Practical Guide Series

A Practical Guide

Alistair Ross

• Publisher: Icon Books
• Year: 2013
• ISBN:
  9781848316287
• Topic: Psychologie
• Subtopic: Psychothérapie

Talk, listen, support and understand better. Develop a hands-on understanding of how counselling works and how it can help people, viewing the subject from both a client's and a trainee counsellor's perspective.Learn how to listen more attentively and be a better communicator, be more empathetic with a heightened perception of others, and improve your relationships with both those around you and yourself.Providing expert insights, real-life case studies and useful skills, this Practical Guide offers an invaluable guide to anyone interested in learning more about counselling.

PART ONE
Counselling in context

1. Why people don’t go for counselling (and that might include you)?

Counselling is a word that often frightens people, and if someone suggests we need counselling we either think: ‘They think I’m mad’ or ‘I don’t need their help.’ Feeling that counselling is for ‘mad’ people or for people who cannot cope, and worrying about the stigma attached to that, is a common reason why people who could benefit from counselling sometimes don’t seek help.

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Listen for a moment to the experience of May, who came to see me a few years ago. She had just split up with her boyfriend, a relationship in which May had invested a great deal of herself. She had never been to counselling before, and was quite uncomfortable about the idea. ‘I’m not that kind of person’, she said with emphasis. ‘What kinds of people go for counselling?’ I gently enquired. ‘You know, people who haven’t got friends, sad people, oh, I don’t know’, May cried. I replied, ‘Sometimes things happen that are too much for even our friends. We don’t want to deal with their pity, shock, or “I told you so”. Sometimes there is the relief of experiencing the comfort of a stranger. That’s what counselling is for.’ May looked up, blinked as if acknowledging that something important had just occurred and then settled back into her seat. She came back for eight more sessions of counselling which enabled her to acknowledge the pain of loss and to begin to see herself differently.

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Clearly it had not been an easy decision for May to come for counselling. So why is it that many people find it difficult to see a counsellor? What stops us from going for counselling? What are the obstacles? Why can’t we just take a tablet? It would be so much easier if we could complete a psychological quiz that gives us the simple answer: ‘You are this kind of person and this is what you need to do.’ In fact, to a certain extent we can. There are various research-led, evidence-based and reliable questionnaires used to measure key factors in mental health such as depression (Patient Health Questionnaire PHQ9), anxiety (Generalized Anxiety Disorder GAD7) and general psychological well-being and functioning (CORE-OM, a client self-report questionnaire designed to be administered before and after therapy). These tend to be used in some, but not all, formal counselling contexts rather than in the more informal opportunities where we use counselling skills. However, sometimes it can be useful to bring them into the more informal arena.

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A long-standing friend, Tom, came to stay for the weekend because he was feeling depressed and wanted some ‘space’. It soon became clear to me that his depression was pronounced. I would ask him a simple question, ‘What would you like for dinner?’ and it took him fifteen minutes to answer, with no awareness that such a length of time had gone by. As I am not medically trained I suggested he visit his GP. Tom was reluctant to do this; however, I had a PHQ9 depression questionnaire available (as I often use them with my clients), so I asked him to fill this out. This gave a measure of just how depressed he actually was and it helped Tom see this for himself. He took the form with him when he visited his GP and they also found it very helpful, as sometimes when depression hits it can be difficult to communicate fully how you are feeling. The GP offered Tom anti-depressant medication and suggested a brief course of cognitive-based support from a counsellor. Up until this point he had been resistant to my suggestion that counselling could help and had raised all sorts of objections. Tom found the cognitive therapy group very helpful in identifying and confronting the recurrent thinking patterns that triggered some aspects of his depression. The good news is that, despite being signed off work for eight weeks, Tom was able to return to work and function just as well as before. In fact, Tom being off work was helpful as his manager needed to cover Tom’s job and discovered for himself just how difficult it was, and provided more support from that point on.

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Obstacles to counselling

What are the kinds of objections people raise that prevent them from going for counselling?

Obstacle 1: ‘Counselling is a sign of weakness.’

