Counselling

Counselling: Support And Guidance

What Is Counselling?

Counselling is an opportunity to talk about problems you're experiencing, with someone who listens and cares. It's based on a relationship of mutual trust and respect that develops between you and your counsellor, so that in time you feel you can talk about any issue and be heard and understand. A counsellor will seldom give direct advice or tell you what to do. The main aims of counselling are to help develop our own insight into problems, help us reassess and improve our coping skills, and to help us find our inner strengths and resources. The overall effect is that we should feel less alone and isolated, less confused and depressed as we begin to understand ourselves better. And less of a victim as we discover we do have choices and can take more control of our lives. Sessions vary in length and frequency depending on the need and how a counsellor works.

Different Forms of Counselling

Telephone & On Line - This can be one-off crisis counselling via a helpline or a regular appointment with your own already established counsellor according to the terms of your contract. Some organisations will be able to phone you back so you don't pay for the call. Free-phone helplines don't usually appear on your itemised phone bill but if this is a concern check it out with the organisation.

For safety reasons, we do not recommend telephone, email or internet counselling from the start, where abuse is concerned, because it is open to misuse, and counselling in this way lacks the personal dynamic which can be so effective. However, if these ways are the only ones available to you, or you do not feel ready for one-to-one or group work, they can be good. If this is your choice, thoroughly check out the service being offered. It should be based at a bone fide address where you could send mail if you need to or visit. Counsellors should belong to one or more of the larger counselling associations such as BACP or the UKCP.

Face-to-face - This is usually one-to-one, in the organisation or counsellor's own premises. A lot of organisations, such as rape crisis centres, offer face-to-face counselling free. Private Counsellors charge various amounts, usually from £25 to £60 or more per consultation depending on the area where they work, their experience and skill.

Some offer concessions or other ways to assist those on low disposable incomes.

Group work - This usually involves one or two counsellors working with a group of people. This can be offered by voluntary organisations free or may involve payment if provided privately. Sharing each other's experiences is usually an important part of the process; if facilitated and managed well.

Outreach - This is counselling or support given in the client's home, school, community centre, or any other premises away from the counsellor's usual main base or consulting rooms. This can be helpful for clients who have disabilities or other special needs.

More about Costs and your Investment - Organisations such as rape crisis centres offer face-to-face counselling usually free or for a small fee. Private counsellors usually charge and their fees vary according to qualifications and experience. Some operate a sliding scale according to the income of their clients, or make arrangements to spread the costs over time. Do not reject private therapy because you are concerned about the cost. In many circumstances, they may offer their services free, and many counsellors offer a free introductory consultation. Access to counselling may occur via an Employee Assistance Programme, Occupational Health or your General Practitioner; the duration of counselling in these circumstances is often limited.

When it comes to choosing a particular model of therapy or counselling be wary of those who oversell their methods or make promises to cure quickly and painlessly. No counsellor can or should ever make such assertions in the fields of abuse and sexual violence. Some methods do work quicker than others but only if those methods suit the individual client.

If a counsellor claims to use methods that work quickly it is reasonable to expect them to offer it on a basis where you may delay payment until satisfied or secure a money back guarantee; after all, if you are expected to trust the counsellor it is only fair that the counsellor trusts you.

What is the Best Counselling Style for Me?

Independent studies of different counselling methods have mostly concluded that it is the quality of the relationship between client and counsellor that matters most.

Lambert, M.J. (1992) 'Implications of Outcome Research for Psychotherapy Integration', in Norcross and Goldstein (1992), pp. 94-129.

Estimates that therapeutic change is around 40% due to client and extra-therapeutic variables, 30% due to relationship factors, 15% due to expectancy and hope factors, and 15% due to the techniques and models of individual approaches. See Hubble et al. (1999) for much more on common factors.

Other Forms of Help

Some victims of abuse and sexual violence are able to access help for themselves by private study at home from books and other sources of information. This can be invaluable but is an unusual path to full and sustained recovery.

For those who choose to work this way it is wise to have some outside support. Some use the internet to access counselling or support through chat rooms but it is important to check out the validity of such services. Authentic organisations will have land line telephone numbers and addresses which can be validated together with codes of ethics and practice, complaints procedures and be able to provide details of their qualification criteria and insurance arrangements.

What People Should Generally Expect from Counselling and Support Services

It is important that you talk to your counsellor about what your expectations and needs are. Just like any other relationship, the more you know and can communicate what you want and need, the better chance you will have of receiving it and speeding the process. No counsellor has a crystal ball, neither can they mind-read so they will not know your needs or what you are thinking without you telling them. It may be easier at first, to write down needs than to say them.

