Categories
FAQ

Don’t I have to be mental to go to a counsellor?

Answer: no.

This article is talking about counselling for mental illness… in fact, a counsellor may not be able to work with you if you are mentally ill.

Counselling and psychotherapy are not psychiatry.  They are a valuable form of psychological support that can assist you in unravelling problems (sometimes emotional, sometimes cognitive) but only if you are able to participate in the process too.

If you are diagnosed with a mental illness, then counselling may be contraindicated – and certainly counselling won’t be as effective if you were not able to engage in the process with a good (or at least a reasonable) sound sense of yourself and a stable-enough mental health.

Beginning Counselling.

All counselling begins with an assessment.  This is not a mental diagnosis because counsellors are not qualified to make such diagnoses.  Instead, we are making sure (as much as we are able because we are human and don’t have foresight!) that you are able to engage well enough with the counselling processes, and with us as your counsellor. 

Counsellors won’t announce that you have an undiagnosed mental illness during the assessment.  Apart from anything, counsellors are not qualified to make diagnoses of mental health – although we have experience and training in being aware if there is something amiss in a person’s mental health (which may help us judge if we are the right sort of therapy for an individual, or might help us to help a client find the right sort of therapy).

Counselling and maintaining mental well-being.

If we do become concerned for your mental well-being, we have resources (such as our supervision and access to psychiatric support where needed) that we can consult.  This is to make sure that we have your best mental health in hand.

If we are concerned for your mental health it may be ethical to bring this matter up with you (it’s not likely we will go behind your back to your GP or other mental-health processional).

All in all it’s not very often that a person coming to counselling will cause us to seek such advice, but we are prepared if this might be the case.  At least … counsellors should be so prepared.

Psychiatry & mental illness.

Mental illnesses are diagnosed by psychiatrists.  A psychiatrist would fully assess someone in person (ie face to face), taking a history of the person’s mental behaviour & capacity from the person themselves and also from as many other sources as possible.  More than one problem can be identified during diagnosis.

Once there is a diagnosis a full treatment plan can be put in place, requiring the psychiatrist to consider medical, social and psychological (eg counselling) treatments available.

Whilst a counsellor/psychotherapist may be aware of a person’s mental illness, they are not in a position to diagnose.  An ethical counsellor’s approach would be to discuss their concerns with their supervisior and other psychological resources before deciding whether or not to discuss with you their observations and their advice about seeing your GP.  Think of this like having a potential problem highlighted for you, and the choice to take the matter any further remains yours.

Talk with a Counsellor.

If you’re thinking about counselling and that it might help you, but you’re afraid that you might be seen by others (or, indeed, the therapist) as having a mental illness, be assured that this is most likely not the case … irrational fears are certainly very powerful, but we can deal with stuff like that in counselling.

Talk it through with the counsellor.  You may be relieved.

Categories
Couple Relationships FAQ

On Bringing Couple Counselling to a Close

Couple Relationship Counselling is about working in therapy with conflicts in a couple’s relationship.  The couple can be married, in a civil-partnership, being romantically involved or just simply colleagues who have a relationship (business or personal) that has developed conflicts (read more…).

Closing States of Couple Counselling.

There are two states for the end of couple counselling: resolved and unresolved.

Resolved: when the initial conflicts – plus conflicts that appeared during the course of couple counselling – have been worked through to the couple’s satisfaction. Satisfaction may mean: enough so that the couple can work on the issues themselves without further therapeutic intervention.

Unresolved: when the initial conflicts – or conflicts that appeared during the course of couple counselling – have only been partially worked  through & the couple are still distressed at – or helpless from – the conflicts.

Both of these states can be worked with during an ending to couple counselling. Although resolved might appear to be a better state, it depends upon what the couple want as it’s their relationship (and always has been even with therapeutic intervention).

When a couple decide to end counselling, working toward an ending is an appropriate choice (rather than simply stopping counselling without notice).

Topics for Closing Sessions.

In the final sessions it can be helpful to discuss the following:

  • What matters presented at the assessment for couple counselling (read more…).
  • What matters came up during the couple counselling?
  • What matters do both partners agree that we have worked through?
  • What matters do partners disagree on.
  • What matters are left outstanding (any “unfinished business”) – for both partners together, or for each individual partner?
  • What might the couple wish to do about the unfinished business?
  • What has been gained from the counselling process … and what is being lost as it ends.

