Project Report by

Ashwin DSilva
JBIMS MFM
Roll No 12F226

Contents

1. Definitions of Counselling?
2. Historical Development of the Counselling Profession
3. Goals of Counselling
4. Approaches to Counselling
5. Counselling Skills
6. A Counselling Session
7. Workplace Counselling
8. Workplace Counselling and Stress
9. Roles of a Workplace Counsellor
10. Why Organisations Offer Workplace Counselling
11. Benefits of Counselling Services
12. Form of Counselling Service
13. Ethical Standards in Counselling
14. Workplace Counselling in India
15. Refrences



Definitions of Counselling

As a profession counselling is relatively new. It grew out of guidance
movement, in opposition to traditional psychotherapy. A few definitions
described below will illustrate the meaning and process of counselling
profession:

"An effort to help the client engage in those types of behaviour which will
lead to a resolution of the client's problems" (Krumboltz, 1965).

"Counselling denotes a professional relationship between a trained
counsellor and a client. Relationship is usually person-to-person, and is
designed to help clients to understand and clarify their views of their life
space, and to learn to reach their self-determined goals through meaningful,
well-informed choices and through resolution of problem" (Burks & Stefflre,
1979, p. 14)

"An interaction in which the counsellor offers another person the time,
attention, and respect necessary to explore, discover and clarify ways of
living more resourcefully, and to his or her greater well-being" (The BAC,
1999)

These definitions indicate that counselling as defined by different people
have few common components, as described below:

"Counselling is aimed at helping people make choices and act on

them"

Counsellors are the people who listen to others and help resolve
difficulties

A relationship: Counsellor develops a relationship which is based on

unconditional positive regard and trust.

A process: Counselling is a process in which the counsellor and the

clients involve themselves in a psychological process to solve
problems.

The counselling is designed to help people make choices and solve

problems.

The counselling helps in recognizing one's potential and to use this

potential in an effective way.


Counselling as a Helping Relationship

Counselling shares many characteristics of other helping professions. People
working in these professions are expected to help others, e.g., medical
doctors, psychotherapists, nurses, paramedics, school counsellors, etc.
According to Rogers (1961, p. 40), helping relationship is defined as the one
in which at least one of the parties has the intent of promoting the growth,
development, maturity, improved functioning, improved coping with life of
the other".

This definition describes various interpersonal relationships in social
settings, e.g., mother-child, teacher- student and many other relationships
where people interact with each other and their interactions affect
behaviours and attitudes of others. However, counsellor-client relationship
affects in a unique way, different from other interactions. In the following,
certain characteristics of helping professions are described. All of these are
also found in client-counsellor relationship.

Characteristics:

Affectiveness: Helping relationships is more affective (with feelings, and
emotions) than cognitive.

Intensity: Counsellor and client are expected to share openly their
perceptions and reactions to each other and to the process.

Growth: The relationship is dynamic. As the client grows and changes, so
does the relationship. Counselling is a unique and dynamic process in
which, from counsellor and client, one assists the other. The counsellor
helps the client to grow in a positive direction and actualizing his own
resources to grow.

Privacy: During or after the counselling session all client disclosures are
confidential.

Support: Counsellors, through counselling relationship, offer the client a
system of support that often provides the necessary stability for taking risks
and changing behaviour.

Honesty: The helping relationships is based on honesty and open and direct
communication between the counsellor and the client. The above
characteristics indicate that the counsellor will provide support to the client.

However, counselling relationship is not befriending, as in friendship both
people share with each other but in counselling sharing is one-sided.
However the supporting elements are strong in both friendship and
counselling relationships.

Counselling as a Relationship
Counselling is sufficient for constructive changes to occur in clients (Rogers,
1957). The counselling relationship is characterized by core conditions
namely empathy, unconditioned positive regard, and genuineness.

Counselling as a Repertoire of Interventions
In counselling several questions (like which, when, and with what client) are
answered and while interventions are decided an attempt is made to have a
match between the client and the counsellor.

Counselling as a Psychological Process
Goals of counselling have a mind component. Some psychologists like
Rogers, Albert Ellis and psychiatrists like Berne and Beck have contributed
enormously to counselling theories. For example, information about human
nature has been derived from psychological theories. Some people argue
that counselling is not a profession as it is used in so many disciplines in so
many sphere of life, e.g., loan counsellors, business counsellor, etc., but the
difference is that professional counsellors work according to some
theoretical model. Psychological research contributes both to creating
counselling theories and to evaluate counselling process

Distinctions between Counselling & Psychotherapy

Hahn (1953) writes, "I know few counsellors or psychotherapists who are
completely satisfied that clear distinctions have been made". Hahn goes on
to point out that the most complete agreements are that counselling and
psychotherapy cannot be clearly distinguished; counsellors practice what
psychotherapists consider psychotherapy and psychotherapists practice
what counsellors consider to be counselling, and despite the above they are
different.


Blocher (1966) distinguishes between counselling and psychotherapy by
pointing out that the goals of counselling are ordinarily developmental-
educative-preventive, and the goals of psychotherapy are generally
remediative-adjustive-therapeutic. He describes that five basic assumptions
about client and counsellor differentiate both:

Counselling clients are not considered to be "mentally ill", but they are
viewed as being capable of choosing goals, making decisions, and generally
assuming responsibility for their own behaviour and future development.

Counselling focuses on present and future.

The client is a client, not a patient. The counsellor is not an authority figure
but is essentially a teacher and partner of the client as they move towards
mutually defined goals.