You may be entering therapy for the first time and have no idea of what will happen other than you want to feel better than you currently do. It is very important that you express all your feelings, thoughts, hopes and fears at the start, and then throughout therapy to the best of your ability. Keeping your feelings about what is said to yourself is your right, but it is not very helpful in a counselling environment if you wish to make progress.

Good therapy is not something done to or for you; it is a living process within which you and the therapist play active parts. Therapy works best when it is an honest two-way process of communication, and you have an equal responsibility.

It takes time to establish a trusting relationship with a therapist, so expect it to take a few sessions before you feel completely comfortable.

It is important that you go at your own pace and don't overwhelm yourself. Do not try to rush things for a quick fix, or because you feel you owe it to your partner, or other oughts, shoulds and musts.

We all resist change, so do not be at all surprised if you are tempted to quit therapy just before some real changes or breakthroughs are about to happen. Being committed to therapy can change your life. Be prepared to feel some loss and fear because of this.

Therapy is very often hard work, and can be emotionally draining at times. After an intense therapy session expect to feel exhausted for a while. Counselling outcomes depend very much on your resolve to achieve resolution. Others around you may resist your changes and growth and they will usually need time to adapt to the new you.

Sometimes, therapy can release emotions and memories that have been "locked in time" for many years, and sometimes after a therapy session you may feel like a child for a while, with a child's fears. It is not unusual when dealing with buried feelings and repressed memories, to actually feel that you are becoming worse than you were before you started.

Sometimes therapy is short term, sometimes prolonged. Be prepared to take whatever time it takes to get the result you want. Becoming a healthier and balanced person can feel very unfamiliar and uncomfortable at first. This is normal and to be expected.

Your therapist will not be perfect as a person and will make mistakes as all of us do. Hopefully he or she will acknowledge and take responsibility for those mistakes.

You should expect your therapist to have good, strong, boundaries, to be ethical and to treat you with respect. The therapist should avoid a dual relationship while your therapy is in process and during your subsequent processing. This means generally that he or she is not there as a support between consultations unless that service is part of the contract. The therapist cannot be a close personal friend although one should expect friendliness and support.

Dual relationships include suggestions regarding joint business ventures, provision of accommodation at the counsellor's home or doing work for them. If a counsellor ever flirts or suggests a sexual relationship with you, leave as soon as you can, do not return and consider reporting the therapist to their regulating body.

There are many therapeutic methods, models and styles, they can't all suit everybody. We are unique, have differences and find ourselves in different situations. If you feel that the therapeutic model or style used by your therapist is inappropriate for your needs, you should talk this through with your therapist and be prepared to change to a different style or a different person.

After therapy one will still encounter the wide range of emotions, from the heights of joy and happiness to the depths of sorrow and rage, that's life. Good counselling is not about avoiding unpleasant feelings or for that matter inducing and extending the pleasant emotions, but much more about how to use all feelings well. This ability results in a state of growing confidence and self-esteem, a being in touch with one's real self; whatever the prevailing circumstances.

As a result of therapy what you should feel is a growing sense of wholeness and peace, which on the one hand enables you to enjoy the good in life, while on the other hand helps you to resolve and settle the unpleasant experiences, problems and feelings much more quickly.

Many people believe that once therapy is complete their lives will progress smoothly; that is unreasonable. When you have changed, life will still be difficult at times. You will still be faced with problems, conflicts, loneliness and boredom, as well as achievement and success.

What Does Effective Counselling Feel Like?

You cannot judge whether therapy is good by the way you feel in the moment. Some experience counselling as a haven they can't wait to get to. Others dread every session and have to force themselves to go. Counselling is not always comfortable.

Generally, you know you're with a good counsellor when you develop more and more skills to heal yourself, when you become able to recognise your own patterns and to feel and interpret your own emotions well.

Considerations When Choosing a Service if you are the Victim of Abuse and Sexual Violence

Seeing someone who's experienced in dealing with childhood abuse and sexual abuse has obvious advantages, but may not be essential. On the other hand, some people want to know that their counsellor is a survivor of abuse to feel they could really understand, and many specialist counsellors are those who have recovered from their own experiences of abuse.

It may take time and some effort to find the right counsellor or group for you. Be willing to phone around and even to meet several people before you make a final decision. Most counsellors will talk to you on the phone, but it is often far better to visit the counsellor; in that way, you will get a better impression and also be able to assess the setting.

Memory Retrieval

During counselling, it is likely that memories will surface as part of the natural processes and that is to be expected. Many clients want to tell their story, others may need to be heard in a safe environment, and this too is a normal direction that some victims wish to take.

On the other hand, no counsellor should, unless there are very exceptional circumstances, directly ask or prompt a client for memories, or to give additional details regarding their history.

Examples of memory retrieval work:

Being asked and/or being prompted to recall events and the details.

Being offered possible scenarios. Then possibly being asked if they are the same or similar.