A purpose of such a review is so that couples counselling can end with the work being reviewed openly.  Both partners can leave therapy knowing what is agreed as being resolved, and what matters are left unresolved.  Knowing what work is left to do means the couple can consciously continue to work on further matters in their own time and their own way.

Number of Sessions.

The number of sessions to bring couple counselling to a close will be decided in a discussion with the couple.  It’s preferable that an ending to counselling is brought about once the presenting issues have been worked through – so the ending is a case of how many sessions would be required to discuss sufficiently the closing sessions topics.

This, plus any outstanding matters the couple wish to talk about.

Ending Counselling without Final Sessions.

Leaving counselling without such an ending as discussed above can be unhelpful to the couple’s relationship.  Unresolved conflicts can continue in the relationship – assuming that the relationship continues.

Sometimes the couple decide they wish to separate and they leave the relationship (couple counselling can also be used to help a couple to separate) and when the couple no longer maintains the relationship, the counsellor’s “client” (the relationship) can no longer be brought to counselling.  Other types of endings can then be discussed.

So, working towards an ending in couple counselling are an important part of the counselling process.  whether the couple involve the counsellor in the ending or not.

Categories
Statistics

I’ll show you how Counselling Improves Well-Being (CORE)

CORE-34 Statistical Evidence shows Counselling Improves Well-being.

This article discusses how the use of a survey containing 34 questions (called “CORE-OM”) allowed me to demonstrate that counselling can improve psychological distress. Four psychological areas are measured

CORE-34 Measures Four Psychological Areas.

  • Well-being
  • Symptoms
  • Functioning
  • Risk states (eg self-harm)

History of the iCounsellor.co.uk (2009/10) CORE Survey.

The survey was taken during the period 2009-2010 and with clients’ permissions. All clients were British and between the ages of 22 and 49. Firstly, the survey was offered at the second session (rather than the first as clients are particularly more anxious than usual during the first session and this tends to skew results). Counselling commenced as it would usually. The survey was offered a second time during a session in the ending period of therapy and the information shared with the client.

The statistical information showed that psychological improvements are recorded during the period in which the person was in counselling.

What is CORE-OM?

Clinical Outcome Measure

Initial Distress Levels
Final Distress Levels
[Severe][Low Level]
[Modererately Severe][Mild]
[Moderate][Healthy]
[Mild][Healthy]

The table above shows that the individuals who took up counselling with Dean Richardson/iCounsellor.co.uk during 2009-2010 experienced improvements in their distress levels (data is taken anonymously from actual client data CORE forms and used with permission). CORE measures improved levels of distress in such areas as well-being, symptoms/problems, life-functioning and states of risk/harm.

Clients achieving a reliable improvement:100%
Clients achieving no change:0%
Clients deteriorating:0%
Average number of sessions: 
Meridian average:7.0
Mean average:10.4

The CORE Outcome Measure (CORE-OM) is a client self-report questionnaire designed to be administered before and after therapy. The client is asked to respond to 34 questions about how they have been feeling over the last week, using a 5-point scale ranging from ‘not at all’ to ‘most or all of the time’. The 34 items of the measure cover four dimensions: subjective well-being; problems/symptoms; life functioning; and risk/harm. The responses are designed to be averaged by the practitioner to produce a mean score to indicate the level of current psychological global distress (from ‘healthy’ to ‘severe’). The questionnaire is repeated after the last session of treatment; comparison of the pre- and post-therapy scores offers a measure of ‘outcome’ (i.e. whether or not the client’s level of distress has changed, and by how much).

For further information on CORE, including downloadable CORE forms, see the CORE-OM website.

How client and therapist use CORE together.

CORE-OM Scores & Severity Levels

140   Severe (85+)
130    
120    
110    
100    
90   Moderate to Severe (68-84)
80    
70    
60   Moderate (51-67)
50    
40   Mild (34-50)
30    
20   Low level (21-33)
10   Healthy (0-20)
0    

Distress Severity Levels

Some therapy agencies and therapists use CORE as part of the assessment. For me, it is an optional part of my counselling procedures. A client may wish to take the CORE survey at the start & end but they do not have to participate in the survey. The survey is not offered to couples in couple counselling because couple counselling works on the relationship, not two individuals (and CORE does not measure distress levels of a relationship, only the individuals).

CORE can therefore be used as part of a “tool-kit” to complement not only the counselling experience but to give the client something visual and measurable.

