Counselling, Clients & Choice – who to go to see?

Who to Go To See?

Some clients may feel they face a daunting task when they decide to go to see a therapist. Not only do they have to continue to wrestle with those personal challenges which set them off on the road to seeking support from a professional therapist, but there is the immediate challenge of identifying the type of therapy which will be most appropriate for them.

The work of deciding who to go to see must sometimes seem like trying to tackle a decision tree created by an eccentric scientist. There are a profusion of options with each leading onto yet another set of decisions to be unpacked, each promising like a set of Russian Dolls to lead to the client to the centre piece but without ever actually getting there. The sheer variety of therapeutic approaches to be considered and compared is remarkable.

For example, the advantages of hypnotherapy can be contrasted with the benefits of aromatherapy, psychotherapy could be considered against art therapy and one might even want to try and compare holistic massage with acupuncture. The list of potential comparators is continuous and very long.

The meticulous and determined client may be able to weave between the solicitations of practitioners, plough through the voluminous writings of theorists and negotiate the esoteric research to eventually arrive at a conclusion as to the favoured approach. Even if a decision on the broad strategy is then confirmed, there can still be another awkward branch in the decision tree to be climbed. This requires the exhausted client to chose from within that strategy, the specific school to be enrolled into.

Psychotherapy & Counselling

Psychotherapy provides a good example of this type of challenge. A client may have decided to undertake a course of psychotherapy and to seek out a counsellor. The next issue to confront will be to decide of what type of counselling or psychotherapy to pursue.

The most well used modalities are probably Psychodynamic Counselling and Cognitive Behaviour Therapy (CBT). Yet fundamentalists from each approach can view the other as representing a very different world. High priests have publicly regarded what some will see as the opposing faith with much suspicion even to the extent of questioning the effectiveness of the work.

It may be however that we can challenge that rather dogmatic and for some potential clients, a rather unhelpful approach. Perhaps the two ways of working are not quite as irreconcilable as some may want us to believe. Psychodynamic counselling has been a traditional approach to counselling.

Traced back from the work of the founding fathers (or should it be the quarrelling brothers?) of Freud and Jung, this type of opened ended counselling encourages the client to reflect on what has occurred in his or her life. There is often a particular interest in experiences in early years. He or she will look back to patterns in relationships mindful of what is going on within the counselling room.

The counsellor will work with the client to try to develop an awareness of what has impacted in the past and is still powerful enough to affect where he or she is now. The theory suggests that to understand is to take ownership. And ownership brings with it a possibility of change.

Within this specific type of counselling there are variations, some acknowledged and labelled and others left to slowly emerge. For example, the work within the counselling room places much emphasis on the relationship between client and counsellor. Some counsellors will therefore be sphinx like in their approach revealing as little about themselves as they can to the client.

Everyday courtesy questions by the client from ‘how are you’ to ‘did you enjoy your break’ may be met by a degree of blank stonewalling which would make even the occasional carved effigy seem expressive and emotional by comparison.

Yet other perhaps more flexible psychodynamic counsellors may allow an exchange of pleasantries, small talk and even laughter in the room. The task for the client will be to detect the counsellor’s style from the initial assessment session – and to then decide on what is most likely to help him or her work within the therapy room.

Cognitive Behaviour Therapy (CBT)

CBT has a much shorter history. Formed by a break away from traditional psychotherapy therapy and lead by Aron Beck, the model built on behaviour therapy and is still continuing that process of development and evolution. Despite the initial attempts of some theoreticians to maintain a rigid consistency, CBT has spawned many variations on Beck’s initial theme although there are still some standard practices.

CBT will unlike its psychodynamic cousin, often work to fixed number of appointments. Sessions will have a structure with an agenda which allow client and therapist to remain focussed on issues to be addressed. There is an emphasis on the here and now, on looking forward and on finding ways to ensure that issues are resolved. The expectation is that improved well being for the client lies ahead with some form of change of thought or behaviour rather than just in understanding.

Yet even if most CBT therapists share the rudiments of a common faith, the practices between CBT counsellors can be experienced very differently. Some CBT therapists will quickly launch forms and diaries at an unsuspecting client with a speed that would leave Olympic sprinters feeling breathless and inadequate. Others will allow models reflecting thoughts and actions to be sketched out, encouraging the client to decide on how to work and what to change – particularly between sessions.