Suggestions by the counsellor to invent scenarios so that they could work with them.

Memory retrieval work is generally discredited for the following reasons:

Clients can feel under pressure to please the counsellor and invent material.

Memories recovered in this way are usually considered poor evidence in both criminal and civil proceedings; unless there is substantial corroboration.

It is highly likely that a defence lawyer could easily discredit such evidence, and any counsellor who claimed to have worked in this way.

The client is seldom convinced that their recall is accurate. This can lead to doubts about themselves and considerable emotional turmoil.

Recovered memories of abuse frequently cause a state of high emotional trauma. This is nearly always accompanied by states of being vulnerable to further suggestion and control.

It can result in increased dependency on the counsellor, which could be considered as abuse. It is therefore generally regarded as an obstacle to healthy resolution, where the ethical goal should be towards autonomy.

Where memory retrieval work is employed with the victims, the only significant benefit seems to be to the perpetrators of those who did the harm, their legal defences; or to those wishing to form a state of dependency.

Touch

Some forms of counselling and therapy include touching and/or holding, and if this is the case it will be an important issue for you to consider. Touch is very rare in counselling for abuse, but it can be a part of group work, Touch of any kind, even slight and accidental, can evoke strong emotions. Those feelings could be of comfort and be cathartic, or of discomfort and be damaging. On the other hand, not to touch in certain circumstances could feel like rejection.

Within the counselling profession there is a continuing debate regarding the use of and issues around touch, and a general principle within the guidelines of all bona fide healthcare professions is to 'first, do no harm' (Primum non nocere).

First do no harm. One of the principal precepts that all healthcare students are taught, and is a fundamental principle throughout the world. Another way to state it is that, "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the health care provider that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

For you, it may be wise to mention the issue of touch from the start.

Once again, your own instincts about what you want are an important source of guidance.

If the style of counselling offered includes touching you may wish to look elsewhere, or to be able to exclude touch.

No counsellor or helper may insist on touch unless you agree.

The final judge of whether a counsellor or group is right for you can only be yourself, and in the end, you must trust your own instincts and how you feel. Ask yourself if you would feel comfortable telling this person intimate details of your life, and will be able to be open and honest with them regarding your material? Do you feel safe with them, do you like their manner towards you and their attitude to your questions? Ask yourself if you feel that you can trust this person. The more open you can be, the more likely it is that you will gain from the counselling or group work.

Warning signs

The following site has useful information and a list of warning signs to help you identify when things may be going wrong between you, a therapist, group leaders or other helpers:

http://www.goodtherapy.org/blog/warning-signs-of-bad-therapy/

 

Useful Questions to Ask a Prospective Counsellor or Group Facilitator

(It may be easier to hand this list to the counsellor)

Have you worked with victims of abuse and sexual violence?

How long for?

What kind of training have you had?

What are your qualifications?

What is the goal that you aim for with clients?

How do you work with survivors and what are the techniques you use?

Can you work if I have few or no clear memories?

Do I have to talk about the details of the abuse/incident?

Please tell me about the professional support and supervision that you have?

What are your views on touch, holding and physical contact between yourself and clients?

What degree of confidentiality do you offer?

How much do you charge? Is there a sliding scale or are there other arrangements to assist with the cost? (Do not dismiss the possibility of private counselling – some offer free places or delayed payment)

How long do you work with clients on average?

Ask for all the terms and conditions ~ in writing.

Ask for the details of the professional bodies to which they belong, insurance cover and check this out.

If you have issues to do with race, religion, sexual orientation, disability, alcoholism, eating disorders, or other specific problems, or some other aspect important to you, prepare some special questions that will help you determine the attitude and experience of the therapist or group leaders.

You may feel strongly that you want to work with a woman or with a man.

You may prefer to choose a counsellor of your race, economic background, sexual preference, religion, or someone who has experiences similar to yourself. If you have such preferences there may be specific organisations that only have counsellors of a certain gender, sexual orientation or religion that can help. Your own instincts about what you want are an important source of guidance.

Most organisations are made up of counsellors and helpers of all sorts of backgrounds, beliefs and sexual orientation. If specific attributes are important to you it is up to you to ask.

It may be worth considering the value of working with a helper that challenges some of your preferences...

Reflection

Once you've contacted several counsellors compare the way you felt when you were talking with them:

Which one seemed to understand you best?

Was it easy for you to clarify what you said when you felt that you had not been understood?

Were you able to be honest and direct?

Did you feel that the therapist was focused on you?

Did you get some useful feedback when explaining your needs?

Did the therapist seem fairly flexible and at ease?

Was the therapist open and clear about the boundaries and what is expected of you?

When you start work with a counsellor, you should continue to bear in mind the above points and feel understood and supported.