CORE is not a tool for a complete diagnosis. Rather, one might think of CORE a little like a room-thermometer; the thermometer might indicate if the room could benefit from more heat being added but, in reality, it’s the people within the room who will decide if they require more warmth. CORE therefore may suggest an improvement has or has not been recorded, but it’s the client him/herself who’s opinion matters.

When used, the CORE survey takes about five minutes to complete, and is done in the counselling room. When completed, I summarise the most important details and discuss with the client about what the survey reveals to us. This can often be a useful source of topics to discuss in counselling. Near to the end of our counselling work, another survey allows us to compare how the client was in the past with how they are now.

What the iCounsellor.co.uk (2009/10) CORE survey demonstrates about Counselling.

By using CORE, clients and I were able to demonstrate statistically that a person’s psychological well-being, symptoms, life-functioning and states of harm or risk were improved during the counselling process.

For practitioners to assess meaningful improvement over the course of therapy, two measurements are important: reliable change and clinically significant change.

  • Reliable change is change that exceeds that which might be expected by chance alone or measurement error, it is represented by a change of 5 or more in the clinical score.
  • Clinically significant change is indicated when a client’s CORE score moves from the clinical to the non-clinical population (eg a CORE score of around 10 or below).

 

Update November 2013: I thought it important to add this note to clarify that as a counsellor working with individuals I no longer use CORE in my practice (and I never used it with couples … as CORE is unable to measure a relationship).  CORE statistics are helpful to those who are seeking to prove a position (such as seeking funding, or demonstrating an outcome of using a particular model of therapy, for instance).  For clinical work, however, I have found that it’s the relationship between client and counsellor that is far more important in discussing & determining outcome… and a reflection of a client’s state of mind using numbers can be less than helpful. 

© Article Dean Richardson 2010.

Categories
FAQ Individuals

What Happens in Individual Counselling?

What Happens in the First Counselling Session.

The first session is called the assessment. Before you and I begin therapy, we must be sure:

  • Is therapy is right for you?
  • Is working with me and my style of therapy the right thing for you?
  • Do we both think that our working relationship could be good enough to work in therapy together?
  • Are there any mental issues that might make counselling difficult (or impossible) with me.

What Happens in Subsequent Counselling Sessions.

How it can help you.

You (and your partner if couples counselling) and I sit opposite each other, chairs at slightly an angle, and we have conversations. What we talk about is up to you, and what we discover during our conversations can be revealing, helpful, and life-transforming. Sometimes matters that are difficult to talk about with others can become easier to talk about with me. I don’t talk about our conversations with anyone else – so our therapeutic relationship becomes trustworthy.

Categories
FAQ Individuals

What is an Assessment for Counselling (Individuals)?

Before therapy commences in earnest, an individual is invited to an assessment.

An assessment allows the the individual to give an overview of their problems to the therapist, allows the therapist offers some helpful, information-gathering questions, and allows both the opportunity to discuss if they can work together to achieve the focus discovered in the assessment. 

During the assessment, the options of brief/time-limited counselling and open-ended counselling are considered and discussed by the therapist.

If the client and therapist agree not to proceed into therapy a referral may be made to another therapist.  Otherwise, counselling proceeds after the assessment.

Click for full details about assessments for individual counselling.

Categories
FAQ

Brief Counselling or Open-ended Counselling?

It used to be the case that I offered either brief counselling or open-ended counselling to individuals coming into counselling for the first time.

Experience has taught me that open-ended work can work through some matters in a brief way, and brief work can sometimes need an open-ended approach.  

In other words, it’s the focus of counselling that is the most important, not the length of time spent.

Having written that, I will still  go through an assessment for counselling with new clients.  An assessment is where we discuss what you need from counselling and if I’m the therapist to work with.  We’ll pay attention to the problems that you are bringing to therapy, see how you respond to what I say and ask.

Later in the assessment session, we’ll discuss our approach to the focus for counselling (open-ended / brief) and see what approaches we agree / disagree with.

Brief Counselling.

Brief counselling works on a single (usually) focus and is a set number of sessions (discussed and agreed between you and I).  The therapist and client have to be able to work well together – a kind of instant therapeutic rapport that can be used in the work click to read more.

Open Ended Counselling.

Counselling that is not limited to a set number of sessions.  But we will still work with a clear focus of our work (which might be at working towards an achievement, a change in emotional state, a transformation of life circumstances and so on).

Categories
FAQ

Can I ask my Doctor/GP for Counselling?

Counselling can be made available to you on the NHS via your GP.

There is often “stepped” process involved – including a waiting list to begin treatment depending on your presenting issues.