The counsellor is not morally neutral or amoral but has values, feelings, and
standards of his/her own. Although the counsellor does not necessarily
impose these on clients, he or she does not attempt to hide them.

Counsellor focuses on changing behaviour, not just creating insight.

Counselling & Psychotherapy: Differences

Differences in origins

Differences in goals

Differences in process

Differences in issues/ settings

Differences in clients

Differences in training & orientation

Differences in Origins

Counselling evolved from the human potential movements of late 1950s and
1960s; many of the psychotherapies have their roots in psychoanalysis
although many schools evolved and have broken away. The goals of
psychotherapy are more likely to involve a quite complete change of basic
character structure, and reconstructive. In contrast, counselling is directed
toward aiding growth.


Differences in Goals

In psychotherapy the goal is to change the personality while counselling
deals with the goal of helping people to utilize existing resources for coping
with life better.

The goal of counselling is to help individuals deal with the developmental
tasks appropriate to their age. The adolescent who is being helped with
problems of sexual definition, emotional independence from parents, career
decision making and preparation , and the other tasks typical of that age in
different cultures would be receiving counselling. Similarly, a middle-aged
person grappling with stresses of his age would seek the help of a
counsellor. However, more emotional and severe problems will be under the
domain of a psychotherapist.

The goals of psychotherapy are more likely to involve a quite complete
change of basic character structure; the goal of counselling are apt to be
more limited, more directed towards aiding growth, more concerned with the
immediate situations, and aimed at helping the individual function
adequately in appropriate roles.

Differences in Process

In the process of psychotherapy emphasis is on the past while the process of
counselling emphasize on the present. The purpose of the process of
psychotherapy is treatment of the patient but counselling proceeds with the
purpose of the growth of the client. Psychotherapy and counselling also
differ in frequency and depth of work. In psychotherapy usually there will be
20-40 sessions over the period of 6 months to 2 years, while in counselling
sessions will be limited, i.e., 6-12 sessions and the duration shall be usually
less than 6 months

Differences in issues/ setting

Psychotherapists are more apt to work in hospital settings or in private
practice; counsellors are more apt to work in educational settings. A wide
range of settings/ issues for counsellors are self awareness, relationship
difficulties, abuse, anxiety, self-harming, vocational problems, lack of
assertiveness, career transitions, etc.


Differences in Training & Orientation

Some practitioners of counselling may be trained at the doctoral level with a
supervised internship, as psychotherapists are. But many counsellors have
less training, with relatively little psychology and little or no formal
supervised internship. More objective observers distinguish between
counselling and psychotherapy on the basis of the extent of training in
personality theory, research methods, and formal internship.

Similarities between Counselling & Psychotherapy

Counselling and psychotherapy are similar in many procedures and
concepts. Both have the same seating arrangements and directions during
the process of conducting sessions. In both psychotherapy and counselling
special relationship is built and both value clients. Psychotherapists and
counsellors use the same theoretical models. Counselling skills are used by
those practicing psychotherapy and counselling. Both psychotherapy and
counselling have same ethical and professional boundaries like
confidentiality, time limits, payments, ethical issues



Historical Development of the Counselling Profession
Counselling as a distinct profession has developed in a variety of ways
during the 20th century. Counselling has emerged and developed largely as
an American product in the 20th century. Its acceptance and widespread
use in the USA far exceeds that of other countries. The development in
counselling profession can be roughly divided into two broad categories:

1. Our heritage from the past: Before 20th Century
2. 20th century- To date

The development in 20th century and later years is largely attributed to
following landmark events/ factors:

Vocational Guidance Movement

Mental Health Movement

Standardized testing

Licensure and legislation

Our Heritage from the Past: Before 20th Century

Primitive Times

Primitive societies shared fundamental economic enterprises, that is why no
elaborates career guidance was required at that time. Most of the career-
related conflicts of present-day society were absent in early primitive life. It
is quite possible that the earliest (although unconfirmed) occasion in which
humans sought a counsellor was when Adam reaped the consequences of
his eating the apple in the Garden of Eden. An abundance of evidence
suggests that persons throughout the ages have sought the advice and
counsel of others believed to possess superior knowledge, insight, or
experience. Perhaps the first counterparts of the present-day counsellor
were the chieftains and elders of the ancient tribal societies.

Later, as skills became more recognizable and important to societies,
occupational trades began to passed down, mostly within families. However,
no elaborates career guidance programs were developed or needed because
occupational limitations were usually determined by two criteria: age and
sex. Thus, potters passed on the secrets and skills of their trade to their
sons, as did the smiths and carpenters. Women passed on their skills to
their daughters. Anyway, the occupational opportunities were limited in
those times.

A study of early primitive life can lead one to conclude that most of the
conflicts existing in present-day society regarding career decision making
were absent.

Early Greek Counsellors

In the early civilizations, the philosophers priests, or other representatives of
the gods and religions assumed the function of advising and offering
counsel. The historic origins of the concept of developing one's potential may
be identified in the early Grecian societies.

Plato:
Plato is generally recognized as one of the first to organize psychological
insight into a systematic theory. Belkin (1975) noted Plato's varied interests:
Education, persuasion, and most importantly a method to deal with these
questions (through real human interactions). Dramatic method: through the
dynamics of real human interaction in which characters are as important as
the things they say)

Aristotle
He studied how people interact with their environment and others.

Hippocrates:
He indicated that mental disorders were diseases due to natural causes. In
4th century BC, he suggested that the disturbance of four humours in body
causes different behavioural problems. He in fact provided the first medical
model of behaviour problems.

