Counselling and psychotherapy

Saintly

Odysseus wrote: »

However, as an aside its an issue that gets to me, the use of the word counselling in cases like this, a psychotherapist or a counsellor provide counselling. As such a person it would not be my place to be handing out needles, the worker would have I hope given them advised on the issue at hand, but this is different to counselling. Not having a go at you mate, but I think its an abuse of the word that is becoming more popular, counselling is a psychotherapeutic intervention and differs vastly from helpful advise. Off topic I know its just a personal bugbear of mine.

It's a bugbear of mine too but for different reasons!! Counselling is certainly not exclusive to the realm of psychotherapeutic interventions. There are 4 recognised levels of counselling, each equally valid and important to the client 1) Information giving, 2)Implications counselling 3)Supportive Counselling and 4)Psychotherapeutic Counselling. (Kings Fund Report originally which escapes my mind, taught everywhere and most recently I spotted it in 'Counselling in Health Care Settings, Bor et al 2009 or 8, can't remember offhand but book is on my desk!)

I'm a social worker and am acutely aware of my abilities and limitations in counselling (brief interventions are essentially our forte), however I am also aware that some of the nurse specialists in oncology/HIV etc engage in stages 1-2. These are also valuable counselling interventions. I am not in any way diminishing the complexities or skills of psychotherapeutic interventions but am pointing out that there is a clear framework of counselling interventions of which psychotherapy forms a part, not the whole.

Odysseus

Saintly wrote: »

It's a bugbear of mine too but for different reasons!! Counselling is certainly not exclusive to the realm of psychotherapeutic interventions. There are 4 recognised levels of counselling, each equally valid and important to the client 1) Information giving, 2)Implications counselling 3)Supportive Counselling and 4)Psychotherapeutic Counselling. (Kings Fund Report originally which escapes my mind, taught everywhere and most recently I spotted it in 'Counselling in Health Care Settings, Bor et al 2009 or 8, can't remember offhand but book is on my desk!)

I'm a social worker and am acutely aware of my abilities and limitations in counselling (brief interventions are essentially our forte), however I am also aware that some of the nurse specialists in oncology/HIV etc engage in stages 1-2. These are also valuable counselling interventions. I am not in any way diminishing the complexities or skills of psychotherapeutic interventions but am pointing out that there is a clear framework of counselling interventions of which psychotherapy forms a part, not the whole.

Yeah I hear what you saying, BTH I completely disagree, those levels you are talking about, are in my own opinion of course, not counselling. I have issuses with the HIV pre-test for example. I often get a referral as someone has gone beyond their capacity.

I'm of the school that if its considered to be a counselling intervention, then a counsellor should be doing it. Staying with the nurse example I don't give advise about STI's for example.

I'm not having a go at you, but if you doing brief interventions, which I would presume you would see as a counselling intervention, so should an accredited counsellor not be doing this work? I sure you have trained in brief interventions, but are you a member of a counselling body. I'm sure your a member of an SW body but that's different.

Its more a case of counselling and psychotherapy being watered down [just my opinion again]. Personally I have significant issues with the way people use "counselling interventions" its often a case of anyone can be a therapist. Which to be honest they can, but do the training, the personal therapy, ongoing training, supervision and become a member of a professional body.

I'm not familar with the report your referring to, but that the type of thing I object to the "Counselling in Health Care Settings". If its counselling, it should be done by a counsellor or psychotherapist. As I have said not having a go at your professional work, but I do feel strongly about other professions engaging in counselling.

Unfortunately we know have a culture where lots of health care workers view this to be part of their work. That's generally fine and dandy until a person gets in over their head, or are effected by a particular case. THB it depends on what type of advice and implications "stuff" your referring to. Part of the issue is what is considered counselling if you get my point.

If I'm working at those levels you are talking about, [as you noted some times people need advise or be made aware of the implications of their actions] I consider it to be more psycho-educational that counselling or psychotherapy. When that occurs I view it as being moved from a counselling position within the session. As I said it happens and sometimes its needed, however [and this depends on the context and content] I don't know if I would consider it counselling.

However, brief interventions are moving more into provoking a lifestyle or psychological/emotional change and I do consider that to be therapy. It can be a difficult line to draw, so you will always have differences in opinion.

Saintly

Odysseus wrote:

Yeah I hear what you saying, BTH I completely disagree, those levels you are talking about, are in my own opinion of course, not counselling. I have issuses with the HIV pre-test for example. I often get a referral as someone has gone beyond their capacity.

Obviously you can disagree - but the levels I'm talking about are recognised and accepted throughout literature and in daily practice - and are regularly promoted by the likes of Ursula Bates/Gerry Butcher etc in professional development, here in Ireland.