An illustrative example would be:

  • Initially, your doctor may first ask you to come back again in a few weeks time to see if things are better.
  • If things don’t feel better then next you may next be given access to reading material – a form of self-guided self-help therapy.
  • If this doesn’t help you may be offered access to a computerised [tooltip text='Cognitive Behaviour Therapy (CBT) is a form of talking therapy that is focussed on helping a person change the ways they think, how they feel, and their behaviour, in a stepped process. CBT has a reputation for being a manualised treatment (patient is diagnosed and a matching treatment prescribed) which is how computer-based CBT treatments have been created.
    http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy'] CBT [/tooltip] treatment.  This may help you identify and deal with your problems through suggestions the computer may offer based upon your responses to questions.
  • If these “self-guided” therapies remain ineffective, a referral to a low-level  (trained & qualified) therapist may be the next step – involving a waiting list of several weeks or months.
  • If the low-level impact fails to help you, you may be referred to another therapist for further treatment.

Low-level impact treatments are cost effective to the NHS because of their being no need to train highly skilled therapists.

The initially-mild interventions offered to you should be overseen by a therapist who should have an initial qualification, adequate experience & appropriately supervised (i.e. newer (lower-cost) therapists are more commonly used early low-impact intervention stages of a patient’s NHS counselling).

You may later be offered a fixed number of sessions of face-to-face counselling if the previous therapeutic intervention didn’t work for you. You may be offered to meet with a more experienced psychotherapist or psychiatrist if the previous experiences of therapy are ineffective.

Why CBT/Stepped Process?

This NHS stepped process is partially due to costs and partially due to new procedures introduced called IAPT (read more).

CBT is a treatment that GP’s can understand – it principally works on a diagnoses/prescription modality, where several treatments can be normalised (i.e. the CBT therapist follows someone’s recommendations/instructions for treating a particular ailment).  Of course, one would not take a prescription from an unqualified GP, so one would not be prescribed a form of therapeutic treatment from an unqualified CBT therapist – but there are various levels of experience & qualifications.

IAPT originally only offered CBT (cognitive behavioural therapy).  Mild forms of CBT can be offered by minimally trained therapists using a form of manualised therapy (e.g. you may be diagnosed and a therapist may refer to a set of therapeutic interventions that are recommended for your form of diagnosis).

Whilst CBT can be effective for certain issues it is not a fix-everything therapy and not everyone likes to feel like they are responding to a manual-of-therapy.  If you can be helped by the processes then this will be beneficial – albeit that to get to the higher forms of treatment the previous experiences of treatment may have to have failed first.

Private Counselling – Your Choice of Treatment.

Unlike NHS Stepped-Treatment, private counselling with Dean Richardson begins with the FULL service.

There is no tiered/stepped process with Dean. You start immediately with full 50-minute weekly sessions working with Dean face to face.  No computers giving you questionnaires.  No books to read.

You and Dean will begin with an assessment session (meeting to talk about what you need from counselling, and discussing what counselling may and may not be able to help with).

You and Dean will meet weekly (usually the same day, same time, same location – which helps many people manage their commitments elsewhere).

With Dean’s assistance you might decide to discuss choose how many counselling sessions you wish to attend (such as brief/focal counselling) or you may with to work with Dean until the focus of the needs for counselling have been fully addressed.

No waiting lists – no maximum number of sessions.

It’s a very personal counselling service that aims to create a therapy that works for you and your needs.

Categories
FAQ

Do I have to pass (or fail?) an Evaluation to get Counselling?

If you’re thinking of private counselling, then there is no test or evaluation! In private counselling, an assessment for counselling is where you and the counsellor meet to initially discuss what you want from counselling, and what the counsellor can offer you.  This is an ethical approach and informs you about what sort of therapy you are opening yourself up for.

Things can seem somewhat different in NHS counselling.  With newer IAPT services (read more), you may initially be recommended the lowest form of therapeutic intervention to begin with (e.g. go home and come back in a few weeks if things don’t feel better …  or try a computer program that may offer some suggestions on how to cheer up your life).  To the next level of therapy you may feel that you have to be unsuccessful with the previous level of therapy

It might be some time before you meet the most basically trained counsellor – and even more time to meet with an experienced therapist.

This can feel like you have to keep failing stages in therapy before you are allowed to go to the next stage.