Early Hebrew, Christian and Islamic Teachings emphasized the rights of
individuals and humanistic ideals. Many contributions of that time can be
similar to what was later to develop in the field of psychology. The primary
concepts of all religions later in 20th century provided basics to democratic
societies and counselling movements.

Middle Ages (10th 15th Century)

During middle ages, attempts at counselling increasingly came under the
control of church. At that time education was also largely under church
jurisdiction. By the early middle ages, the duty of advising and directing
youth had become centered in the parish priest.


A few important characteristics of middle ages are as under:

Return to demonological explanations.

Church became the primary social and legal institution in Europe.

Physicians became the doctors to treat the mentally ill.

Exorcism again was practised.

Priests diagnosed people by looking for signs of the devil, e.g., rashes
and dead skin spots (by pricking)

Muslim Traditions in Counselling & Psychotherapy

Dark ages were not dark for Muslims. While demonology persisted in the
Western world, Muslim civilization was at its peak. Al-Razi, Al-Ghazali, Ibn-
e-Miskwayh, Ashraf Ali Thanvi laid great emphasis on the development of
the whole man; common therapeutic goals are changing man's relationship
to God as well as to society. They put forward a radical humanistic approach
by giving respect to individuals. They held that man has the potential to
grow by using his inner resources. They also believed that ignorance was
disease and knowledge was cure.

16th Century

Philosophers and educators, such as Luis Vives (1492-1540) recognized the
need to guide persons according to their aptitudes.

17th Century

Books like "Tom of All Trades: Or the plain pathway to preferment" (Powell,
1631) aimed at helping youths choose an occupation. Also during this time,
Rene Descartes (1596-1650) and others began to study human body as an
organism that reacted or behaved to various stimuli. These studies were to
be forerunners for later more accurate and scientific studies.

18th Century:

In the 18th century Jean-Jacques Rousseau (1712-1778) suggested that the
growing individual can best learn when free to develop according to his or
her natural impulses. He advocated permissiveness in learning and learning
through doing. The famous Swiss educator Johann Pestalozzi (1746-1827)
expressed the belief that society could be reformed only to the extent that
the individual in that society was helped to develop.


19th Century

US Educator Horace Mann in his 12th Annual Review stressed on main-
stream schools and that the objective of education should be to reform
society. Mann reported that "in teaching the blind and the deaf and dumb,
in kindling the latent spark of intelligence that lurks in an idiot's mind and
in the more holy work of reforming abandoned and outcast children,
education has proved what it can do by glorious experiments. Mann also
believed that education should have as one of its objectives the reform of
society.

The biologist Herbert Spencer (1820-1903) set forth his concept of
adjustment. This biological concept held that forms of life that do not adapt
their environment eventually become extinct. From this, Spencer concluded
that perfect life consisted of perfect adjustment. In other words, biological
adjustment is criterion of life. Adaptive behaviour is that which maintains
life.

By the end of 19th century, several influential figures contributed to the
field of Psychology, e.g., William James, Wilhelm Wundt, Albert Ellis, Perls,
etc. The work of some psychiatrists also influenced the field of counselling.
For example, Sigmund Freud's psychoanalysis influenced later prominent
theorists of Perls, Ellis, and Adler. Similarly, Dorothy Dix advocated organic
than moral treatment (prevalent at that time) at least for seriously mentally
ill.

20th Century to date

1900-1909: Vocational Guidance Movement

In 20th century, when society was growing more complex, and finding one's
appropriate place in society became increasingly complicated, it seemed a
ripe time for a genuinely scientific approach to meeting many human needs.
The time had come for the development of counselling to meet these needs.
However, no single date can mark the beginning of counselling.

The counselling profession entered the schoolhouse in the early 20th
century. Three persons emerged as leaders in the development of
counselling:


Jesse B. Davis

Counselling may well have begun in 1898 when Jesse B. Davis advocated
that students should be preached to about the moral value of hard work. He
was known as a broad scholar, writer and a tireless activist. He introduced
"vocational and moral guidance" as a curriculum into an English language
composition course. Davis worked for educational and vocational problems
of students; a clear illustration of the early ties of counselling to vocational
guidance. He suggested that a good character shall be considered an asset
to any person who decides to enter the business work. He suggested that
there shall be a guidance lecture once a week in schools with the goal of
building character. This was the first systematic guidance program in public
schools and can be considered a forerunner of counselling.

Frank Parsons - the Father of Guidance

Parson founded a vocation bureau in 1908 in Boston, eventually led to the
National Vocational Guidance Association in 1913. In 1909, he wrote the
book, Choosing a Vocation, which was divided into 3 areas:

Personal investigation

Industrial investigation

Organization and the work

Parson's work had significant impact on the vocational guidance movement.
His bureau established a direct connection with the Boston schools. He
suggested that the following three factors are important for the wise
selection of a vocation:

Extensive self-study on a "Schedule of personal data"

A knowledge of requirements and conditions

True reasoning on the relations of these two

He introduced an unusual feature of the intake interview "the observation".
This approach would get clues to possible flaws in the client, such as slow
auditory reactions, defective verbal memory, etc. The counsellor would
observe shape and size of head, enthusiasm, vitality, features, etc. and then
would have some idea about the appropriateness of that person for some
particular job. He offered a method to match a person's personal
characteristics with an occupation. He also recommended the client about
methods that could be used for self- improvement, like reading good suitable
books to develop analytical thinking. Biographies were suggested for finding
commonalities and get inspiration. Counsellor would then fill in the details
by reading between the lines and would make a detailed analysis of
industrial job opportunities, work conditions, pay, demands, etc.
Frank Parson is known as a broad scholar, a persuasive writer, a tireless
activist, and a great intellect. He is rightly called the "father of guidance" and
is best known for founding Boston's Vocational Bureau in 1908. He initiated
vocational guidance movement, but he would not have envisioned the
growth of the movement from the several dozen, he trained, to 115,000
school counsellors by 1994. Parson (1909) believed that the vocational
counsellor should have the following traits:

A practical working knowledge of psychology

An experience involving sufficient human contact

An ability to deal with young people

A knowledge of requirements and conditions of success

Information about courses and means of preparation

Scientific method analysis

Frank Parson's work on vocational guidance classified the facts, identified
the causes, and drew the conclusions about several issues pertaining to
suitability of people for different work environments.

