The Management of Counselling and Psychotherapy Agencies

Colin Lago, Duncan Kitchin

• Publisher: SAGE Publications Ltd
• Year: 1998
• ISBN:
  9781446238158
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

The authors of this book provide clear guidelines on the many aspects of knowledge, skill and management expertise increasingly required by all counselling services. Due consideration and detailed advice is given on a broad range of essential issues, from setting up a counselling service to customer relations and quality control.

Topics examined include: implications of funding; budgeting; staffing; location and furnishing of premises; daily working routines; how to ensure a competent, professional, safe and ethical working practice; and the sheer complexities of being a manager of therapists.

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Laying the Foundations: Creating a Counselling Service

A considerable number of Counselling Services have become established in the United Kingdom during the last fifteen years. Inevitably, the establishment of these services has reflected an enormous amount of hard work and planning by the various persons and committees involved. Clearly, the nature and philosophy of these emerging projects will reflect both their individual aims and unique structures as well as their more global drive to provide counselling type resources.

(Lago, 1981)

Almost two decades have now elapsed since the article from which the above quote is taken, was written. In this intervening period considerable expansion has taken place within the world of counselling and this is reflected in a much wider range of services now available. Nevertheless, many would argue that the levels and distribution of counselling provision are still inadequate, patchy, under-resourced, over-reliant on voluntary contribution and effort and under-researched. This general inadequacy of counselling facilities exists in the face of an increasing rise in need, demand and expectations of counselling in society at the present time. Many more counselling services are needed and we hope this book will be helpful to all those involved in such endeavours, as well as to those services already in existence.

Historic Origins

When people ask ‘How did the Counselling Centre begin?’ the answer is not the short, simple one they probably expect. It is actually a glimpse into the social history representing the changing face of the caring professions in the twentieth century. (James et al., 1985)

The above quote is taken from an article describing the establishment and structure of the Nottingham Counselling Centre and was made in the context of its historical origins in the Charity Organization Society established in 1875. A diagram of organizational development (similar to a family tree) is provided below (see Figure 1.1). From this diagram one may see the emergence of a range of different organizations, with different emphases geared towards serving the needs of the community and reflecting the ideas and concerns of those particular times.

Figure 1.1 Diagram of Organizational Development (James et al., 1985)

An overall analysis of the above diagram reveals that the changes of name and directions of the organization have occurred at intervals of between 25 and 40 years. Many of the counselling services referred to in the opening quote of this chapter will now have been in existence for three or more decades and many structural changes will have occurred in the interim. Nevertheless, locating the cornerstones and laying the foundations upon which to build a sound professional structure remains as important today for new organizations as does the ongoing capacity for existing organizations to embody structural changes when required.

Why Counselling? Why Now?

The following slogan was recently featured in an advertisement on behalf of the National Society for the Prevention of Cruelty to Children. ‘What she needs is a good listening to.’

Recently, both the Midland Bank and the Labour Party coined the use of the term ‘listening’ within their slogans and advertising literature. The Labour Party thus became ‘the listening party’ and the Midland ‘the listening bank’. It is suggested here that such advertising terminology was no accident but an attempt to create an ideological perspective based upon trends recognizable as current in society.

Listening, of course, is a central activity in counselling and psychotherapy. So is empathy. As a technical concept that owes much of its origins to the development of the work of Dr Carl Rogers in client-centred therapy, over 20 different definitions have now been developed, including an extensive treatment of it by Rogers himself. Not lagging far behind, marketing personnel have appended the term to a range of beauty products, including that of Empathy shampoo! Similarly, at about the same time, a security company developed the slogan ‘Securicor Cares’. Care of others, in the general sense, is embodied within the concept of counselling. ‘Care’ also is a mnemonic for Rogers’ core therapeutic conditions of counselling.

C.A. – communicated authenticity (congruence, genuineness)
R. – regard (acceptance, warmth)
E. – empathy

However interesting, ironic and humorous the above examples may be, they do give an indication of the impact of ideas, derived from counselling and psychotherapy, upon society during the last decades. This is also revealed by a research survey conducted on behalf of the Royal College of Psychiatrists in 1991 that showed that 85 per cent of the 2000 respondents believed that depression was caused by life events and that counselling, not medication, was the most appropriate form of assistance. A decade or two previously, medication was the preferred model.