Additionally, throughout therapy:

You should feel generally liked and respected.

You should be treated as a unique individual.

There should be evidence that the therapist is interested in you and your issues.

Expressions of emotion and information given should be limited to what is helpful to you.

You should experience clear and safe boundaries within which you can work.

You and your therapist should refrain from contact outside the process.

The therapist should be comfortable and listen to you respectfully if and when you ask questions about any aspect of the process and therapeutic relationship, or if you wish to be critical or to challenge anything.

You should gain a growing sense of being able to rely on your own feelings and find your own solutions.

You should generally feel empowered and as an equal with the therapist.

DABS Disclaimer: Be aware that while the clear majority of counsellors work to the highest ethical standards, a few do not. At present, there is no ultimate and effective independent regulation of the counselling profession.

As things stand anyone can call themselves a counsellor/therapist, they do not have to be trained, there is no legal requirement for counsellors to be insured or to belong to a regulatory body. Ultimately one can be faced with having to take time consuming civil action for damages against an individual if things go wrong. Even here, if the counsellor has no assets it may not be a worthwhile pursuit.

Even if a counsellor does belong to a regulatory organisation and claims to be bound by their codes of ethics, faced with a complaint they can simply resign AND continue to practice. Some organisations specifically state that they exist to protect the counsellor. No counsellor can be 'struck off' as is the case with medical practitioners and therefore many who have behaved unethically continue to work quite lawfully.

It is wise to check that the counsellor you work with is insured. It is also wise to find out a little about any regulatory body that a counsellor belongs to. As a general rule, they should belong to a large bona fide well known and respected association that can deal with complaints properly. Some smaller associations do not have the resources to investigate complaints very well and others, as stated above, are formed to protect their members rather than the public. Until there is proper compulsory state regulation this remains the case.

If you feel there is a problem: If a counsellor ever wants to have a sexual relationship with you, get out right away and report the therapist to the appropriate licensing board.

If you don't feel respected, valued, or understood, or if your experience is being minimised or distorted, that's a sign that you're in bad therapy, or at least that there's a bad relationship between you and the counsellor. If you feel there is something wrong in the counselling relationship, or if you get upset or angry with your counsellor, talk about it in your session. Afterward, you should feel you've been heard and understood. However, if your counsellor discounts your feelings or responds defensively, then you're not getting the respect you need. Look elsewhere.

Confidentiality is of major importance in counselling. Your counsellor will not tell anyone what you have told him or her, except in exceptional circumstances and only after discussing it with you. These circumstances usually involve your safety or the safety of others and there are some circumstances where the law does not permit confidentiality. You are advised to check out a prospective counsellor's own code of practice and to discuss this with your prospective counsellor first if you have any concerns.

Main source: The Courage To Heal, Mandarin Paperbacks London 1990 © 1988 by Ellen Bass & Laura Davis

The Clinic for Boundaries Studies: The only organisation in the UK working around all aspects of professional boundaries and the prevention of boundary violations. The Clinic runs preventative, recovery and remedial services. The Clinic's specialist support services are designed to support members of the public who may have been harmed by professionals including counsellors & therapists.

0203 468 4194 ~ www.professionalboundaries.org.uk

Here are details of some books written specially for people who were sexually abused as children. We hope you find something here to help you begin your healing or take it further:

Adults Molested As Children:

A Survivor's Manual for Women and Men

Euan Bear with Peter T. Dimock

Beginning To Heal:

A First Book for Men and Women Who Were Sexually Abused As Children

Ellen Bass & Laura Davis

Breaking Free:

Help for Survivors of Child Sexual Abuse

Kay Toon & Carolyn Ainscough

Healing the Trauma of Abuse:

A Women's Workbook

Mary Ellen Copeland & Maxine Harris

Right To Innocence:

Healing the Trauma of Childhood Sexual Abuse

Beverly Engel

Victims No Longer:

A Guide for Men Recovering from Sexual Child Abuse

Mike Lew

Breaking Down The Wall Of Silence: To Join the Waiting Child

Alice Miller has achieved recognition for her revolutionary work on the causes and effects of child abuse - here she works towards demolishing the wall of silence which surrounds the sufferings of early childhood as they affect everyday life, politics, the media, psychiatry and psychotherapy. An infant's trust and dependency on its parents, its longing to be loved and to be able to love in return, are boundless. To exploit this dependency, to confuse a child's longings and abuse its trust by pretending that this is somehow good for it, Alice Miller condemns as a criminal act, committed time and again out of ignorance and the refusal to change. The essential first stage in this healing process is feeling the truth of our experience. Only this, Alice Miller writes, can enable us to recognise childhood events and resolve their consequences so that we can lead a conscious, responsible life. If we know and feel what happened to us then, we will never wish to harm ourselves or others now.

Alice Miller