This is a contemporary version of the outmoded British ‘stiff upper lip’ tradition that suppresses the visible display of any emotion, which is seen as a sign of weakness. In a recent television drama a central character plays the role of a counsellor but is also a volunteer with the Samaritans (an invaluable UK telephone helpline available 24/7). His partner says, ‘I can’t imagine what it’s like, spending all day listening to people moaning at you and you still volunteer to do more. You are a good man.’ The implication is that people going for counselling are just moaning. Yet even if we maintain our stiff upper lips, our emotions are still there, felt and experienced, even if not displayed, and remain ‘locked up’ like a prisoner waiting for a release date. In fact, far from it being ‘weak’ to release these emotions, it takes real strength and courage to look at problem areas and examine painful feelings. Starting counselling is often the first step in identifying difficulties and resolving problems.

Obstacle 2: ‘What’s wrong with talking to my friends? What does a counsellor do that they can’t?’

Friends are great, especially in times of trouble. They rally round, offer support and advice even if we don’t want it, and make sure we know that they care. But friends are not so great when we are just stuck or our issues don’t resolve in ways others expect. Yet precisely because someone is a friend we offer them as much as they offer us. Friendship at its best is a mutual exchange of listening, sharing and caring, where we take responsibility for our friend as well as ourselves. As May discovered, counselling offers a very different kind of relationship. In counselling you are the sole focus of the work where the counsellor uses their therapeutic skills to listen to you in your confusion and ‘stuckness’. You don’t need to take any responsibility for the counsellor and can therefore view your issues with more clarity.

Obstacle 3: ‘I don’t want to rely on anyone.’

We can become so focused on the need to be self-sufficient. We think, ‘I must do this’ or ‘I must do that’ in order to prove how strong, tough, independent or resilient we have become, and we almost begin to develop a false sense of self. On the outside we appear strong (the false self) while we are really feeling weak and vulnerable but cannot let others see this (the real self). Often this response comes from a painful experience early in life of being let down, and this is exactly an area where counselling can really help.

Obstacle 4: ‘I’ll be letting my family down.’

Families are always complicated, and we can often feel a sense of split loyalties. Many families or relationships operate with some form of unspoken taboo that you mustn’t speak about either the family or your relationships within the family to anyone else. This ‘family loyalty’ is especially strong in many ethnic and some religious communities, where it extends beyond the immediate family itself. But within wider society there are problematic issues that need addressing, the discussion of which is hindered by this taboo. Sexual abuse is still a very difficult subject to acknowledge and work with, but there are many other forms abuse can take. For example, domestic abuse or intimate partner violence is far more prevalent than is commonly recognized. Yet even when people are at breaking point, physically and emotionally, their fear of telling another person and ‘betraying’ a loved one is overwhelming. People who need counselling often don’t go for it because of feelings of shame, believing they are betraying someone, in a form of mistaken loyalty. There is also a fear that if they talk about their past there will be consequences involving social workers or the Police, especially if there are children involved.

Obstacle 5: ‘I don’t want to ask for help.’

Most of us find this difficult to do. I once leapt over a pedestrian barrier, caught my foot on the top and fell directly onto my wrist, which cracked. Lying on the pavement struggling to get up I heard someone ask, ‘Are you all right mate?’ I replied, blinking back the tears, ‘I’m fine.’ A subsequent visit to casualty saw my arm encased in plaster from my shoulder to my fingertips, so clearly I was anything but fine, but due to pride and shame I wasn’t able to accept help when it was both needed and offered. Psychologically people often do the same, often because it means acknowledging that there really is a problem. Underlying this fear of asking for help is another concern: that if they do acknowledge a problem, their life really will fall apart. Yet usually the opposite happens. The relief at being able to talk to another person helps reduce anxiety. Asking for help is a healthy sign of maturity and growing self-awareness. We can often begin to understand our problems better, and counselling offers a safe context to explore painful feelings and make difficult choices.

Obstacle 6: ‘I don’t want anyone to know.’

