Positive Health Online

In my February 2008 article Touching Stillness to Assuage Stress[1] I mentioned that the then latest (2006/2007) government statistics cited 420,000 individuals in Britain as believing they were experiencing work-related stress and psychological disorders. In the 2007/2008 HSE (Health & Safety Executive) Statistics[2] this figure increased to 442,000.

This Survey of Self-Reported Work-Related Illness, Stress-related and Psychological Disorders cited high incident rates of work-related mental illness reported among teachers, nurses, medical practitioners, certain professional and managerial groups, public administration workers including housing and welfare officers, police officers, prison officers, and UK armed forces personnel. It also highlighted that the approximately 5,750 new cases per year "almost certainly underestimates the true incidence of these conditions in the British workforce".

Dame Carol Black, national director for health and work, recently called for urgent and comprehensive reform of work-related health services following her March 2008 review of the health of Britain's working-age population which revealed that ill health is costing the UK economy £100 billion annually.[3]

I am conscious that these statistics are work-related and thus cover only a proportion of society. In the current climate of uncertainty as the 'credit crunch' bites and the 'economic downturn' impacts in varying degrees throughout society, it is impossible to estimate how many adults and children are suffering unprecedented levels of insecurity, desperation even, and are in need of solace.

The daily media doses of bad news regarding global economic disaster, the scale of personal and corporate debt leading to redundancies, short term working, house repossessions . . . continue to ratchet up levels of distress.

On 5 November 2008 the HSE supported National Stress Awareness Day with the theme 'Don't Worry Take Action'. I support this advice – for everyone in distress, not just employees – since worrying without taking any action markedly increases anxiety and compromises wellbeing and one's ability to cope with adversity.

One course of action is to seek solace through counselling and other holistic approaches to wellness.

The definition of solace is to find comfort and to alleviate grief, pain and anger.

Counselling serves a wide range of client groups, with an even wider range of emotional issues. Good counselling is about connection – helping someone connect back into life. A great therapist is both a great teacher and a healer – someone with wisdom and perspective.[4]

Talking in confidence to someone trained and experienced in real listening, and skilful in encouraging honest introspection, articulation of feelings and objective examination of issues, can be enormously empowering. It can help achieve greater clarity so that you can devise your own ways of addressing your problems and be assisted to implement strategies for therapeutic change.

At a time when the government think tank Foresight's 2-year report into the country's mental health highlights a strong link between debt and mental illness, and recommends "a campaign to boost the mental health of the nation to combat rising rates of depression, anxiety and drug abuse"[5] I see both a real opportunity, but also a dichotomy.

In seeking solace, those in distress often consult their doctor, expecting him or her to 'fix' them, which places a huge burden of expectation upon the GP to prescribe medication.

Many medical practitioners refer patients for counselling instead of or in addition to prescribing, but waiting lists in some parts of the country involve an 8 month wait. Some PCTs providing integrated healthcare offer complementary therapy options . . ., and then there are the GPs who prescribe anti-depressants for a whole range of symptoms of distress (and who provide repeat prescriptions, sometimes for years).

As a professional person-centred, integrative counsellor and complementary therapist, I naturally support holistic approaches to health and wellbeing and am opposed to the medical model of mental illness and the 'medicalisation of distress'.[6] I also refute the logic that views being frightened, overwhelmed or confused as being ill, and I am uncomfortable with the tendency to label people according to so-called 'disorders'.

As stated previously, to seek solace is to seek comfort and the alleviation of grief, pain and anger. This objective fits in well with the ethos of counselling which is the relief of human distress and promotion of emotional wellbeing.

Widespread confusion exists, however, as to what precisely counselling is, and unfortunately many people believe that if you need it you must have character defects and be mentally ill. The pharmacological revolution of the 1950s/60s conjured the illusion of administering specific cures for specific so-called disorders and anxiety states, encouraging the view that psychiatry was within the paradigm of physical medicine.

I believe that the confusion arises out of lack of understanding about the different counselling orientations (the types of counselling approach and for whom which is best suited), and also partly because of the confusing vocabulary used within the counselling and psychotherapy world. Research[7] shows that the very word 'psycho' (psychotherapy, psychology, psychiatry) puts people off, and that there is still societal stigma attached to counselling/therapy.

