Counselling effectiveness

Bernard99

http://counsellingresource.com/types/effectiveness.html

Found this on the www.

As part of a counselling course, we have been reflecting on the personal development part recently. That as much as we need to learn the practice of counselling, we also need to learn about ourselves, to get in touch with ourselves as individuals. To know ourselves, our boundaries, our limitations and our strengths. And that this is as important to our efficacy as counsellors as the practice of any particular approach we choose to prefer.

It gives us confidence. It allows us to "meet" clients and value the person in front of us, to counsel the person, not their behaviours.

Here's a quote from the above article:

"While no one type of therapy stands out in terms of overall effectiveness, however, individual counsellors clearly do. Within given approaches, research shows very significant variation between individual counsellors. Indeed, the evidence suggests that the abilities of individual therapists may be a more significant factor in determining outcome than therapeutic orientation! So there may not be a clear answer to the question of whether there are better or worse therapeutic orientations, but there certainly are better and worse therapists. Pinning down exactly why this is so -- exactly what kinds of factors account for the variation in individual results -- is much more difficult. The research evidence cannot yet help the client to understand exactly why one therapist might be better or worse for them than any other. Worse, there is no evidence that any of the various counsellor accreditation schemes serve to pick out better therapists, and neither years of counsellor experience nor duration of their training have any strong bearing on therapeutic outcome. (Indeed, some research has even suggested that counsellors in training and newly-qualified counsellors are more effective than their more experienced peers!)"

I'm struck by a simple question in response.

How much does this understanding differ from other professional practices? What other professional practices are limited in the same way by individual variabilities? For example, Teaching, GP's etc?

Very interested to get some feedback from the board on this.

Odysseus

Personal therapy, and in some cases psychometric testing are not guarantees but they do help weed out some unsuitable candidates. Personal therapy varies very much in a persons training, some bodies/courses require more than others.

CBT therapists especially psychologists would in a lot of cases see no need for person therapy; the other end of that continuum being psychoanalysis. I was in analysis for 5 years and for 2 of them it was twice weekly. At the end of the day the need for personal therapy started with psychoanalysis.

I'm not aware of any other profession where there is a need to experience the process that you supply for a living, unless you’re training people for combat, or endurance events. They are they only ones that come to mind for me.

You have to careful here too, I still get the "but you where never an addict you can't really understand" sh!te.

Now do the individual differences you are asking about relate to personal therapy, or is it more about individual practice. I'm a Lacanian psychoanalyst this means I conduct psychotherapy in a certain way, but one of my peers may operate in a different manner, but we could both be working in that modality.

The point you made about newly trained vs older therapists is often used, even though I forgot the original source. However, I would not see it as being solely connected to personal therapy, or am I picking you up wrong?

Bernard99

Ah yes.

There are two points here I suppose. Maybe a bit circular.

First is the level of introspection required by counsellors.

Second is the question of variability within the population, and this is what I wanted to focus on. That it is, according to the article referenced above, the quality of the individual counsellor that more determines the successful outcome of the therapeutic engagement, rather than the approach that is used. Quite a claim.

This appears to place more emphasis for a successful outcome on the individual counsellor than the approach used.

Does this then bring us back to the importance of personal development for practioners?

Outside of methodology used (PCT, CBT, PSYD), how do we measure the quality of a counsellor?

Odysseus

Bernard99 wrote: »

Ah yes.

There are two points here I suppose. Maybe a bit circular.

First is the level of introspection required by counsellors.

Second is the question of variability within the population, and this is what I wanted to focus on. That it is, according to the article referenced above, the quality of the individual counsellor that more determines the successful outcome of the therapeutic engagement, rather than the approach that is used. Quite a claim.

This appears to place more emphasis for a successful outcome on the individual counsellor than the approach used.

Does this then bring us back to the importance of personal development for practioners?

Outside of methodology used (PCT, CBT, PSYD), how do we measure the quality of a counsellor?

In order to measure something and I'm not sure there is any agreement on what a successful outcome is. Is it just the reduction of symptomatology? Can it be measure on something like global functioning scales?

It has been a topic of debate since I start training, even with my own modality the end of treatment and what defines it, is not a given. Within psychoanalysis some people would make a distinction between a therapeutic analysis, that being where a person is dealing with life much better than when they started, and one where the person continues with therapy after this point for other reasons.

I think that part of the problem is there is not standard of training in psychotherapy. Can you really compare a person with a diploma and 6mths of personal therapy to someone who has post-grad training and years of personal therapy? This is why I support the two levels of psychological therapists proposed in the Stat Reg process.

I would be interested to hear what the other people who engage in clinical work think on it.

Torakx

Anyone think it might have something to do with natural abilities regarding emotional intelligence?
What i mean is some being slightly more gifted at seeing emotional que's/needs etc.
How does one know if they are suited to psychology as a profession?
Is this a key factor?
Just some ideas and questions i had after reading this thread.

Bernard99

It is clear that if one progresses through a period of study and qualifies within a profession that they could reasonably expect to have that reflected professionally and have the merit of their studies recognised and valued.

No one would deny that. Masters v's Degree v's Diploma etc.

This doesn't remove the issue of the personal qualities of the individual playing a substantial part of the impact of the therapy that is regarded (?) as successful. And that's regardless of the approach used and I suspect the level attained.