To those clients who may regard the continual use of pen and papers in the same way that an ageing vampire may view a garland of garlic, such flexibility in approach may come as blessed relief.

Which approach to take?

This initial glance may suggest that CBT and psychodynamic counselling are two very separate approaches but perhaps there is a greater harmony than the fundamentalists who exult in the division between the two schools, would want us to see. One has a great diagnostic strength in allowing clients to understand deep rooted reasons for distress. The second offers a positive, perhaps ironically, even a dynamic way forward which may offer clients a way out of a cognitive and behavioural habits which may have become destructive.

Some may see those two strengths as actually suggesting a potential fit between the two approaches which could provide real benefits for clients although others may react in consternation at the thought of such simplistic heresy and doctrinal abuse and revert to a more confrontational approach.

As clients or as counsellors, we will form our own view. Perhaps what is more important is the suggestion that therapists should be encouraged to think outside of their initial training and established paradigms and to look for imaginative ways of taking the best from different techniques which may prove to be in the overall interest of the client.

That is ambitious. Such an approach requires counsellors and therapists to actively seek out a better understanding of other therapies. Within the counselling world that may mean either the CBT or the psychodynamic therapist looking with increased interest at other techniques such as gestalt, person centred or solution focussed therapy.

There are a myriad of approaches looking to attract clients. Some are carefully developed, claiming validation with empirical testing while others may strain credibility with claims which are asserted rather than proved. Nevertheless, as counsellors we work hard to maintain a degree of empathetic objectivity within the counselling room.

Perhaps we now need to bring that skill to bear on our ability to look with interest and excitement at different therapies and to actively look for useful opportunities and ideas rather than just anticipating threats and incompetency.

Choice and selection

On the wider issue of choice and selection, it may be argued by some that it is the responsibility of each client to look at different therapies and that this work should be done by the individual seeking assistance before he or she first contacts a particular counsellor.

That approach may be understandable to those standing outside the therapeutic tent. For those inside the canopy however, there is an understanding that clients may not always be in a position to complete this rational research.

This suggests that the responsibility for encouraging informed choice by clients should also lie with therapists rather than just the individual who is seeking support. There is a case for proposing that all those who are involved in providing counselling services should ensure that before work is commenced with a new client, a broad sweep of information should be provided on different approaches. This requirement would encompass not just counsellors and therapists but also agencies and health authorities.

Protecting the client

As general concerns about providing protection to members of the public have grown, other industries within the UK have had to develop ways of ensuring that what was loosely called ‘best advice’ was provided to clients interested in buying services.

It could be argued that seeking out a programme of therapy is more akin to agreeing a course of medical treatment or even in embarking on a long term savings plan than mirroring a one off consumer purchase. In these circumstances perhaps that provision of ‘best advice’ at the commencement of support is an approach which we in the counselling world should now be considering in a proactive way. That would require each individual counsellor having a level of competency which would enable them to provide wider information on a variety of therapies in initial discussions with clients.

All accredited counsellors with umbrella organisations such as BACP and BABCP are already expected to commit to continual CPD. If additional training work were required it could fit within that annual development work. It may be of course that many counsellors do already pursue this more integrated approach and it can be argued that this requirement is already implicit within the ethical codes set out by some umbrella organisations.

We should acknowledge however that some bias may exist given the strength of commitment by some therapists to their particular specialism. That bias may also be seen reflected within some agencies. If we are really concerned that clients should be able to make an informed choice perhaps it is not sufficient even for formal organisations to just pay lip service to acknowledging that other approaches exist. The comparative information provided should be sufficiently robust to merit the description of best advice.

The client’s needs and duty of care

What is important is what will fit with the individual needs of each client. When clients first go to see a therapist they should expect informed discussion and consultation. As responsible counsellors and therapists, our primary concern has to be for the well being of clients. We need to be clear about how best to support the client at the commencement of the counselling process as well as during the actual work.

As therapists we have a duty of care. With the onset of regulation and with increasing public interest in our work, we may now want to look with increased attention at how to discharge that duty of care at the commencement at the work with clients. We owe that to our clients and our profession.

Geoff Boutle Counselling BasingstokeAbout The Author

Geoff Boutle is an experienced BACP Accredited Counsellor and UKRC registered independent counsellor working in Basingstoke and North Hampshire.

Find out more about Geoff’s work by visiting his GoToSee profile page here


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