Negative experiences of counselling are not uncommon and the harrowing accounts by highly educated, articulate journalists Sally Brampton and Stephanie Merritt of their own unhappy encounters[8] of how exasperatingly difficult it can be to navigate one's way around the therapy maze, about their desperation, confusion, waiting, hit-and-miss results and apparent absence of anywhere to turn to when things don't work out, raise awareness that in seeking solace one does not have to give power away to counselling/therapy 'experts'.

But what Precisely is Counselling?

The terms 'counselling' and 'psychotherapy' are often used interchangeably as there is overlap between them.
 
There is no one definition of counselling, but it is generally regarded as a 'talking therapy' – where you do most of the talking.

Counselling is a contractual arrangement usually involving a series of one-to-one private and confidential meetings with your counsellor which can help you explore your distress and understand yourself and your concerns better. Hopefully, the experience of counselling and your improved understanding, bring you greater freedom and choice to live in a more fulfilling way. Counselling/psychotherapy helps with decision making, but a counsellor will not tell you what to do. Information/advice agencies, telephone helplines, support or self-help groups are better sources if that is what you seek.

Counselling is always undertaken at the request of the client, and no-one can properly be 'sent' for counselling or psychotherapy. There are many situations these days where people with influence in our lives may suggest talking therapies as a solution to a problem. This should be offered without any pressure or strings attached.

What are the Different Types of Counselling?

The BACP website[9] gives an explanation of 23 counselling and psychotherapy theoretical approaches.

These fall into 3 main categories:

Humanistic/Person-centred Counselling
The Humanistic approach encourages you to explore your feelings and take responsibility for your thoughts and actions. Emphasis is on self-development and achieving highest potential rather than dysfunctional behaviour. A 'Client-centred' or 'non-directive' approach is often used and the therapy can be described as 'holistic'.

The counselling relationship is very important in Person-centred counselling with the counsellor being sufficiently accepting of you to allow you to freely express emotions and feelings which may have caused emotional problems and are affecting you in the here and now. This enables you to come to terms with negative feelings and develop inner resources; also to perceive yourself as having the power and freedom to change.

This kind of counselling is very much like having chats with someone who is impartial and supportive and who – having an above average knowledge of human behaviour – can help you see the bigger picture.<

Sessions revolve around you, in a way and at a pace that is comfortable to you, and tend to be non-time limited, with you deciding jointly with the counsellor when to end the relationship.

Cognitive and Behavioural Counselling
Cognitive counselling combines cognitive therapy and psychotherapy and encourages you to draw on your own resources to develop the skills to change destructive patterns of behaviour. Negative ways of thinking are explored and treatment is structured and directive involving diary-keeping, progress charts, etc.

Behavioural therapy is based on the belief that behaviour is learnt in response to past experience and can be unlearnt, or reconditioned, without analysing the past to find the reason for the behaviour.

CBT combines cognitive and behavioural techniques. You are taught ways to change thoughts and expectations; relaxation techniques are also used. This therapy is often time-limited in terms of number of sessions.

Psychodynamic Counselling/Psychotherapy
This approach stresses the importance of the unconscious and past experience in determining current behaviour. You are encouraged to talk about childhood relationships with parents and other significant people, and the therapist focuses on the client/therapist dynamics and in particular on the transference (i.e. when you project onto the therapist feelings experienced in previous significant relationships).

Psychoanalysis is based on the work of Sigmund Freud, who believed that the unacceptable thoughts of early childhood are banished to the unconscious mind but continue to influence thoughts, emotions and behaviour. The psychodynamic approach is derived from psychoanalysis, but usually provides a quicker solution to emotional problems.

Clients can expect sessions to last for years.

Integrative
Some counsellors work in what is called an 'integrative' way meaning that they integrate techniques from other counselling styles.

Conditions that could Benefit from Counselling

People seek counselling for a wide variety of reasons. These could include abuse, academic worries, addictions, anger issues, anxiety, bereavement/grief, bullying, depression, domestic violence, eating disorders, loss, low self esteem/confidence, nightmares and sleep disorders, phobias, relationship problems, self-harm, sexuality, stress, trauma, work-related issues – or a combination of problems.

