Categories
Therapies

The A, B & C of Working with a new Counsellor.

When you have the opportunity to begin therapy with a counsellor, the initial meeting will bring up anxieties for many therapy-newbies.  Even experienced patients can get the heeby-jeebies before the assessment, and whilst this is probably the same social anxieties as you might experience when meeting with anyone new, the counselling assessment may be just that little more distressing.

It’s untrue that counsellors, psychotherapist and psychiatrist can read into your very soul!  At the same time, it’s particularly true that many experienced counsellors do gain the experience of being able to understand where a new client is coming from during the client’s story.  Counsellors call it empathy, and the more ethical ones of us counsellors use it to try and help you understand yourself. But, this isn’t going to be an article on how kind and amazingly helpful we, as therapists, are! 

Because of recent reports of counsellor/client imbalance (who knows – maybe it’s always been so) I’d like to give you three tips that may help you face your new therapist for the first time.  I’d like you to feel a little more empowered than you may normally do.  Introducing my A, B, C of working with a new Counsellor.

 

A is for Authenticity

[dropcap style=”font-size:52pt;color:black”]A[/dropcap] is for Authenticity.

During the first meeting with a counsellor, you’ll probably be asked a series of questions.  This isn’t always true, though.  Some therapists pride themselves in being able to work therapeutically without asking any questions at all. Amazing (even frustrating) as thatm ight be, we’ll save that discussion for another time.

So – “A” is for authenticity – meaning: be true as yourself to yourself as you can be in any of your replies to the counsellor.  The counsellor isn’t trying to trap you or catch you out.  The therapist is trying to learn about you and your story, primarily so that the therapist can judge if they are the right person to be working with you.  If you don’t know an answer, say so.  If you’d rather not answer a question, you can say you’d prefer not to answer that.  The counsellor may be curious (and hopefully respectful of your reply too) and may ask you to say a little more.  Again, if you’d prefer not to go into a subject area you can decline to do so.

An assessment should be a mutual one – you’re assessing the therapist too. Being authentic means that you will get a better experience from a counsellor who is, too, trying to be as authentic with you as possible.

 

B is for Behaviour

[dropcap style=”font-size:52pt;color:black”]B[/dropcap] is for Behaviour.

Don’t change your usual behaviour.  Or, if for reasons of social niceties you feel you do have to change your behaviour, share with the counsellor your change in behaviour and try to describe how you might normally behave.

Socially, we humans can have a whole series of different behaviours that we bring out depending on what situation we’re in.  Sometimes we’re the life of the party.  Sometimes we’re the businessman that invites new business orders.  Sometimes we’re the dad picking up his kid from school surrounded by female-conversation we feel awkward to join in with. But meeting with a counsellor is about you, the inner person, and behaving just as your true, authentic self is best.

If your behaviour is effecting your life, and it’s something you want to change as part of the therapy, then it’s useful to discuss this with your counsellor too – your counsellor may need to learn about those behaviours … and you’re the tutor

 

C is for Challenging the Counsellor

[dropcap style=”font-size:52pt;color:black”]C[/dropcap] is for Challenging the Counsellor.

You’re meeting with a counsellor, presumably, to find to help.  If the counsellor is asking questions that make you uncomfortable, or the counsellor says something that disturbs you, challenge the counsellor.  You don’t have to feel that you must comply with the counsellor because you’re feeling forced to do so.  If you’re not receiving help, you have the right to point this out.

Challenging doesn’t have to be confrontational or impolite.  It can be a simple way to show that you don’t agree with the counsellor, or that you would like the counsellor to be somewhat more clear about what he or she has just said.  if we remember that counselling is a partnership there are a vast number of studies that it is the relationship between counsellor and client that makes the difference – not what the counsellor does to you. 

So, if you feel uncomfortable about what’s been said to you, challenge the counsellor to explain more.

Addressing Client/Counsellor Imbalance.

This article has had a hidden agenda – it’s been about addressing a reported-increase in the imbalanced between the some counsellor/client relationships.