I’m not suggesting that this occurs all of the time – each individual will be (or should be) treated on an individual needs basis – but it is not uncommon for people seeking counselling on the NHS to frail levels of treatment until one is found that is successful,

With Dean Richardson you are not offered one level of therapy first, followed by other levels if they are unsuccessful. What you receive from Dean is his full service from the beginning (although, of course, we will always take matters at a pace that works best for you).

At the beginning of counselling, you and Dean will go through an assessment for counselling.  This is where BOTH you and the counsellor will discuss your needs for counselling (i.e. not just you being assessed, you are assessing the counsellor and his methods too).  You and Dean will talk about what can (and cannot) be offered to you. 

The assessment is not a test – Dean is not looking for you to score a high mark (or get a low one).  An assessment is an effective way for you and the counsellor to both assess if working with Dean is, or is not, a good idea.  Other options, such as a referral to a more appropriate therapist, are available too.

Categories
FAQ

What is an “Assessment” for counselling?

An assessment for counselling is where you (plus your partner, if couples counselling) meet with the therapist a session (sometimes more as required) and discuss what you need from counselling and what the therapist can offer.  The therapist will ask you some questions to help understand a little more about your needs for counselling.  This will also helps both the therapist and the client to judge if both are able to work with the therapist’s style of therapy.

The therapist will offer you a number of tentative thoughts about what he learns from you.  He may offer an interpretation or two based on how he may understand how some matters may link together. T his is all part of seeing if a psychodyamic approach to therapy is suitable for you.

This is a mutual assessment – the therapist is not just assessing you for counselling.  You are assessing the therapist and the form of therapy on offer.  Both client and therapist are seeing if they can work together.  If client or therapist have any concerns of each other they can discuss these openly with each other.

At the end of the assessment, the therapist and client should have a clear idea about what the therapy is to offer, and what the client needs from the therapy. Alternatively, discussing a referral to another therapist might be more appropriate.

See also:-

Categories
FAQ

How do I begin Counselling?

Beginning counselling in Portsmouth, Hampshire with Dean Richardson is straightforward.

It might help you to be aware that once you have arranged to meet for a first session with Dean (the ‘assessment’) you’re pretty much assured to begin counselling with him – should you choose to.  The assessment session is to ensure that the problems you present for counselling are matters which Dean and you can work with.  It is not to evaluate you to past a test that would allow you into therapy.

Dean takes on a limited number of simultaneous cases.  This is to ensure that you (or you and your partner, or the support group you may join) gets the best out of Dean as therapist.  Dean makes sure that he is not overworked by having a maximum number of cases at any one time during the week.  So, when you look on the front page for list of times Dean is available, you know that Dean is already available to take you on as a new case.

Individual or Couple Counselling.

  1. Take a look at Dean’s available appointments range.
  2. Contact with Dean – letting him know when you’d like to meet.
  3. Dean will return your contact to confirm – or offer another appointment time that’s near to your choice.
  4. You and Dean will meet for a counselling assessment to discuss your needs from counselling and to see if you and Dean both believe it will be beneficial for you to work together in therapy, or if maybe a referral to a colleague or another service might be a better choice.
  5. If there is nothing contraindicative to proceeding into counselling, you and Dean will arrange a weekly appointment (usually the same day, same time and same location as the assessment appointment).
  6. For individual counselling Dean and you meet together weekly for either a fixed number of sessions (see Brief Counselling), or until the issues you came into counselling for are worked through sufficiently for you and Dean to both recognise that the counselling is done.
  7. For couples counselling, you and your partner will meet with Dean until the issues you and your partner came to address have been sufficiently worked through for you all  to agree that the work is done.

Support Groups.

  1. Take a look at Dean’s available groups.
  2. Contact with Dean – letting him know which group you’re interested in joining.  Choose an appointment time from here to come for a meeting to discuss your needs from group therapy.
  3. Dean will return your contact to confirm your appointment time, or to offer one as near as possible to your choice.
  4. You and Dean will meet for a 50 minute talk to discuss your needs from a support group and to discuss if both you and Dean believe it will be beneficial for you, or if a referral to a colleague or another service might be appropriate.
  5. If you and Dean both agree about you joining a group, you both will arrange for you to be added either onto a waiting list to join a not-yet-meeting, or to be given a starting date to join an existing group. 
  6. Because some groups only accept new members when the membership quota has dropped below the maximum membership number, you may be waiting for your place in the group to become available.  You and Dean will look after your needs in the meantime either by arranging holding sessions with Dean, or by discussing other means to look after you whilst you wait.
  7. When your place in the group becomes available, you will be given your start date.