsellor [Corey G 2009]
McLeod  also mentions the important aspects of referral. The key steps in the referral process, for a counsellor, are:  knowing what alternative resources are available;  engaging the person in a discussion around the possibility of seeing someone else; and  making the referral and managing the 'passing over' stage.
This essay has attempted to discuss some important issues in counselling and psychotherapy. The aims and purposes of counselling have been discussed including empathetic listening and its importance. The counselling environment must be safe for the client to feel comfortable in exploring and reflecting on his or her personal issues. Not only physical safety is important, psychological and emotional safety is also very important. For example, the counsellor must strive to develop a therapeutic relationship with the client based on trust, empathy, warmth and support conveying the core conditions. Limitations to the counsellor or indeed to its process is related to counsellor competence, how much is the counsellor is experienced, emotionally and educationally, to help and assist the client is a major issue. If circumstances occur when the counsellor is not competent, or the type of psychotherapy the counsellor is offering is not suited for the client the counsellor needs to refer the client to an appropriate agency.
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