This article was originally submitted in 1999 to Australian Catholic University as part of a Masters Programme.
The great seventeenth century poet and satirist Alexander Pope wrote in his famous poem, Essay on Man, the following words:
“Know then thyself, presume not God to scan;
The proper study of mankind, is man.”
I have chosen to introduce this essay with these words because in a sense they capture succinctly something of the essence of the counselling encounter. Preceding the application of specific theories and models, what we have at the very heart of the counselling experience is the reality of at least one person whose life consists of a myriad of issues and who is endeavouring to bring a sense of meaning and understanding to those same issues. The subject of the counselling experience, usually referred to as the client, is then the alpha and omega of the whole process. It is vitally important that we do not lose sight of this fact, for all too often external forces like the dynamic employed can overwhelm and even submerge the reality of the client’s own being. In a primitive and almost quaint way, Pope, highlights what is driving all counselling practice, viz., that through a thorough, detailed and professional exploration of the issues of concern for the client, hopefully will come a deeper self knowledge and level of self awareness that will provide a sense of balance which will help the client with the daily skills of living.
This is the philosophical basis for my counselling practice. My role in the counselling encounter is to facilitate the process of personal growth in my clients and to assist them in the often difficult task of effecting the changes they desire to bring about. To do this most effectively and to honour my clients’ processes, it is essential that I undertake the tasks of assessment and decision making in a thoroughly comprehensive and professional manner. The task of this essay then is to detail the aforesaid mentioned tasks, specifically from the perspectives of the four dimensions listed as integral to the process.
The task of assessment.
Before we look at the client’s perspective, it is important to discuss the nature and importance of assessment. Underpinning the process of assessment in counselling and psychotherapy is the desire to find “ a useful balance by considering both a pathological approach (focussing on what makes people unhealthy) and a salutogenic approach (focussing on what makes people healthy) for understanding clients and their problems. (Kleinke, 1994. P.195)
Given that most people engage in counselling because they are experiencing some difficulties in their daily living, it is both obvious and essential that these problem areas need to be addressed. Often distress is caused by a failure in the person’s coping skills which can result not only in distress, but can also lead to dysfunctionality in relationships with self and with others. In his article “Problem solving psychotherapy ”, Fische defines the role of the therapist in the following way.
“The principal job of the expert in psychotherapy is to assess where the clients are stuck, what mainly they are doing to get unstuck, and how to influence them to stop doing what they regard as logical or necessary.” (Fische, 1990. P.271)
What Fische is saying in effect is that it is the task of all therapists to help clients change from implementing ongoing solutions that are not working and to help them learn new strategies and skills which assist them in viewing and understanding their problems differently. This then is the reason which underpins my belief in the value and necessity of all encompassing assessment and decision-making procedures for my counselling practice. In their book, Therapeutic Psychology: Fundamentals of Counselling and Psychotherapy, the authors Brammer, Shostrom and Abrego write that the purpose of integrative assessment is to attempt to answer several key questions.
“What are the client’s presenting problems? How do these problems fit into a comprehensive picture of client functioning? How does the client’s unique history influence his or her experience of and manner of dealing with the problem? Does the client’s problem have a function in the larger systemic context? What is the therapist’s experience of the client and his or her interpersonal style?” (1989. p.150)
It is the task of assessment to begin to unravel the answers to these questions, by providing the framework on which to build the counselling dynamic. It is important to note that diagnosis and assessment are not the same processes. They do however have the same end goals, viz., to facilitate the processes of growth and change through the implementation of strategies and procedures appropriate to the individual client’s needs and aspirations. I am not skilled in the technical aspects of clinical diagnosis, though I do utilise all resources at my disposal to assess the presenting problems confronting my clients, in order to implement the most appropriate and beneficial procedures for their welfare.
The client’s perspective
There are numerous reasons why assessment is important from a client’s perspective. I try to work with basically a coping skills model of assessment that is focussed on three areas of the clients’ experience : (1) their interpersonal relationships, (2) their cognitive and feeling capacities and (3) their approach to self and life. The importance of assessment for me is seen by the fact that it is one of the foundational underpinnings of my counselling practice. In the last few months, I believe that with the techniques and skills I have learned and studied, I have acquired a level of knowledge and maturity that was previously lacking in my practice.
