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COUNSELLING
Counselling is a form of psychological or talking therapy that offers people a chance to change how they feel and to make better life choices. Counselling is a specialist service, which provides the opportunity for individuals, families or groups to explore issues of concern in a safe and confidential environment, with the purpose of facilitating personal growth and enhancing quality of life. A counsellor should respect the client’s viewpoint, while helping to deal with specific problems, cope with crises, improve relationships or develop better ways of living.
Counsellors do not usually offer advice. Instead they help the client to gain insight into feelings and behaviour and to change the behaviour if necessary. They do this by listening and commenting on what the client says from the counsellor’s particular professional perspective.
Counselling falls into two types:
· Non-directive: i.e. client led, where the client takes the lead in what’s discussed;
· Directive: i.e. suggesting courses of action and perhaps giving ’homework’ exercises.
There are several counselling approaches and each model has its own theory of human development and its own way of working.
Examples of non-directive counselling include:
· Psychodynamic counselling is based on the theory that past experiences have an influence on experiences and feelings in the present and that important relationships may be repeated with other people in later life. This form of counselling is informed by psychoanalysis and psychoanalytic psychotherapy.
· Client-centred or humanistic counselling is based on the principle that the counsellor provides empathy, unconditional positive regard and congruence. This form of counselling is based on the theories of Carl Rogers.
Examples of directive counselling include:
· Cognitive-behavioural counselling is based on the way a person’s beliefs about her/himself shapes how s/he interprets experience. The objective is to change self-defeating, or irrational beliefs and behaviours by altering negative ways of thinking. The counsellor helps the client to examine attitudes, beliefs and the consequences of these attitude and beliefs. The counsellor usually gives the client tasks or homework to do between sessions. This form of counselling is usually task-orientated and short term.
· Gestalt counselling focuses on the patterns of thought, feeling and activity. A key part of gestalt counselling is the acting out of important conflicts in a person’s life; this allows the client to take up different positions to represent different aspects of themselves.
PSYCHOTHERAPY
Psychotherapy is essentially a conversation, which involves listening to, and talking with the client, with the aim of helping them understand and resolve their predicament. The client is expected to take an active working part in the process. As with different types of counselling there are different types of psychotherapy. The following are examples of some of the best-known psychotherapies.
Psychoanalysis and psychoanalytic psychotherapy privileges the unconscious processes of the mind. It is through language that the unconscious finds expression. Thus the therapist asks the client to say what immediately comes to mind or ’free-associate’, this allows the therapist to pick up hidden patterns and meaning in what the client is saying. The psychoanalytic psychotherapist is interested in the way the client relates to him/her and how this links with other important relationships in the client’s life. This is known as the ’transference’ and is an important tool in the analytic relationship.
Person-centred or client-centred psychotherapy and humanistic psychotherapy is where the therapist encourages the client to talk freely about difficulties. S/he will be warm, responsive and non-judgmental. S/he is trained to help the client make sense of issues in their life and enable the client to move on.
Cognitive Behaviour Therapy (CBT) works by changing the client’s attitudes and behaviour. CBT focuses on thoughts, images, beliefs and attitudes that the client holds (cognitive processes) and how these relate to the way the client behaves as a way of dealing with emotional distress. An important advantage of CBT is that it tends to be short and during this time the therapist and client work in a collaborative way to understand the client’s problems, testing attitudes and beliefs and changing behaviour. CBT is a short-term talking treatment, which combines psychotherapy and behavioural therapy.
Can counselling/psychotherapy help if someone has a diagnosis of a serious mental illness?
Everyone in distress needs to be listened to respectfully. Shine reports from service-users indicate that being offered empathetic listening is not a common experience for people with and affected by serious mental illness. Access to counselling and psychotherapy may play an important role in recovery.
An important research paper1 on the benefits of individual psychotherapy for people with schizophrenia was written up by Gottdiener and Haslam after conducting a meta-analytic review of all research in this area to determine the efficacy of individual psychotherapy for people diagnosed with schizophrenia. Gottdiener and Haslam write “schizophrenia remains a significant public mental health problem, and any treatment that could help people who suffer from it ought to be known and available”. The aim of the review was to resolve the debate surrounding the efficacy of individual psychotherapy for people diagnosed with schizophrenia. The results showed that individual psychotherapy was associated with improvement in overall functioning. The three types of psychotherapy included in the research are; psychodynamic psychotherapy, cognitive-behavioural therapy and non-psychodynamic supportive therapy.
As illustrated above, psychotherapy can be beneficial for someone with a diagnosis of serious mental illness.
What is the difference between psychotherapy and counselling?
The distinction between counselling and psychotherapy is not clear-cut. However some of the differences are that counselling and psychotherapy differ in the length of time they may take and in their intensity. There is also a difference in the training requirements of each profession. Psychotherapists have usually undertaken a longer or more intensive training, allowing them to work in a more intensive way and with more deep-seated issues.
Counselling may be more useful for people who have a particular problem they want to deal with or who need support in a stressful time in their lives. Having said that, there are counsellors who work over a lengthy period with clients and there are psychotherapists who use brief-therapy in their work with clients.
How to find a counsellor or psychotherapist
It may be possible to access a counsellor or psychotherapist through the local GP, the Psychiatric clinic or hospital (if one is attending one) or through a voluntary organisation.
While there are some counselling services available through the health services, most counsellors and psychotherapists work privately. The GP may refer a patient to a therapist; one may get a recommendation via a health worker or through one of the organisations listed below.
All counsellors and psychotherapists are subject to accreditation procedures, a code of ethics by their governing association and a complaints procedure. It is useful for potential clients to check out qualifications, training and any other information that will enable them to make a decision about entering into a therapeutic relationship.
It is also important to point out that counsellors and psychotherapists specialise in different areas of mental health e.g. addiction, phobias etc. Because of this it is vital for a person with a diagnosis of schizophrenia to engage with a counsellor or psychotherapist who has knowledge and experience in working with serious mental health issues.
At the moment counsellors and psychotherapists are not subject to state regulation, however the Department of Health and Children is addressing this issue.
Counselling and Psychotherapy Associations
-Irish Association for Counselling and Psychotherapy (IACP)
8 Cumberland Street
Dun Laoghaire
Co. Dublin
Ph: 01 2300061
-Irish Council for Psychotherapy (ICP)
(An umbrella organisation representing a broad range of Psychotherapists in Ireland)
73 Quinns Road
Shankhill
Co. Dublin
Ph: 01 2722105
Self-Help Groups
Some people find it helpful to talk about their experiences with others who can empathise because they have been through similar situations themselves. People can get practical help by working through their problems with others and develop strong support networks among peers. Self-help groups are run by Shine and cover most areas of the Republic of Ireland.
1 W.H Gottdiener, N.Haslam. The Benefits of Individual Psychotherapy for People Diagnosed with Schizophrenia: A Meta-Analytic Review. In Ethical Human Sciences and Services, Volume 4, Number 3, Fall/Winter 2002
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