There are events, actions and memories in each of our lives that we don’t want anyone else to know, whether because of guilt, embarrassment or shame. One common fear about counselling is, ‘Who else will find out what I have said?’ Counsellors use the word ‘confidentiality’ to explain that all information they receive about you will be treated with respect and not talked about with anyone outside of the counselling session, with the exception of their clinical supervisor (a clinical supervisor is someone who helps counsellors work to their best professional, therapeutic and psychological standards). There are legal exceptions to absolute confidentiality and these are dealt with in detail in a later chapter, but in almost all cases a counsellor will not pass around information about you, and will go to great lengths to preserve anonymity and confidentiality for their clients.

Obstacle 7: ‘I don’t know what to talk about, and anyway talking doesn’t really help.’

Often people know something somewhere is wrong but can’t quite put it into words. One client, Jon, said to me, ‘I don’t know why I am here.’ I replied, ‘There’s no hurry. Tell me a bit about you, as the difficult bit is getting started.’ As Jon told me about himself he relaxed and was able to say by the end of the session that he was experiencing some very distressing nightmares that had seriously unsettled him. His fear, as we discovered later, was that he thought he would be laughed at or ridiculed. So talking to another person often does a great deal of good. Discussing issues with somebody who is attentive and not judgemental helps relieve the emotional pressure caused by keeping thoughts and feelings to ourselves. Yet counselling is so much more than just talking. Counselling enables us to understand who we really are and how we relate to those around us. Counselling often gives new insights that we were not previously aware of.

Obstacle 8: ‘I can’t afford counselling.’

In the UK at least, psychological support, counselling and psychotherapy (individual or group) is available free of charge through the National Health Service (NHS). This normally requires a referral from your doctor to a psychological service where you will be assessed (sometimes over the telephone) and offered different levels of help. This can include accessing a computer program or reading material, contact by email or telephone, face-to-face counselling and therapy, or support groups. It is important that we are really honest in these assessments, as we often downplay the distress we’re experiencing, and as a consequence do not receive as much help as we really need. The counselling offered may be for a single session, a limited number of sessions over a few weeks or spread over months, or as a longer series of sessions lasting for several months or even years. In most other parts of the world counselling is available through voluntary groups or organisations, as well as low-cost clinics often staffed by trainees. However, counselling provision is primarily through health-care insurance. The number of sessions provided will depend on the diagnosis given and what is deemed to be appropriate. This is also affected by the level of insurance cover, as not all psychological issues are covered by all insurance policies.

Obstacle 9: ‘Why burden someone else with my problems?’

We never want to feel we are a burden to someone else. We want to be wanted for who we are and seen as a person, not a problem. Sometimes we have inadvertently been given that message as we were growing up by an overworked and exhausted parent whose patience had just run out. A colleague, Sophie Campbell, expressed it particularly well when she said, ‘I feel that talking my problems over with someone I don’t know might lead me to hold back a lot of stuff because I wouldn’t want them to be “troubled” with me or by me.’

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Make a list of the reasons why you would object to counselling if someone suggested that you needed it. For example, Clive, an ex-soldier, came to counselling and in the first session said, ‘I don’t really believe in this stuff but my friends told me I need to sort myself out.’ Clive’s friends were being very honest with him, although at this point ...

Table of contents

• Title page
• Copyright information
• About the author
• Contents
• Introduction
• PART ONE: 
Counselling in context
• 1. Why people don’t go for counselling (and that might include you)?
• 2. Counselling – what is it?
• 3. What’s in a name?
• 4. Where did counselling come from?
• 5. Counselling – what does it do?
• 6. Values, ethics and boundaries in counselling
• PART TWO: 
Counselling skills in practice
• 7. Starting with the self
• 8. Attentive listening
• 9. Establishing a relationship
• 10. Feeling safe and confidentiality
• 11. Using questions, exploring, clarifying, summarizing and paraphrasing
• 12. Affirmation, empathy, respect and non-judgement
• 13. Finding focus and identifying steps forward
• 14. Exploring silence, the unconscious, and creating a sense of presence
• Acknowledgements
• Further Reading
• Index