Theoretically, I have shifted from an almost exclusively humanistic approach to a more eclectic one, drawing largely on Rogerian techniques to assist initially in the establishment of rapport and empathy, but then employing a mixture of cognitive therapy and rational emotive techniques. My experience has been that it has given more definition not only to my methodology, but has also provided a framework in which my clients are able to express themselves confidently and constructively, as well as engaging themselves in the process of their own development.
With regards to the client’s presenting problem, I try fairly early to assist the client in identifying, clarifying and prioritising what are often numerous issues in order to discern the best method of procedure. As part of this process of information gathering, I help them to note several of the issues associated with their behavioural problems, including their thoughts, feelings and responsive behaviours when confronted with difficulties. Part of the strategies I employ with the client is to assist them in assessing their previous attempts at dealing with the presenting problems. As I have experienced graphically, it is essential that the client be able to assess his/her own expectations with regards to the process itself, as well as their expectations of the outcome of therapy.
Several of the issues that I would explore with the client in a coping skills model involve helping them to assess their general social skills, including their ability to be a good conversationalist and listener and the balance they achieve between assertiveness and respectful tolerance. It is also of benefit for them to assess the more intimate interpersonal skills (such as the ability of selecting and maintaining viable loving relationships) and the level of possession of their appropriate socialisation skills.
Other areas that the client may benefit from exploring include the realms of their cognitive and feeling capacities. Through assessing their ability to concentrate and to be flexible in finding solutions to problems, clients can display their abilities for effective cognitive functioning. By demonstrating a capacity to be in touch with their feelings and to experience appropriate emotional arousal, the client may well demonstrate their own level of true self awareness and esteem, which may well underpin their own self –expectations.
Kleinke outlines five themes which often become the focus of psychotherapy. These are : losses, interpersonal conflicts, symptoms, personality disorders and developmental dysynchronies. (p.201) The reason I am listing these is that they have become foundational elements in my own process of assessment of clients. The other technique that I am striving to incorporate into my model of counselling is the Lazarus model of BASIC-ID, which helps clients and myself in the assessment process.
Even though the client may never be fully aware of the need for or the value of assessment, I believe that we do them and ourselves a grave disservice if we do not approach it responsibly and with maturity. Not trained as a diagnostician, I must be vigilant in my determinations as to the nature and intensity of client’s presenting problems. Often there are obvious manifestations of disorders beyond the level of my competency and I try to respond quickly and appropriately to them through the medium of proper referrals.
With regards to clients who are not suffering from some major diagnostic mental disorder but who present for therapeutic interventions aimed at helping them to get “unstuck”, then I have just as much responsibility to provide them with proper assessment before the process of decision making can be undertaken. Brammer, Shostrom and Abrego write on this point :
“The integration of assessment information requires a process of developing a description and explanation of the client’s problems that will be used as the basis for developing a therapeutic plan. The therapist is interested in linking the client’s presenting problems to the client’s own personalised meaning of the problem, unique developmental history, family system interactions, and formulate explanations that hypothesise about why the client has become symptomatic at this particular time.” (p.156)
The counsellor’s perspective.
Counsellors usually learn to accommodate themselves to their role. This has been my ongoing experience, especially during the course of this year. Prior to undertaking formal counselling studies this year, my training had been limited and the results of some of my interventions to say the least have been of dubious value. I have written in another essay about the expectations that people can have of you, which arise out of another role you have in society. This has often been the case with myself, where people have not really delineated between my role as a priest and my developing role as a counsellor. I shall return to this theme when I develop the sections on the organisational and wider social context. For now, I want to focus on critically assessing my role as a counsellor and the way this impacts on my decision making with regards to my clients.
The point I wish to stress about accommodation to roles is that most often the counselling experience remains a somewhat mysterious and perhaps even frighteningly risky one for clients. One of the reasons why I have become so committed to the concept of assessment is so that I will always strive to respond to my clients as unique individuals with specific issues and not as diagnostic problems with presenting symptoms. I believe that the latter approach only serves to re-inforce the erroneous notion that the purpose of counselling is to provide a healing or a cure.