Clifford Beers: Mental Health Movement

During the same period (1900-1909), other professional developments
evolved independently and merged to help form the modern approach to
counselling. Mental health movement, like vocational guidance movement,
owes much to the efforts of one person. Clifford Beers, a former Yale
student, was hospitalized for mental illness several times during his life. He
found conditions in mental institutions deplorable and exposed them in a
book, A Mind That Found Itself (1908), which became very popular. Beers
advocated better mental health facilities and reforms in the treatment of the
mentally ill. His work had an especially powerful influence on the fields of
psychiatry and psychology, where many of these people referred to what
they were doing as counselling. Beers was the impetus for the mental health
movement in the United States, and his work was a forerunner of mental
health counselling.

He noted abuse of weak and violent patients. Weak patients and violent
patients were abused the first day they would admit into a hospital because
of the helplessness of the later and aggressive behaviours of the former. This
procedure seemed to be a part of established code of dishonour. His
descriptions aroused public to humanitarian movements. During 798 days
of depression in hospital, he said that he draw countless incorrect
deductions.

These and similar descriptions aroused the public to initiate
1. Humanitarian reforms
2. Scientific inquiry into the problems of mental illness and its
treatment.

With the help of a few psychologists of the time, Such as William James and
Adolph Meyer, the mental hygiene movement was launched to educate the
general people. Mental Hygiene movement was responsible for legislative
reforms, aftercare, and free clinics for the mentally ill. In 1909 Beers
supplied the leadership for National Committee for Mental Hygiene.

Psychopathic Hospitals

Viewpoint that individuals are products of both their environment and
heredity gave rise to new type of institutions called "Psychopathic Hospitals".
Psychopathic Hospitals located in communities became the forerunner of
modern day community mental health centres. In these hospitals outpatient
treatment was preferred rather than custodial care. They Improved
standards of treatment, though controversial, and provided base for
establishing local clinics for disturbed children.

Other Early Leaders in Guidance Movement

The work of Jesse Davis, Eli Weaver, and Frank Parsons and a host of other
pioneers created momentum for the development of a school counselling
profession.)

Anna Reed:

Developed guidance programs to judge a person's worth by his/her
employability. Reed was an admirer of the prevailing concepts of the
business world. She believed that guidance services are important for
developing best educational products. Contrary to today's philosophy, she
placed the business needs above those of the individual.

Eli Weaver:

Eli Weaver established teacher guidance committees in every high school in
New York to help youths discover their capabilities for the most appropriate
employment


Davis S. Hill:

Davis S. Hill advocated and worked for a diversified curriculum
complemented by vocational guidance.

1910s: Standardized Testing
Prior to World War I human assessments were made on the basis of
individual differences on a variety of tasks. The French psychologist Alfred
Binet and his associate Theodore Simon introduced the first general
intelligence test in 1905. In 1916, a translated and revised version was
introduced in the United States by Lewis M. Terman and his colleagues at
Stanford University, and it enjoyed widespread popularity in the schools.
Prior to World War I technical efforts to human assessment were limited to
the work of individual researchers attempting to measure individual
differences on a variety of tasks like reaction time and sensorimotor abilities.

World War I was the third important event of the decade. To screen its
personnel, the U.S. Army commissioned the development of numerous
psychological instruments, among the Army Alpha and Army Beta
intelligence tests. Several of the army's screening devices were employed in
civilian populations after the war. These were based on group testing.

The first standardized achievement and aptitude tests were constructed at
that time. Testing of special aptitudes in music, mechanics, and arts was
also started.

In 1915, the first guidance journal "Vocational Guidance" was published.

The first standardized achievement tests predicted success in areas such as
academic performance.

Robert Yerks, APA president, headed a committee of psychologists to develop
IQ and other measures.

In many ways developments in mental measurements and other types of
human assessment formed the basis for the early technology of counselling
practice


1920s

The 1920s were relatively quiet for the development of guidance profession.
A notable event was the certification of counsellors in Boston and New York
in the mid-1920s. Another turning point was the development of the first
standards for the preparation and evaluation of occupational materials.
Certification in guidance profession started in mid-twenties. Along with
these standards came the publication of new psychological instruments
such as Edward Strong's Strong Vocational Interest Inventory (SVII) in 1928,
which set the stage for future directions.

In 1921, Cattel founded Psychological Corporation to sell tests First centre
of Marriage and family counselling by Abraham & Hannah (1929) marked
the beginning of the subspecialty

This decade not only stimulated the development and usage of standardized
tests, but also was significant to the development of one of the early
specializations in counselling: rehabilitation counselling. Vocational
rehabilitation services were initiated for veterans. In 1921 Rorschach's very
popular inkblot test, Psychodiagnostic, was developed.