Odysseus wrote:

I'm not having a go at you, but if you doing brief interventions, which I would presume you would see as a counselling intervention, so should an accredited counsellor not be doing this work? I sure you have trained in brief interventions, but are you a member of a counselling body. I'm sure your a member of an SW body but that's different.

I know you're not having a go - social workers come across this all the time, as the majority of other professionals have absolutely no idea of the content of our training -which is fair enough, it just means we have to get better at PR. First of all, UCD graduates (and presumably other social work graduate programmes, can't speak past my own uni) are certified in counselling, when awarded the Masters. We all receive regular clinical supervision and are employed in counselling settings (65 per cent of my referrals related counselling related to illness). We work in conjunction with psychologists and psychiatrists. We are all very clear on what we can and can't do. Equally, we're all clear that not everybody who requires supportive counselling, needs to see a psychologist, psychotherapist or a psych.

We're very clear about what needs to be passed on. I'm competent in crisis intervention, solution focused therapy, motivational interviewing etc. It has been indicated to the IASW that when statutory registration for counselling comes in, social workers will be recognised as counsellors. The IASW has not sought to be a membership of any other body, on the basis that statutory registration should be introduced (longstanding party line) and is the only relevant and appropriate yardstick for good practice. I work with some social workers who have also trained in psychotherapy, others in CBT, all of whom just belong to IASW.

Odysseus wrote:

Its more a case of counselling and psychotherapy being watered down [just my opinion again]. Personally I have significant issues with the way people use "counselling interventions" its often a case of anyone can be a therapist. Which to be honest they can, but do the training, the personal therapy, ongoing training, supervision and become a member of a professional body.

I agree that the terms counselling and psychotherapy are flung around - but I also sometimes think that psychotherapists assume that psychotherapy is the sole form of counselling that should and can be offered. That's fine - but it's a blinkered view that can be irritating to the rest of us in the sandpit, particularly when it contradicts so much in counselling literature. Psychologists and psychiatrists, in my experience, work from a completely different perspective - so I'm sure you understand, it can be frustrating for us, to have to justify our professional training and competence in other contexts. That said, registration should eliminate the problem of random people doing 2 day courses in CBT and then setting up shop as CBT practitioners.

Odysseus wrote:

I'm not familar with the report your referring to, but that the type of thing I object to the "Counselling in Health Care Settings". If its counselling, it should be done by a counsellor or psychotherapist. As I have said not having a go at your professional work, but I do feel strongly about other professions engaging in counselling.

Which is essentially where we differ - though thankfully, my counselling competencies are recognised by my university, by my professional body, by registration should it arrive here and by my employers - here and abroad.

Odysseus wrote:

However, brief interventions are moving more into provoking a lifestyle or psychological/emotional change and I do consider that to be therapy. It can be a difficult line to draw, so you will always have differences in opinion.

Brief interventions have long been regarded as a form of therapy. I honestly do hope that registration settles some of the issues. And to finish up, despite my occasional frustrations, I have the height of respect for psychotherapists and the work that they do. Keep on trucking!

Odysseus

Sanitly, thanks for a very informative post, I'm going to be offline for a few days, I don't want you to think that I'm avoiding responding to your post. I'll get back to you when I' back online. Cheers.

DrIndy

This is an intereting debate - so i have split the posts off to a new one to let the debate continue.

Odysseus

Saintly wrote: »

Obviously you can disagree - but the levels I'm talking about are recognised and accepted throughout literature and in daily practice - and are regularly promoted by the likes of Ursula Bates/Gerry Butcher etc in professional development, here in Ireland.



I know you're not having a go - social workers come across this all the time, as the majority of other professionals have absolutely no idea of the content of our training -which is fair enough, it just means we have to get better at PR. First of all, UCD graduates (and presumably other social work graduate programmes, can't speak past my own uni) are certified in counselling, when awarded the Masters. We all receive regular clinical supervision and are employed in counselling settings (65 per cent of my referrals related counselling related to illness). We work in conjunction with psychologists and psychiatrists. We are all very clear on what we can and can't do. Equally, we're all clear that not everybody who requires supportive counselling, needs to see a psychologist, psychotherapist or a psych.

We're very clear about what needs to be passed on. I'm competent in crisis intervention, solution focused therapy, motivational interviewing etc. It has been indicated to the IASW that when statutory registration for counselling comes in, social workers will be recognised as counsellors. The IASW has not sought to be a membership of any other body, on the basis that statutory registration should be introduced (longstanding party line) and is the only relevant and appropriate yardstick for good practice. I work with some social workers who have also trained in psychotherapy, others in CBT, all of whom just belong to IASW.