Brendan McLoughlin, writing in his chapter entitled, “The Client Becomes a Counsellor” says,
“Counselling is not a cure, but a context in which we can have experiences which help us to gain insight and gradually become more responsible for ourselves. That process may remove distressing symptoms of all kinds, but symptom reduction is not the end point- in itself. The achievement is that it helps us to be more responsive to ourselves as whole beings, mind and body, psyche and soma.”
The last sentence has become an operative principle for my counselling analysis and practice. It is perhaps the conclusion of this chapter that provides real insight into the relationship between the counsellor and the client when they share the same entity.
“The client who becomes a counsellor…must never stop being a client, in the sense of continuing to bring the same kind of attentive listening to his or her process. Of course there has to be an end to formal counselling and there needs to be a balance between introspection and unselfconscious participation in life. The client who becomes a counsellor especially has the duty or remaining in touch with his or her own inner world if he or she is to avoid abusing clients to satisfy the neurotic parts of him or herself.” (Mearns and Dryden, 1990. p.65.)
It seems to me that in some ways I was already engaging in a cognitive behavioural approach without the technical advantage of knowing what it was. I have had for a long time a deep conviction that activating situations ( be they people or events) are not really the things that influence or cause disturbance within us, but rather the views we have especially of the beliefs and principles that orchestrate our response to these events. Ellis emphasises the role of irrational beliefs in emotional disorders and he identifies three major irrational beliefs which invariably are expressed in extreme terms such as demands, musts, shoulds and oughts. These three irrational beliefs are:
- I must do well and win other people’s approval or I am worthless;
- Other people must treat me considerately and kindly in exactly the way I want them to treat me (or they should be blamed and punished);
- Life must give me everything I want quickly and nothing that I don’t want.
As a consequence of the Mental Status Examination, I find myself quickly identifying any signs of this irrational belief system and responding to it. In this regard as well as in my general counselling practice, I employ the use of metaphors to enhance and foster insight in my clients. Metaphors are one of the most ancient aids to human communication, and epic tales such as Gilgamesh is as relevant today as it was almost 4000 years ago.
Barker writes that
“… the power of the metaphor derives from its ability to convey meaning to the part of the brain that deals with imagery, symbols, and people’s overall view of the world.” ( 1996, p. 9) He further states that in the discipline of psychotherapy, the use of metaphors is one of many strategies that are used to make our communications more effective. “Metaphor can be used to assist in the development of rapport with our clients; it can help in the establishment of treatment goals; and it has many uses in the course of treatment, once goals have been established.” (1996, p. 30)
My experience has led me to conclude that I use metaphors quite creatively with my clients and that it enhances their journey of self-discovery. Since it appears to be effective I shall continue to develop it as part of my assessment and decision making strategies.
The organisational and wider social contexts.
There are two things that I mention as being instrumental forces in society as we approach a new millenium. The first of these is the rapidity of change and our ability to cope with it. The second is not unrelated ; it is the impact of the media and the ways in which they influence our abilities to think, process and understand information.
Everything today is affected by the immediacy of the technological revolution, even long-standing institutions which struggle against real forces which threaten their very survival. Accountability has to be transparent in a world that increasingly demands
impeccable integrity in the light of impossible scrutiny. Everything today seems to lend itself to the possibility of litigious action. People are becoming unrealistically cautious and politically correct in the extreme, driven not so much by a sense of the moral imperative but rather out of a fear generated largely from morally bankrupt and corrupt institutional forces.
Hence we live in a world in which the media creates a phenomenon like Diana, then constantly recreates it in accord with its own need for self perpetuation. It is like a huge parasite feeding on itself in order to continue its dubious life.
None of us remain unaffected by these forces in society. In recent years the organisation of which I am a member has rightly been criticised for many serious failures in areas of sexual morality and abuse. Yet I cannot help but wonder whether or not such well publicised events do not serve as a cover up for the much broader issues of abuse which we know occur most frequently in familial settings.