Helena Kennedy, QC, has recently established a very strong case for increased counselling and psychotherapeutic care of young people who get into trouble (Katz, 1995). Many children who go on to become persistent offenders can apparently be identified at eight to ten years old. The economics of incarceration, of keeping a child in a young offender institution are considerable, indeed more than at the most expensive public schools. Under 16s presently represent 20 per cent of the population and yet expenditure on child and adolescent mental health represents only 5 per cent of the total spent on mental health services.

Both of the above examples are indicative of the belief systems in contemporary society at the present time that see the appropriateness of counselling intervention, despite resistant and persistent policies of non-investment. For example, child psychotherapy is the only NHS-recognized profession for which trainees must fund their own training!

Counselling approaches are generally seen as valid, relevant and effective in this culture at this time (McLeod, 1993). Indeed, Wood (1990) has elaborated further on this theme of ‘fit’ between therapy and culture, recognizing the importance of cultural acceptability of the healing form. Describing counselling as a ‘subtle but powerful ritual’ he recognizes that the ritual may be on the cutting edge of cultural change. The relationship, therefore, between a culture and its healing rituals is an interesting and complex one.

McLeod (1993: 8–16) in his book An Introduction to Counselling traces the historic and cultural origins of counselling. Citing a range of sources, he asserts that the origins of counselling and psychotherapy as we know them today can be traced back to the beginning of the eighteenth century, which represents a turning point in the social construction of ‘madness’. A shift occurred at this time, from dealing with problems encountered in living through religious perspectives implemented at community level towards the ‘medicalization’ and individualization of human difficulties.

This historic period incorporates the major changes involved in society moving from a predominantly rural/agricultural base to an industrial one. Through the industrial revolution, capitalism began to dominate economic and political life and the values of science began to replace those of religion. In addition, Albee (1977) has argued that this emerging capitalism required the development of a high level of rationality accompanied by repression and control of pleasure seeking. This required the development of a work ethic, an increase in personal autonomy and independence. The accompanying psychological shift that occurred was from a ‘tradition-centred’ society to one in which inner direction was emphasized. A basis for this shift to secular individualism had already been laid by the philosopher, Descartes, in the seventeenth century (Flew, 1972). Through recognizing the movement from small rural communities where everyone knew everyone else and behaviour was monitored and controlled by others, to urban industrial societies where life was much more anonymous and internally focused, one may understand some of the underlying historical conditions that have led to contemporary forms of interpersonal help, which focus on the individual, inner life of the person.

Prior to the eighteenth century, people who suffered mental ill health would have been nursed by their extended families and local communities. The advent of larger urban areas, factory conditions, fragmentation of communities and greater anonymity between people eventually led to the establishment of workhouses and asylums – society-based responses. People who were deemed mad or insane were certainly not productive and in many cases were disruptive. It is not appropriate here to provide a wealth of detail of this period, interesting though it is, but it is crucial to understand that through this historical period the medical profession came to assume control over asylums (Scull, 1975). The defeat of moral treatment can be seen as a key moment in the history of psychotherapy: science replaced religion as a dominant ideology underlying the treatment of the insane (McLeod, 1993).

New medical-biological explanations for insanity were formulated and many different types of physical treatment were experimented with (Scull, 1979). By the end of the nineteenth century psychiatry had achieved a dominant position in the care of the insane. According to Ellenberger (1970) the earliest physicians to call themselves psychotherapists were Van Renterghem and Van Eeden who opened a clinic of suggestive psychotherapy in Amsterdam in 1887. Thus, the first clinic for suggestive psychotherapy was established one century ago. Many more ‘clinics’ have only recently formed and we trust that some of the cumulative learnings gained during this historical process will inform this book.