At the present time, Increased Access to Psychological Therapies (IAPT) at the NHS has introduced an increase of newly trained CBT counsellors.  Whilst this is a good thing, unfortunately the practice of IAPT low-level CBT intervention offered by newly-qualified IAPT therapists has, somehow, embraced the medical approach to therapy.  Doctors practice the role:  “there’s something wrong with you, and I have to cure you.”  This is leading to an unfortunate counselling-practice of “I am the counsellor, so I have to cure you.”

Studies show that counselling and psychological therapies are effective because of the relationship between the therapist and client.  The effectiveness is not because of being given instructions-to-follow in order to be cured by the counsellor.

This is not an attack on CBT.  This therapist incorporates CBT in his private practice.  I incorporate CBT from a position of collaboration and empathy between myself and my client – we’re in this shit together.  In my professional opinion, the client experiencing a newly qualified therapist’s sometimes-dominant instruction is counter-productive.  You cannot be cured of anything by being told what to do (except, perhaps, allowing for a sadistic/masochistic relationship being played out between the counsellor and client – a discussion for another articl).

This article offers you, the client, the very legitimate and very real approach that you’re a fellow in the therapy. You are not a subordinate, and I hope you won’t feel like you are when you next go to meet with a new counsellor.

A, B, C and meet your counsellor with the expectation of equality & collaboration.

Enjoy your first meeting with your new counsellor!

Categories
News Uncategorized

“In Treatment” returns for Season 3 – Sky Atlantic

Saturday 12th November 2011 – Sky Atlantic – “In Treatment” returns for its third and final season (see http://skyatlantic.sky.com/in-treatment/gabriel-byrne-returns-for-the-final-season-of-in-treatment).

“In Treatment” is based on BeTipul – a drama portraying real-life psychotherapeutic sessions between psychologist and his patients.  Each episode is focussed upon one session between client and therapist and over time one sessions how the therapeutic alliance progresses as the therapy develops.  We are fortunate in that we get to understand what’s going on in the therapist’s mind by being able to attend his own supervision (and sometimes his own therapy) so that we sometimes can learn how the therapist uses his experiences and struggles of clients (eg his ‘counter-transference’) in order to help the clients themselves.

Gripping drama – accurately portrayed.

Because I do not video nor record any of my therapy work for reasons of confidentiality, “In Treatment” is an excellent demonstration to show people, who are interested in my work as a psychodynamic counsellor, how our clinical work could progress between us as client-and-therapist.

“In Treatment” episodes are on Saturdays at 10pm and 10:30pm, followed by Sunday at the same time.

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
Couples FAQ

Is Couple Counselling Right for Us?

Are you looking for assistance in helping you and your partner decide how to improve your relationship?  Or are you looking for someone to tell you what to do?

If the former, then couple counselling might be something that is right for you.

If the latter, then couple counselling may not be suitable for you.

A couple counsellor has no instructions or recipes that if you follow to the letter you will find that your relationship improves.  However, a couples counsellor is skilled in helping couples learn what they’re not paying attention to (or have stopped paying attention to).  Some couple counsellors will be curious about the past history of the relationship – when was there a time when things were better.  Some couple counsellors will be curious about the present day – how does the relationship nurture unhappy behaviour.  Some counsellors will sit quietly and listen (actively) to an argument go on for a while – learning about what the partners cannot see for themselves.

Couples counselling can help perturb unhappy behaviours – but both partners have to wish for the relationship to change.  Unhappy behaviours may have become necessary for one (or both) partners (eg avoiding sex) – and dislodging these behaviours might release even more unhappiness if this is not first understood – this is just one of the aims in couples therapy.

Do you think couple counselling might be right for you both?

Categories
FAQ

What does Counselling Cost?

Different therapists charge different rates for different forms of counselling, psychotherapy and other therapies.

Dean Richardson has broken down his fee structure so that you only pay for the counselling/psychotherapy service you need.

All fees have two parts: a standard fee (what the general member of public will be invited to pay) and a sliding scale (what a person with limited income can be invited to consider paying).

Click to read more about Dean’s costs for counselling.