Child Guidance Movement:

Child Guidance Movement was primarily initiated as the result of the work
of G. Stanley Hall. Hall was also influenced by Freud, and introduced his
ideas in USA. He studied different phases of mental life in all ages.
Child-study movement was fourfold:

Individual as the focal point of study

Importance of the formative years

Need for reliable, factual knowledge about children

More accurate methods of child study

Child study centres were designed to promote the well-being of children. The
first child guidance clinic was founded in Chicago in 1909 by an English
psychiatrist, William Halley, who worked on children delinquency and
misbehaviour.


1930s

Williamson's Trait-Factor Approach:

Highlight of this decade is the development of first counselling theory by
Williamson et al. Williamson used this theory to work with students and
unemployed. His theory is a trait-factor, directive, and counsellor centered
approach. His approach is also considered the Williamson modified
Parsons's theory. He emphasized traits (aptitudes, interests, personalities,
and achievements) of the counsellor for the effectiveness of counselling. His
pragmatic approach emphasized the teaching, mentoring, and influential
skills of the counsellor. His theory dominated counselling for the next 2
decades. It was based on a scientific, problem solving, and empirical method
that was individually tailored to each client in order to help him stop his
non-productive thinking.

John Brewer:

John Brewer helped broaden counselling beyond occupational concerns. He
emphasized this change and published a book "Education as Guidance" He
maintained that every teacher be a counsellor and that guidance be
incorporated into school curriculum. The purpose is to teach the student to
live outside the school.

1940s

By 1940 over 500 psychological tests appeared. A Measurement Year Book
was constructed to catalogue tests
During this decade, three major events radically shaped the practice of
counselling:
1. The theory of Carl Rogers: Client Centered Approach
2. World war II
3. Govt.'s involvement in counselling

Carl Rogers

Carl Rogers rose to prominence in 1942 with the publication of counselling
and psychotherapy. More than any other person, Rogers influenced the way
American counsellors interact with clients. Client centered approach
maintained that counsellor serve as a mirror, reflecting the verbal and
emotional manifestations of the clients. He emphasized in his two books:
"counselling and psychotherapy" "client centered therapy" that the client
assumes the major responsibility for solving his/her problems. His
nondirective approach was opposite of traditional method of counsellor
being the focus of attention. This approach was different from the trait
approach of Williamson. After continued research and application efforts,
this was a semantic change from nondirective to client-centered approach.

Often it is stated that his contribution to counselling is analogous to Henry
Ford's contribution to the development of automotive industry. Aubery
(1977) noted that before Rogers the literature in counselling was very
practical, e.g., a lot of testing, maintaining cumulative records, vocational
and placement functions, etc. Rogers emphasized a new approach focusing
on techniques of counselling, training of counsellor, and research. Due to
Rogers' influence guidance for all intents and purposes suddenly
disappeared.

World war II & Govt.'s (US) Involvement

After World War II, counselling and guidance movement appeared to be
taking a new vitality and focus. Involvement of psychology in World War II
was far greater than World War I. There was a postwar explosion effect, e.g.,
funding as well as stipend and paid internships were available to students.

In 1944 alone over 60 million tests were administered to 20 million soldiers
and civilians and Veterans Administration (VA) established centres to
provide counselling. VA coined the term Counselling psychologist and funded
the training of counsellors and psychologists.

1950s: Mid Century Legislations

If one decade in history has to be singled out for the most profound impact
on counsellors, it would be 1950s (Aubery). Major highlights of this decade
were. American Personnel & Guidance association was formed in 1952. It
was concerned with vocational, educational and other personnel activities.
Division 17 of Counselling Psychology, separate from guidance, was
established. Previous division was guidance and counselling and this new
division was established to distinguish it from clinical psychology division.
This separation was partly affected by Veterans Administration and was
influenced more by the desire of APA members to work with normal people.
National Defense Education Act (NDEA) of 1958 provided funds to
strengthen school guidance programs and train school counsellors.
At that time the most popular theories were psychoanalysis and insight
oriented theories, trait- factor, and client centered theories. This decade is
also important for the development of new theories, such as Behavioral,
Cognitive and Learning theories.
Extension of the earlier Vocational Rehabilitation Legislation acts 1954 is
another important feature of this decade. Other notable legislations include
the Vocational Education Act of 1963, the 1968 amendments, and
subsequent amendments.

Rehabilitation acts helped provide financial support for an extensive
program to educate rehabilitation counsellors specialized in assisting the
disabled. Since its inception, it has provided training to several thousand
counsellors.

1960s:

The initial focus was on counselling as a developmental profession. Gilbert
Wrenn set the tone for the decade and became one of the strongest
counselling advocates. He wrote the widely influencing book The Counsellor
in a Changing World and worked to resolve developmental needs.

This impact gradually declined as the decade continued because of 3 events:

Vietnam War

Civil right movement

Women's movement

Each event pointed out needs within society and the main focus of that time
was on crises counselling and other short-term interventions. Powerful
influences of Humanistic theories of Maslow and Jourard. The period after
World War II also saw a rapid expansion of community mental health
services.

1970s:

Diversification in counselling settings: Before this time almost all
counsellors had been employed in educational settings, usually in public
schools. Now they were hired in community mental health centres. Rate of
growth of school counsellors declined from 6-10% (1960s) to 1-3% (1960-
70s).

Community counsellor could work in any setting, e.g., in child abuse

centres, hospitals, organizations, etc.

Consistent with this, there was an increase in counsellor education

programs. Counsellor programs increased from 327 in 1964 to about
475 by 1980.

Lewis and Lewis (1977) coined the term community counsellor.

