Counselling

AbstractPeople seek counselling for many reasons. Sometimes those who have had no previous need for mental health services are literally stopped in their tracks by life events—illness, family breakdown, intolerable stresses. People with long-term difficulties may turn to counselling when they feel the statutory services are not able to meet their needs, or as an adjunct to health care provision. With greater social mobility and the separation of family members, counselling increasingly provides the care and support previously offered within local communities. The provision and acceptability of counselling is on the increase. Counselling is possibly the most commonly delivered form of psychological therapy and the British Association for Counsellors and Psychotherapists have over 30 000 members, with equivalent numbers in other countries. Professional training programmes in counselling have mushroomed in response to demand. Counsellors are found in many statutory and voluntary settings—mental health, primary care and medical settings, workplaces, drug and alcohol services, voluntary and charitable organizations, trauma services, and educational settings—as well as in private practice. But what exactly is counselling? What do counsellors do? Is counselling the same as psychotherapy? And, is it an effective form of treatment? Although counselling is a major growth area within mental health, it can be difficult for consumers and purchasers of counselling services to know what kind of counselling and counsellor to use, with lack of clarity about what works for whom. There are many different models of counselling, types of counsellor and many different training courses. It is difficult to make clear distinctions between counselling and psychotherapy. Much of the work of counsellors has not historically been amenable to standard methods of evaluation, and research is relatively new. Currently there is no statutory regulation for the term ‘counsellor’, which means that people are able to practise as counsellors without registration or accreditation. By definition, people who seek counselling are likely to be vulnerable, and the issue of public protection is paramount. The aim of this chapter is to clarify these issues and examine the place of counselling in psychiatry. The chapter begins by looking at the definition of counselling, and how counselling is both similar to, and distinct from, psychotherapy. The chapter goes on to look at the key features of counselling, and different models of counselling. Although counselling can and is used for many psychological difficulties, the chapter selects specific problems where there is evidence that it is an effective intervention: mild to moderate depression, adjustment difficulties, bereavement, trauma, and relationship problems. I then consider counselling in different settings, again selecting a few which illustrate the work of counsellors—primary care, mental health settings, student counselling, and the workplace—looking at the way counselling can be adapted according to the needs of the service. The chapter concludes by looking at issues of training, quality, and standards, commenting on the need for the control of an ever-developing profession without loss of the growing availability of effective counselling services to those in need.