I agree that the terms counselling and psychotherapy are flung around - but I also sometimes think that psychotherapists assume that psychotherapy is the sole form of counselling that should and can be offered. That's fine - but it's a blinkered view that can be irritating to the rest of us in the sandpit, particularly when it contradicts so much in counselling literature. Psychologists and psychiatrists, in my experience, work from a completely different perspective - so I'm sure you understand, it can be frustrating for us, to have to justify our professional training and competence in other contexts. That said, registration should eliminate the problem of random people doing 2 day courses in CBT and then setting up shop as CBT practitioners.



Which is essentially where we differ - though thankfully, my counselling competencies are recognised by my university, by my professional body, by registration should it arrive here and by my employers - here and abroad.



Brief interventions have long been regarded as a form of therapy. I honestly do hope that registration settles some of the issues. And to finish up, despite my occasional frustrations, I have the height of respect for psychotherapists and the work that they do. Keep on trucking!

I hope we are not being set up here Saintly;) Anyway forgive me I not good at separating quotes so I have to do the lot in one go.

Just because some authors state some things and some disciplines acknowledge certain things doesn't make it fully correct. I trained as a psychoanalyst so most of my reading goes in that direction. However, I'm around awhile so I additionally trained in the other modalities that you metioned, I'm just not over familar with the authors you metioned. Furthermore lets remember there have been alot of money to be made over the years in training people up in stuff like brief solution focued, MI and the likes, so the is a financal motivation for trainiers and authors to take that position. Though of course I'm not stating that was the soul reason or that everybody was at that. At the end of the day we all have to work, and we get paid for it.

When you say certified in counselling what does that mean? Does it fulfill the educational requirements for a profession therapeutic body? Even if it did, and it may as in some cases the requirements are poor in my opinion, most have a certain amount, approx two years following graudation before you become a full member IIRC. So I'm a tad confused when you say your certified upon graduation. Additionally, with supervision, my understanding of clinical supervision is that its carried out by a member of a therapeutic body, who is considered to be a supervisor by that body. So is your supervision do by such or is it your line mamager, or another S/Worker. Personally my own opinion is that therapists should be to Masters level in a therapy discipline.

For example I'm required to be in supervision for a certain amount of hours a year by a recognised supervisor, recognised by the bodyn I am a member of.

I was looking over the last copy of the stuff I have on stat reg and I couldn't see the IASW metioned anywhere in the proposal. The is a list of all the bodies involved in the process and it was nowhere to be seen. Do you know where that indication have come from? Also just to note I acknowledge the work that S/workers do as very valauble, so please don't think I am against your profession, I would be making the same points to a nurse, or other profession.

Lets the the MI example you metioned as part of your training, MI has being a popular modality for the a good few years now, however, its very limited in its scope. Whilst it may be of some use in relation to addictive behaviours and of course its not limited to that. However, its a strategy for interventions, if we follow that on in relation to addiction, it lacks a theory. It tells me little out about addiction, it supplies a person with a what of changing a behaviour that's all. To the best of my understanding.

Furthermore, its very limited in its training, for example you could do a Masters in quite a few different forms of therapy, but you can't with MI, crisis intervention, or S/Focused [though I could be wrong on the last]. My point here is that alot of therapists may use these interventions, but they only form parts of courses, and if that is all you have [not you personally] then as a therapist you don't have alot.

You profession engages in very useful work with addicts to carry on from above but would it not be better to referral them on to a therapist in the Addiction Services?

Also I take your point that quite a few S/Workers are quailified in therapy, however, if your employed as a S/Worker you have a different hats to wear that can take you away from your counselling position.


Anyone else here any views on this point though I would suscept I'm out numbered:)

Saintly

Odysseus wrote:

Just because some authors state some things and some disciplines acknowledge certain things doesn't make it fully correct.

Of course not. That's why we look for an evidence base. Which social work counselling interventions have.

Odysseus wrote:

When you say certified in counselling what does that mean? Does it fulfill the educational requirements for a profession therapeutic body? Even if it did, and it may as in some cases the requirements are poor in my opinion, most have a certain amount, approx two years following graudation before you become a full member IIRC. So I'm a tad confused when you say your certified upon graduation. Additionally, with supervision, my understanding of clinical supervision is that its carried out by a member of a therapeutic body, who is considered to be a supervisor by that body. So is your supervision do by such or is it your line mamager, or another S/Worker. Personally my own opinion is that therapists should be to Masters level in a therapy discipline.

Social work is a recognised therapy discipline, with a professional therapeutic body! After completion of a full time two years Masters (vast majority of which is counselling/reflective practice) , which followed a 3 yr Social Science degree, UCD certifys it's graduates in social work counselling, along with the award of the Masters. I have no idea who outside of IASW, national and international employers recognise it - clinical social work supervision is completed by senior social work staff, again as the IASW hasn't been interested in pursuing membership or other bodies.