Helping-skills programs: Helping-skills programs concentrated on

communication and relationship skills, and the emphasis was
humanistic and eclectic.

Guidelines for Master's (1973) and doctorate (1978) degrees in

counselling were outlined.

1980s:

Counsellor Licensure Movement was initiated for official approval of the
profession and also to maintain standards of education in graduate degree
programs.
The National Board for Certified Counsellors (NBCC) was formed in 1983.
The NBCC developed a standardized test and defined 8 major areas of
knowledge:

Professional identity

Social and cultural diversity

Human growth and development

Career development

Helping relationships

Group work

Assessment

Research and program evaluation

1990s:

In 1992, AACD changed its name to American Counselling Association

(ACA) with 16 subdivisions. The changed name better reflected the
work of the members.

Increased attention to counselling within a pluralistic society:

Multicultural issues were given due attention in a pluralistic society.

There was a renowned interest within counselling on addressing

issues related to the whole person. Counsellors became more aware of
social and environmental factors important to the development and
maintenance of mental disorders and health. There was a gradual
trend that there are several factors which are important to the
development of human beings, e.g., spiritual, socio-economic, family,
etc.


Recent Trends in Counselling

In 21st century, the counselling profession is impacted by globalization and
technology. In the late 1980s and early 1990s, counselling extended to
various new directions:

Outreach services for the poor & homeless

Outplacement services or middle-aged workers and senior executives

Prevention and early intervention programs for alcohol and drug

abusers

Emerging concerns with retirees

Stress management

Sports & leisure counselling

Multi-cultural counselling

Globalization and technology

Goals of counselling
A few important goals of counseling are as under:

Facilitating behavior change

Enhancing coping skills

Promoting decision making

Improving relationships

Facilitating the client's potential

Facilitating Behavior Change

Rogers (1961) sees behavior change as a necessary result of counseling
process, although specific behaviors receive little emphasis during the
counseling experience. Dustin and George (1971), on the other hand,
suggest that the counselor must establish specific counseling goals. Almost
all theorists agree to bring about a change in behavior enabling the client to
live a more productive and satisfying life. They believe that the specific goals
make both understand the specific change.

Enhancing Coping Skills

Few people completely achieve developmental tasks.

Inconsistency of significant others can result in ineffective learning in

children.

New interpersonal or occupational role demands may create an

overload and excessive anxiety.

Counselor helps individuals to cope effectively.

Promoting Decision Making

Counselor just promotes not makes decisions. Counselor provides

information, clarifies and sorts out personal characteristics and
emotions, and even attitudes affecting decision making.

The client learns to estimate the probable consequences in personal

sacrifice, time, energy, money, risk, and the like.

One question emerges from the points discussed above that if client has the
major responsibility of improving himself/ herself, then where does the
counselor fit in? The answer to this question is that client works as a
facilitator for the client and provides a safe and comfortable environment
where the client will perceive the counselor as a trustworthy person and will
be able to share his problems with the counselor. In this kind of therapeutic
atmosphere, the client will be able to find the solutions of his problems
himself/herself.

Improving Relationships

Many people have problems relating to others as much of our life is spent in
social interactions. Bowlby's attachment theory states that children of
insecure and rejecting parents establish their adult relationships differently
than those of secure and understanding parents. This problem can be due
to "poor self image", "unstable self-esteem", or "inadequate social skills"
Counselor strives to helps improve quality of relationships. Sometimes
counselor improves relationships by improving client counselor relationship.

Facilitating the Client's Potential

The counselor attempts to promote the client's growth by improving
personal effectiveness and skills like interpersonal relationships and
problematic behaviors like smoking, eating, drinking, shyness, anxiety, and
depression. First counselor maximizes an individual's possible freedom
within limitations. Second, counselor seeks to maximize a client's
effectiveness promoted by giving him control over the environment.


Work Activities of Counselors
Certain activities have evolved for counselors across all settings. First 5 are
traditional or basic activities, later these were expanded to referral, etc. The
rest of the activities were added to the list later.

Individual assessment

Individual counseling

Group counseling and guidance

Career Assistance

Placement and follow up

Referral

Consultation

Research

Evaluation

Accountability

Prevention

Individual Assessment & Counseling

Individual assessment and counselling is considered as a primary skill of
the counsellor. It seeks, systematically, to identify the characteristics and
potential of every client by using standardized tests, observation and self-
reporting techniques like autobiography. Sometime a counselor can also
consult other professionals in this field like psychometrics, etc.

Individual counseling is the core activity through which all the other
activities become meaningful with counseling being one-to-one helping
relationship. It is a client-centred approach that demands confidentiality
and it is initiated when a relationship is established between the counselor
and the client.

Group Counseling and Guidance

Groups have become popular for providing organized assistance to
individuals for a wide range of needs e.g., to drug abuse, to families for
understanding and coping. They may include task groups or psycho
educational groups.

Group Counseling:

Focuses on assisting counselees to cope with their day-to-day

adjustment and developmental concerns.

More popular in agency and institutional settings.

Group Guidance:

The activities of group guidance are educational, vocational, career,

personal, or social.

Groups are designed with a goal of providing students and employees

the accurate information.

More likely to be found in schools/colleges to provide information for

career or educational understanding for personal and social growth,
adjustment and development, personal relationship skills, etc.

Career Assistance

Providing career assistance to clients with dramatic changes taking

place in the world of work.

Providing counselling not at selected stages in life's development, but

across the entire life span.

Technological advancements impact the ways counsellors provide

career assistance and information to their clients.

