Counselling At The Westlake Clinic

What is counselling?  Counselling provides a regular time and space for people to talk about their troubles and explore difficult feelings in an environment that is dependable, free from intrusion and confidential. A counsellor should respect your viewpoint while helping you to deal with specific problems, cope with crises, improve your relationships, or develop better ways of living.

Despite the name, counsellors don’t usually offer advice. Instead, they help you to gain insight into your feelings and behaviour and to change your behaviour, if necessary. They do this by listening to what you have to say and commenting on it from their particular professional perspective. The word ‘counselling’ covers a broad spectrum, from someone who is highly trained to someone who uses counselling skills (listening, reflecting back what you say, or clarifying) as part of another role, such as nursing. We use the term here to mean a talking therapy delivered by a trained professional. Sessions usually take place once a week.

Making this regular commitment gives you a better chance of finding out why you are having difficulties.

How can counselling help? You may come to counselling because of difficult experiences you’ve been going through, such as a relationship breakdown, bereavement or redundancy. Or you may want help dealing with feelings of sadness, depression, anxiety or low self-worth that don’t seem to be connected to any particular event.

Counselling can also help you overcome mental health problems, such as depression or an eating disorder, even if you are already getting other kinds of help from a GP or psychiatrist. It can also help you come to terms with an ongoing physical problem, illness or disability. Counselling can also be a means of coping with physical symptoms or complaints that doctors can’t alleviate. If your GP can’t find a physical cause for your problems, you may want to look further to see whether there is a psychological side to your symptoms.

What are the different types of counselling? There are several types of counselling that follow similar lines to the different types of psychotherapy. (See below for a comparison of the two.)

Each model has its own theory of human development and its own way of working. Some practitioners work in an ‘eclectic’ way, which means that they draw on elements of several different models when working with clients. Others practise a form of ‘integrative’ counselling, which draws on and blends two or more specific types. From the client’s point of view, perhaps the most obvious difference between the types of counselling is whether the counsellor is directive (suggesting courses of action and perhaps giving ‘homework’ exercises) or non-directive (with the client taking the lead in what’s discussed). While it's not possible to include all the various types available, the most popular are discussed below. They are all non-directive, except for gestalt, rational-emotive behavioural counselling and cognitive behaviour counselling.

Non-directive counselling

Psychodynamic counselling This is based on the idea that past experiences have a bearing on experiences and feelings in the present, and that important relationships, perhaps from early childhood, may be replayed with other people later in life. It translates the principles and insights of psychoanalysis and psychoanalytic psychotherapy into once-a-week counselling. The counsellor usually aims to be as neutral a figure as possible, giving little information about him- or herself, making it more likely that important relationships (past or present) will be reflected in the relationship between the client and the counsellor. This relationship is therefore an important source of insight for both parties, and helps the client to ‘work through’ their difficulties. Developing a trusting and reliable relationship with the counsellor is essential for this work.

Client-centred or person-centred counselling This is based on the principle that the counsellor provides three 'core conditions' (or essential attributes) that are, in themselves, therapeutic. These are:

  • empathy (the ability to imagine oneself in another person's position)
  • unconditional positive regard (warm, positive feelings, regardless of the person's behaviour)
  • congruence (honesty and openness).

Again, the counsellor uses the relationship with the client as a means of healing and change.

Transpersonal counselling This is an integrative and holistic approach that utilises creative imagination. It assumes a spiritual dimension to life and human nature. It also presupposes the interconnectedness of all beings with a higher spiritual power, and specifically addresses the link between the two. Transpersonal counselling emphasises personal empowerment. It takes account of the client’s past experiences, but also looks to the future and what is likely to unfold for them, the challenges they may face and the qualities that need to emerge in them to meet those challenges. Its basic belief is that whatever the hardships of human experience, the core essence, or soul, remains undamaged.

Transactional analysis counselling Transactional analysis counselling emphasises people's personal responsibility for their feelings, thoughts and behaviour. It believes people can change, if they actively decide to replace their usual patterns of behaviour with new ones. The counsellor offers:

  • 'permission' (for new messages about yourself and the world)
  • 'protection' (when changing behaviour and thoughts feels risky)
  • 'potency' (to deliver what he or she promised).

Planning the goals of the counselling is part of the process. The focus is on uncovering the 'life scripts' (life plans) that reflect the messages the client was given as a child. The counselling teaches the client to identify in which of the following modes he or she is operating, at any given time:
  • the 'child' (replaying their childhood)
  • the 'parent' (copied from parents or parent-figures)
  • the 'adult' (appropriate to the present situation).

Existential counselling This helps people to clarify, think about and understand life, so that they can live it well. It encourages them to focus on the basic assumptions they make about it, and about themselves, so they can come to terms with life as it is. It allows them to make sense of their existence. The counselling focuses the client on how much they already take charge of their life, and not on what they are doing wrong. At the same time, it takes note of any real limitations, so that they can make choices based on a true view of the options available. Personal construct counselling This is based on the idea that nobody can know absolute truth. Instead, each person constructs their idea of the truth from their own experiences, and this affects the way they see the world. The problem is that people can get stuck with a view of things that prevents them from living life to the full, because they can’t find any alternative ways of seeing things. Personal construct counselling helps people to look at different ways of behaving that may be useful in changing the way they see the world.

Gestalt counselling This is a directive type of counselling, focusing on gestalten (patterns of thought, feeling and activity). It encourages people to have an active awareness of their present situation, and also incorporates communication that goes beyond words. A key part of gestalt counselling is the dramatisation, or acting out, of important conflicts in a person’s life. This could involve using two or more chairs, for instance, so that they can physically take up different positions to represent different aspects of themselves.

Directive counselling

Rational-emotive behavioural counselling This takes the view that people have two main goals in life: to stay alive and to be happy. It aims to remove the obstacles that people place in their own way, and also to achieve a healthy balance between short-term and long-term goals.

Cognitive behaviour therapy This is concerned with the way people’s beliefs about themselves shape how they interpret experiences. The objective is to change self-defeating or irrational beliefs and behaviours by altering negative ways of thinking. Clients learn to monitor their emotional upsets and what triggers them, to identify self-defeating thoughts, to see the connections between their beliefs, feelings and behaviour, to look at the evidence for and against these thoughts and beliefs, and to think in a way that is more realistic and less negative. The counsellor usually gives the client tasks or homework to do between sessions. This could mean recording thoughts and feelings, or doing something that tests out a basic assumption about themselves. This might mean, for instance, going to the shops when their fear is that they might panic.

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