A Rationale for Creating a New Counselling Service

Meeting the Need

In the beginning it is helpful to establish whether there is a real need . . . (BAC Information Sheet 12)

A preliminary survey carried out by Lago (1981) on the establishment of counselling projects provided a range of data on the background and origin of some counselling organizations. In response to one question on the survey, asking ‘What needs did you seek to meet?’, a very wide range of responses were received. Approximately one-third of the respondents cited quite wide definitions, eg. ‘to help young people in distress’, ‘to help people facing problems of life, faith and relationships’, ‘to meet the needs of the lonely and depressed’, ‘to provide a friendly ear to troubled persons’. In this survey 33 replies were received and a third of these provided very clear responses in relation to the specific client group of young people. Items such as homelessness, drugs, unemployment, pregnancy and psycho-sexual counselling were listed.

Other reasons given seemed to focus on filling gaps of provision in the existing range of local authority services and voluntary organizations. One such example that we encountered whilst collecting data for this book was that of a women’s counselling centre that had come into being mainly out of the recognition of a specific set of needs not being met by any other local organization.

At least two of the organizations we consulted indicated that the motivating forces behind their establishment were to do with a juxtaposition of two elements: (i) a hunch/hypothesis that such a need existed and (ii) the enthusiasm, commitment and readiness of the original founders to create such an organization. This dedication, vision and enthusiasm of founding figures (described in 1995 as heroes and heroines by John McLeod in a private telephone conversation on the subject of this book) seems to form an additional aspect required to complete the full equation, ie. perceived need of a client group + the human therapeutic capacity to respond (heroes & heroines) = foundation stones of counselling service. We will return to this aspect a little later in the chapter.

Evidence of Need

Evidence of need quoted in the early survey by Lago spanned the complete spectrum from personal hunch and intuition through to statements citing fieldwork evidence, surveys and research (Lago, 1981: 21). Fieldwork evidence formed the basis of two-thirds of the survey responses. Within this category, the impression created was that of a wide range of working experiences being gained by different people occupying various roles within a community who had begun to ask the questions ‘what is happening here?’, ‘where could these people be referred?’, ‘how come there is no organization to respond to such important needs?’, and so on.

Only three projects were based on existing research and survey results. Three further projects opted to initiate an experimental trial run of the counselling service in order to test the extent of local needs.

A recent example of this last category was that of a GP surgery which had initially contracted in a counsellor to facilitate a staff group comprising nurses and doctors. This introductory phase enabled the staff at the surgery to become more fluent with and understanding of the work of counsellors. This first experience, which was a positive one, developed into offering part-time employment to the counsellor within the surgery. Starting at 5 hours per week, and paid for through ancillary staffing budgets, this commitment eventually grew to almost full-time with a constant waiting list of patients needing to be seen.

Predating most of the above projects, the National Marriage Guidance Council came into being in the late 1930s and early 1940s. During the previous two decades there had been extensive public debate over the nature of marriage. Lewis et al. (1992) describe this era as one in which marriage began to change from being a public social institution to becoming more of a private interpersonal relationship. One of the visible signs of these fundamental social changes was the increased frequency of divorce. McLeod (1994b) records that in response to these social and cultural forces, it was argued that something needed to be done to support marriage.

One important aspect of evidence of need is demonstrated with this example above. That is, there had begun to exist a state of ‘social awareness’ in relation to changes that were happening to the institution of marriage. Further evidence of ongoing need was provided by the London office (of Marriage Guidance), who were receiving, by the autumn of 1945, 4000 letters per month seeking help (Wallis and Booker, 1958). This particular example of one of the most well-known counselling organizations in Britain, is a powerful model demonstrating fit between societal trends and the responses of individuals and organizations committed to meeting specific needs.

Most recent examples of this ‘society–organization fit’ include the considerable spread of counselling availability within General Practice surgeries and the increase in employee assistance programmes available to the employees of large companies.

‘Visionaries, Heroes and Heroines’

In a telephone conversation with one of the authors, John McLeod acknowledged that having spent some considerable time researching his article on ‘issues in the organization of counselling’ he had come to be interested in the conceptual work of the organizational th...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Foreword
• Acknowledgements
• 1 Laying the Foundations: Creating a Counselling Service
• 2 Building a Sound Structure: Management Issues
• 3 Staff Recruitment and Selection
• 4 Ensuring Competent, Professional and Safe Practice
• 5 Daily Working Practices
• 6 Managing Crisis
• 7 Managing Managing!
• Appendix: A University Counselling Service - Complaints Procedure
• Bibliography
• Index