Moreover, criteria of promotions and selections do vary with the passage of
time, for example, in Pakistan promotion is now contingent on person's
work, qualification and research. Hence, the counsellor shall be aware of
these changes so rapidly taking place in the work environment.

Counselling profession is called upon to renew and update its efforts in one
of its traditional areas of service by paying attention to latest changes like
internet use, computer based assessment tools, programs, distance
learning, and interactive learning systems.

Placement & Follow-up

Educational placement in courses and programs has been a traditional
service of school counselling. The concerns for youth employment in 1990 in
USA resulted in increased attention to second placement service and to
match students with type of work, seeking part time or full time jobs.

Follow-up activities are a way to assess the effectiveness of a program's
placement activities.

Referral

The counsellor also refers clients to appropriate counsellors or agencies if
required.

Consultation

It is a process for helping a client through a third party or helping a system
improves its services to its clientele. Counsellors are used as a consultant to
teachers and parents. They are also consulted to prevent severe mental
illness, mostly in agency settings.

Research

Research is necessary for the advancement of counselling profession. It can
provide empirically based data relevant to different goals of counselling.

Evaluation

Evaluation is the process for assessing the effectiveness of counsellor's
activities.

Prevention

It is the most attractive alternative to traditional mental health practices and
seeks to prevent the occurrence of the disorder in the first place. Home and
school are the first social institutions that shape early adaptation and
influence early human development. Accordingly, primary intervention
strategies can be initiated to educate parents and teachers. The counsellors
also work in close alliance with medical doctors to promote both physical
and mental well-being. The current trends are to focus on the holistic
approach to counselling which embodies the dimensions of body, mind,
spirit and emotions.




Approaches to counselling
There are a number of approaches to counselling and psychotherapy which
can be divided into three main categories
1. Psychodynamic Approach
2. Humanistic Approach
3. Behavioural Approach
Although all can be effective, some approaches are better for a certain area
of counselling or psychotherapy than others. The reason there are differing
approaches is that not all human beings are the same and some of us have
difficulties which may be better suited to one therapy than another, this
is known in counselling circles as best fit for client.
Psychodynamic Approach to Counselling
Psychoanalytical and psychodynamic therapies are based on an individual's
unconscious thoughts and perceptions that have developed throughout their
childhood, and how these affect their current behaviour and thoughts.
Psychoanalysis
Freud is widely regarded as being the founder of modern psychology,
developing the therapy known as psychoanalysis. This therapy is based on
the idea that a great deal of an individual's behaviour and thoughts are not
within their conscious control. Psychoanalysis attempts to help clients
develop insight into deep-rooted problems that are often thought to stem
from childhood.
Psychoanalysis is based on the principle that our childhood experiences
have created our current behaviour patterns and thinking process. These
thoughts and feelings can become repressed and may manifest themselves
as depression or other negative symptoms.
By talking freely about thoughts entering their mind, the client reveals
unconscious thoughts and memories that the analyst will seek to interpret
and make sense of. Deeply buried memories and experiences are often
expressed during this time and the opportunity to share these thoughts and
feelings can help clients to work through these problems. These thoughts
can be analysed through free associations (the client says whatever comes to
mind during the session, without censoring their thoughts), dreams and
fantasies, which all allow the analyst to clarify the client's unconscious
thoughts.
Clients are encouraged to transfer feelings they have toward important
people in their life onto the analyst in a process called transference.
Success of psychoanalysis often depends on both analyst and client and
how they work together.
Psychoanalysis is an intensive process and usually clients attend four or five
sessions a week for several years. The regular sessions provide a setting to
explore these unconscious patterns, and try to make sense of them.
Psychoanalysis is mostly used by clients suffering high levels of distress,
and can be arduous for both client and analyst. However, if successful, the
therapy can be life-changing.
Psychoanalytic Therapy
Psychoanalytic therapy is based upon psychoanalysis but is less intensive,
with clients only attending between one and three sessions a week.
Psychoanalytic therapy is often beneficial for individuals who want to
understand more about themselves. It is particularly helpful for those who
feel their difficulties have affected them for a long period of time and need
relieving of mental and emotional distress.
Together, the therapist and the client try to understand the inner life of the
client through deep exploration. Uncovering an individual's unconscious
needs and thoughts may help them to understand how past experiences
have affected them, and how they can work through these to live a more
fulfilling life.
Psychodynamic Therapy
Psychodynamic counselling or psychotherapy evolved from psychoanalytic
theory, however it tends to focus on more immediate problems, be more
practically based and shorter term than psychoanalytic therapy. Carl Jung,
Alfred Adler, Otto Rank and Melanie Klein are all widely recognised for
further developing the concept and application of psychodynamics.
Psychodynamic therapy focuses on unconscious thought processes which
manifest themselves in a client's behaviour. The approach seeks to increase
a client's self-awareness and understanding of how the past has influenced
present thoughts and behaviours, by exploring their unconscious patterns.
Clients are encouraged to explore unresolved issues and conflicts, and to
talk about important people and relationships in their life. Transference
(when clients transfer feelings they have toward important people in their
life onto the therapist) is encouraged during sessions.
Compared to psychoanalytic therapy, psychodynamic therapy seeks to
provide a quicker solution for more immediate problems.
Freud also maintained that the personality consists of three related
elements:
Id, Ego and Superego
Id - The Id is the part of our personality concerned with satisfying
instinctual basic needs of food, comfort and pleasure the Id is present from
(or possibly before) birth.
Ego Defined as The realistic awareness of self. The Ego is the logical
and commonsense side to our personality. Freud believed that the Ego
develops as the infant becomes aware that it is a separate being from its
parents.
Superego The Superego develops later in a childs life from about the age
of three, according to Freud. Superego curbs and controls the basic
instincts of the Id, which may be socially unacceptable. The Superego acts
as our conscience.
Freud believed that everybody experiences tension and conflict between the
three elements of their personalities. For example, desire for pleasure (from
the Id) is restrained by the moral sense of right and wrong (from the
Superego). The Ego balances up the tension between the Id wanting to be
satisfied and the Superego being over strict. The main goal of
psychodynamic counselling, therefore, is to help people to balance the three
elements of their personality so that neither the Id nor the Superego is
dominant.