Odysseus wrote:

For example I'm required to be in supervision for a certain amount of hours a year by a recognised supervisor, recognised by the bodyn I am a member of.

As am I. It's part of my contract and absolutely non negotiable, along with commitment to CPD.

Odysseus wrote:

I was looking over the last copy of the stuff I have on stat reg and I couldn't see the IASW metioned anywhere in the proposal. The is a list of all the bodies involved in the process and it was nowhere to be seen. Do you know where that indication have come from?

Give me time with this - was widely referenced at national conference both this yr and last - will have to dig out more info.

Odysseus wrote:

Also just to note I acknowledge the work that S/workers do as very valauble, so please don't think I am against your profession, I would be making the same points to a nurse, or other profession.

With all due respect, you're acknowledging what you think social workers should do -which is to ignore their counselling training!

Odysseus wrote:

Lets the the MI example you metioned as part of your training, MI has being a popular modality for the a good few years now, however, its very limited in its scope. Whilst it may be of some use in relation to addictive behaviours and of course its not limited to that. However, its a strategy for interventions, if we follow that on in relation to addiction, it lacks a theory. It tells me little out about addiction, it supplies a person with a what of changing a behaviour that's all. To the best of my understanding.

MI lacks a theory?! It is a successful, well established and skilled brief intervention that has an impressive evidence base when compared with outcomes for other forms of intervention in alcohol. Check out the WHO report on Brief Interventions/Alcohol Audit for an overview of the research. A successful MI can be the first step on the road to recovery for someone. It's about client centred practice -some people never want to understand the source of their addiction, they simply want to stop using the substance.

Odysseus wrote:

Furthermore, its very limited in its training, for example you could do a Masters in quite a few different forms of therapy, but you can't with MI, crisis intervention, or S/Focused [though I could be wrong on the last]. My point here is that alot of therapists may use these interventions, but they only form parts of courses, and if that is all you have [not you personally] then as a therapist you don't have alot.

I could not disagree more. Social work training focuses on brief interventions -which have an evidence base, they are short term and cost effective. It comes back to a spectrum of counselling need. Not everyone requires and more importantly wants psychotherapy. Psychotherapy is not and never has been historically the be all and end all of counselling. Clients can choose between a variety of proven counselling approaches, some of which social workers can offer, such brief interventions.

Odysseus wrote:

You profession engages in very useful work with addicts to carry on from above but would it not be better to referral them on to a therapist in the Addiction Services?

I work in an acute hospital service - my work with addiction primarily relates to alcohol. In accordance with WHO/HSE recommendations and what is currently understood to constitute best practice in alcohol interventions in hospitals, I conduct an alcohol audit and MI - hazardous drinkers, I hold onto, Zone 4/ harmful drinkers are referred onto specialist services. Again, this practice is in agreement with psychology and psychiatry. Are we all wrong from WHO down?!

Odysseus wrote:

Also I take your point that quite a few S/Workers are quailified in therapy, however, if your employed as a S/Worker you have a different hats to wear that can take you away from your counselling position.

What different hats? If I am asked to review someone for supportive counselling, that is the only hat I wear. End of story.

Odysseus wrote:

Anyone else here any views on this point though I would suscept I'm out numbered:)

I don't think it's a right or wrong issue. It comes down to how we perceive counselling, based on our individual training. For me, there is a spectrum of counselling need. No shoe fits all. As I said, some clients will benefit hugely from psychotherapy, others do not require or want it. Some prefer cognitive approaches like CBT - incidentally, I am considering the postgrad at which point, my good friend, a psychoanalyst of the Darian Leader school of thought, will prob disown me! The joys! Bottom line - I respect and value psychotherapy but find in general, that it's practitioners are blinkered in their perspective of other professional counselling interventions - even in the face of a clear and long established evidence base. Its not logical to me and is frustrating. Thankfully, I don't experience this from other professionals. Am offline myself for a bit, but ultimately I think we will just go round and round on this one anyway...

tallaght01

This is all very non-evidence based. IN fact it's pure anecdote. But I've never referred anyone for counselling to a social worker. And many social workers have referred patients (or more usually for me, their parents) to counsellors.

Most of my experience would be in bereavement situations, and addiction. That's within the acute hospital settings.

With my paeds bahavioural clinic in outpatients, I send my patients to a child psychologist, or a family therapist.

Within my refugee clinic, most of my counselling interventions involves sensing people to the trauma clinic for torture couselling.

Within this sphere I refer to social work a lot. But they've never been the ones involved in actually counselling my patients.

Am I an exception?

JuliusCaesar

When I was in training, our group therapy was lead by 2 Social Workers trained in psychodynamic therapy. (I'm not a SW)