I'm not arguing against qualification or standardisation, far from it. The public needs to be protected and demanding agreed standards from a profession attempts to address this.

So, yes. Are these as yet unidentified and unmeasured personal qualities innate, learned or what? To be honest, I don't think we are any way near being able to answer that question adequately, and yet the question remains and is apparently a very significant issue.

Qualifications don't automatically gaurantee quality, and yet we can't honestly rely on someone having a "natural ability", because we can't measure it, test it, or credit it against a common standard.

So, are the percentages of "good" therapists v's "bad" therapists mirrored in other professions? All doctors have qualifications and some are very good and some are terrible. Is there a statistical measure here that could be tested and compared across the professions?

Phew.....!

Odysseus

Torakx wrote: »

Anyone think it might have something to do with natural abilities regarding emotional intelligence?
What i mean is some being slightly more gifted at seeing emotional que's/needs etc.
How does one know if they are suited to psychology as a profession?
Is this a key factor?
Just some ideas and questions i had after reading this thread.

Quick answer no, I don't believe in the concept of EI. As to being suited, your personal therapy should sort that out. I know lots of people who studied psychoanalysis for years, [some continue, they just don't work clinically] and spent years in analyis only to discover that they are not suited or no longer desire to work in a clinical manner.

I know that leaves more questions, but that is what it is about. Sometimes the question and its formulation is more important.


Edit: Maybe just to clarify my point on EI, it's not that I don't think it can exist; it's more than I don't see it as having such a fundament role in a therapeutic setting. Then again the way I work I would not be that interested in emotions, the articulation of them is important but I would not see it as being as significant as some therapists believe.

Odysseus

Bernard99 wrote: »

It is clear that if one progresses through a period of study and qualifies within a profession that they could reasonably expect to have that reflected professionally and have the merit of their studies recognised and valued.

No one would deny that. Masters v's Degree v's Diploma etc.

This doesn't remove the issue of the personal qualities of the individual playing a substantial part of the impact of the therapy that is regarded (?) as successful. And that's regardless of the approach used and I suspect the level attained.

I'm not arguing against qualification or standardisation, far from it. The public needs to be protected and demanding agreed standards from a profession attempts to address this.

So, yes. Are these as yet unidentified and unmeasured personal qualities innate, learned or what? To be honest, I don't think we are any way near being able to answer that question adequately, and yet the question remains and is apparently a very significant issue.

Qualifications don't automatically gaurantee quality, and yet we can't honestly rely on someone having a "natural ability", because we can't measure it, test it, or credit it against a common standard.

So, are the percentages of "good" therapists v's "bad" therapists mirrored in other professions? All doctors have qualifications and some are very good and some are terrible. Is there a statistical measure here that could be tested and compared across the professions?

Phew.....!

At the end of the day when we speak of the therapists abilities is it something than can be measured? Are these abilities measured by the client if so then are we speaking of transference? Or are these abilities measured in the same way as CBT is measured in terms of manualised treatments?

CBT or certains forms of CBT are often measured through checklists, that measure whether the therapist followed the treatment format being used. Maybe one of the CBT people could explain it better as I have a limited training in the area. However, when I was training in it, my sessions where recorded and in my understanding they where then assessed on whether I stuck to the treatment format I was supposed to use.

In may indeed be possible to measure therapy in that way, or rather CBT therapy. It is not possible to measure psychoanalysis that way. That is why I do not think we can compared them as treatments, the tools designed to measure CBT do not measure anything in psychoanalysis. I'm not trying to turn this into a CBT vs psychoanalysis, so please if we can avoid that I would be grateful.

sambuka41

Really interesting topic!!

I find the idea of effectiveness strange,how could this even be defined? What would be considered an effective treatment or successful outcome to one may not to another. And i would imagine it would have to be assessed in relation to where the person was before they entered therapy. They may be miles away from this point by the end of their therapy but still not be considered functioning. So how do you compare it,when everyone is so vastly different?

From my work I have seen staff who 'appear' to be very effective but its more to do with the type of work they choose,ie the easy stuff (I dont work as a therapist)So it would seem that they are brilliant but really the material they are dealing with is not the same as the rest of us who are producing modest results.

I also think it really doesn't give a whole lot of credit to the client. Therapy ain't easy!! Its hard work.

I would imagine in reality effectiveness is a combination of:

Personal ability of therapist, personal motivation of therapist, education, modality, client willingness and/or ability to engage, material to be dealt with.

JuliusCaesar

OK.........here's the CBT viewpoint.

Yes therapists are marked on stuff like Interpersonal Effectiveness, Understanding, Feedback, Focussing on Emotions, on Behaviour, on Cognitions, Collaboration, Use of Change Techniques etc. The clinical componant is more important than anything else. Of course if people don't understand, for example, Panic Disorder or OCD, they cannot treat it effectively.

Trainee therapists have to do a lot of self-reflection and self-practice. They have to attain a certain standard. (Obviously that carrys on throughout their career), and have continuous supervision as well as continuous professional development throughout their career.

Outcomes of therapy are measured in improvements in function, in symptoms, in anything else you want to measure. We use both subjective and objective measures. Before and after measurements are taken for all clients so that you can see if the therapy is effective for a particular client and also measure your clinical effectiveness across your caseload.

We tend to work with mental disorders which cause a high degree of distress and dysfunction.