It is interesting to note that in countries where there is supposed to be the highest levels of tolerance and individual freedom, that the incidence of people in therapy is unusually high. In some ways, perhaps therapy has become something of a boutique industry, spawned by a society with an insatiable appetite for self preservation. This is not to belittle the role of authentic psychotherapeutic and counselling practices. It does however lead us ask questions seriously about the customs, practises and freedoms in society that lead to such high levels of dysfunctionality.
Whilst I conduct my counselling practice outside of any official organisational context, I am nonetheless influenced by the value system of the Catholic Church, which I basically support but do not necessarily agree with every tenet it espouses. There is often a duality at work which is not all that surprising given the complex structure of an organisation as large as the Catholic Church. The church has always taught that an informed conscience has primacy in the area of moral decision making. This has underpinned a lot of my counselling practice, especially in the areas of sexual ethics where issues like contraception, family planning and sexual preference often cause tension for many clients. Because of what I believe to be my well reasoned and thought through areas, I have no difficulty in counselling people to live in the freedom that the reality of their own lives brings.
In areas such as euthanasia and abortion, my own value system is not what the world would term “liberal.” This is because of deep seated convictions I hold about the essential nature and sanctity of human life, which I know not everybody shares and which I do not necessarily want them to share. They could however be areas in which I would feel compromised in my ability to be totally open to the counselling dynamic. Whilst I think I would be extremely supportive of the client who was struggling with these issues, I think the issues of conflicting values and countertransference could impede my counselling effectiveness. In that instance I would immediately refer the client to someone who could meet and support their needs more appropriately. This is another example of how valuable the process of good assessment informing decision making is.
In conclusion, my reasons for mentioning the rapidity of change and the power of the media are because they directly impinge on the counselling process in many ways. The prevalence of “quick-fix” psychologies and untrained talkshow therapists can do untold damage not only to clients, but even to the counselling profession itself. In a sense they have become the counselling world’s equivalent of Christian fundamentalism. They each have a certain charismatic appeal, particularly to the vulnerable, but because their foundations are weak, their value is compromised and limited. More than ever, they serve as a foil that testifies to the need for assessment and decision making procedures, based on sound principles which have withstood the test of time.
I have always found a certain earthly wisdom in the writings of Pope and just as I began with him, I would now like to conclude with these couplets from his Essay of Critics and Criticism.
“Be silent always when you doubt your sense;
And speak, though sure, with seeming diffidence:
’Tis not enough your counsel still be true;
Blunt truths more mischief than nice falsehoods do;
Men must be taught as if you taught them not,
And things unknown proposed as things forgot.”
- Barker, P. (1996) Psychotherapeutic Metaphors. A Guide to Theory and Practice. New York : Brunner/Mazell.
- Brammer, L. Shostrom, E and Abrego, P. (1989) Therapeutic Psychology. Fundamentals of Counselling and Psychotherapy. 5th Edn. New Jersey : Prentice Hall.
- Confer, W. (1987) Intuitive Psychotherapy. The Role of Creative Therapeutic Intervention. New York : Human Sciences Press.
- Corey, G. (1986) Theory and Practice of Counselling and Psychotherapy. 3rd Edn. California : Brooks/Cole.
- Feltham, C. (1995) What Is Counselling? The Promise and Problem of the Talking Therapies. London : Sage.
- Howard Esq, A. [Unk] The Beauties of Pope, consisting of selections from his poetical and prose works. London : T.Davison publisher.
- Kleinke, C.(1994) Common Principles of Psychotherapy. California : Brooks/Cole.
- Lukas, S.(1993) Where to Start and What to Ask. An Assessment Handbook. New York. W.W. Norton & Co.
- Mearns, D. (1997) Person Centred Counselling Training. London : Sage.
- Mearns, D and Dryden, W. Experiences of Counselling in Action. London : Sage.
- Thompson, R. (1996) Counselling Techniques. Improving Relationships with Others, Ourselves, Our Families and Our Environment. Washington : Accelerated Development.
- Trower, P., Casey, A. and Dryden, W. (1988) Cognitive Behavioural Counselling in Action. London : Sage.