Which Style of Counselling to Choose?

No one style of counselling suits everyone and none can be said to be ideal in all circumstances. Each uses a specific approach, some employ particular techniques and all work to achieve the same end result (to 'guide us from feeling victims of circumstances to feeling we have some control over our lives')[10] but in different ways.

The overall number of counselling sessions will also differ depending upon type of counselling, with Psychodynamic usually involving years of therapy.

Hopefully the overview provided of the 3 main styles (plus BACP's explanation of the 23 counselling and psychotherapy theoretical approaches) will help you decide which is best for you. My own preference is for a humanistic/person-centred integrative approach.

Choosing a Counsellor

The profession is as yet unregulated, so anyone can set up as a counsellor. In choosing a counsellor it is therefore sensible to check:

• Their qualifications (as a minimum they should have a Diploma or Advanced Diploma in Counselling – those with a Certificate or Advanced Certificate have not yet been deemed fit to practise by any awarding body; those with a degree in psychology but no counselling training do not have the necessary skills);
• Whether they are accredited and with whom (this is a measure of their professional competence,since counsellors cannot be accredited until they have gained significant experience);
• Which professional association(s) they are a member of and at what level, and their code of ethics;
• Their theoretical approach (ie counselling style);
• Their competence in helping you with your issue;
• Cost ;
• Location, timing etc.

Select a number of counsellors who seem to fit your requirements, contact them and ask questions, to get a 'feel' for them and then arrange an initial session with one or more before making your final choice. A good guide is to check how you feel about their manner towards you; whether you could be completely open with that person; and if you would feel comfortable sharing intimate details of your life with them.

Whatever their chosen orientation, counsellors are trained to minimise the extent to which their own personality, beliefs, attitudes etc seep into the therapy relationship.  Where such seepage occurs, it is for you to decide to whether this is acceptable, or not, in the counselling setting.

As Sally Brampton[11] says, "apathy, fear, resignation, misplaced good manners and giving power away to an 'expert' keep a lot of people in thrall to bad therapy". So, do remember that you are the client and have rights, whether or not you are paying directly for the service; that you (not the counsellor) are the expert in your own life; also that development of a mutually respectful, honest and trusting relationship is crucial to achievement of therapeutic change via counselling.

Remember too that if you have had a bad experience with counselling in the past, not all counsellors are like that. Similarly, if you have had a good experience, please don't expect to find a clone of your previous counsellor.

In conclusion, if you are searching for ways to alleviate distress, I hope this article is helpful to you and that you find comfort and solace through counselling.

References

1. Positive Health PH Online Issue 144 February 2008. www.positivehealth.com/article-view.php?articleid=2256  
2. HSE 2007/08. Survey of Self-Reported Work-Related Illness, Stress-related and Psychological Disorders. http://www.hse.gov.uk/statistics/causdis/stress/index.htm
3. Health Starts on the Inside. CIPD People Management Magazine. 26 June 2008.
4. Sarah Brown. The Therapy Maze. BACP Therapy Today. June 2008.
5. Experts Call For Campaign to Boost Nation's Mental Health, Guardian, 22 October 2008 CIPD, People Management, 26 June 2008.
6. Pete Sanders. Why Person-centred Therapists must Reject the Medicalisation of Distress, Self & Society. Vol 34 No 3. December 2006.
7. Brainchild for the British Association for Counselling and Psychotherapy.
8. Sarah Brown. The Therapy Maze. BACP Therapy Today. June 2008.
9. BACP website http://www.bacp.co.uk/seeking_therapist/theoretical_approaches.php  
10. Hetty Einzig. www.bacp.co.uk/seeking_therapist/right_therapist.php .
11. Sally Brampton. Travels through Therapy. BACP Therapy Today. June 2008.

Note: The author does not promote any therapy as a substitute for medical or psychological diagnosis and treatment, and would never interfere with any medical regime a client is following. She is not anti-psychiatry, just anti the medical model of mental illness and the 'medicalisation of distress'.