Humanistic Approach to Counselling

Humanistic Therapies focus on self-development, growth and
responsibilities. They seek to help individuals recognise their strengths,
creativity and choice in the 'here and now'.

Humanistic therapy emerged in the 1950's, and although behavioural
therapy and psychoanalytic methods were available, a humanistic approach
offered individuals another alternative. This approach focuses on
recognising human capabilities in areas such as creativity, personal growth
and choice. Two major theorists associated with this approach are Carl
Rogers and Abraham Maslow.
The main goals of humanistic psychology are to find out how individuals
perceive themselves here and now and to recognise growth, self-direction
and responsibilities. This method is optimistic and attempts to help
individuals recognise their strengths by offering a non-judgemental,
understanding experience.
Person-Centred Counselling (also known as Client-Centred or
Rogerian counselling)
The Person-Centred Approach developed from the work of the psychologist
Dr. Carl Rogers. He advanced an approach to psychotherapy and
counselling that, at the time during the 1940s to the 1960s was considered
radical.
This approach to counselling and psychotherapy sees human beings as
having an innate tendency to develop towards their full potential. But this is
inevitably blocked or distorted by our life experiences, in particular those
who tell us we are only loved or valued if we behave in certain ways and not
others, or have certain feelings and not others. As a result, because we have
a deep need to feel valued, we tend to distort or deny to our awareness those
of our inner experiences that we believe will not be acceptable.
The counsellor or psychotherapist in this approach aims to provide an
environment in which the client does not feel under threat or judgement.
This enables the client to experience and accept more of who they are as a
person, and reconnect with their own values and sense of self-worth. This
reconnection with their inner resources enables them to find their own way
to move forward.
The counsellor or psychotherapist works to understand the client's
experience from the client's point of view, and to positively value the client
as a person in all aspects of their humanity, while aiming to be open and
genuine as another human being. These attitudes of the therapist towards
the client will only be helpful if the client experiences them as real within
the relationship, and so the nature of the relationship that the counsellor
and client create between themselves is crucial for the success of therapy.
Gestalt Therapy
Gestalt Therapy focuses on the whole of an individual's experience; their
thoughts, feelings and actions, and concentrates on the 'here and now' -
what is happening from one moment to the next. Roughly translated from
German, Gestalt means 'whole' and was developed in the 1940's by Fritz
Perls. The main goal of this approach is for the individual to become more
self-aware, taking into account their mind, body and soul.
A therapist will constantly promote the client's awareness of themselves and
often uses experiments that are created by the therapist and client. These
experiments can be anything from creating patterns with objects and writing
to role-playing. Promoting self-awareness is the main objective of gestalt
therapy but other areas such as improving the ability to support ones
emotional feelings are also important. Gestalt therapy is influenced by
psychoanalytic theory and therapists will concentrate on 'here and now'
experiences to remove obstacles created by past experiences.
Transactional Analysis
Transactional Analysis is a theory that involves an individual's growth and
development. It is also a theory related to communication and child
development explaining the connections to our past and how this influences
decisions we make. Transactional Analysis was developed during the late
1950's by psychiatrist Eric Berne.
Berne recognised three key ego-states - Parent, Adult and Child. The
Parent ego state is a set of thoughts, feelings and behaviours we leant from
our parents and other important people. The Adult ego state relates to direct
responses to the 'here and now' that are not influenced by our past. The
Child ego state is a set of thoughts, feelings and behaviours learnt from our
childhood. The ego-states are useful for analysing unconscious scripts and
"games" people play.
Transactional Analysis seeks to identify what goes wrong in communication
and provide opportunities for individuals to change repetitive patterns that
limit their potential. It encourages individuals to analyse previous decisions
they have made to understand the direction and patterns of their life for
themselves. It also helps clients to trust their decisions and think/act as an
individual improving the way they feel about themselves. TA is a humanistic
approach and like Person-Centred Counselling focuses on the here and
now concept.
Transpersonal Psychology and Psychosynthesis
Transpersonal psychology began within humanistic therapies, however
today it is gaining recognition by many psychologists and a number of
professional organisations, and is now often seen as its own separate
psychological theory (along with the other three main categories:
behavioural, psychoanalytical and psychodynamic and humanistic).
Transpersonal psychology literally means "beyond the personal" and
involves encouraging the individual to discover the deep core of who they
really are (the real person that transcends an individuals body, age, gender,
physical space, culture, appearance etc.) It involves building and expanding
on an individual's qualities, their spirituality and self development.
Abraham Maslow's research on self-actualisation was a key factor in the
development of Transpersonal Psychology, which has since been refined by
the work of many others. Transpersonal Psychology encompasses three
major areas: Beyond-Ego Psychology, Integrative/Holistic Psychology, and
Transformative Psychology.
Psychosynthesis was developed by psychiatrist Roberto Assagioli and
involves an integration of the psychological and transpersonal elements.
Psychosynthesis accepts the idea of a higher, spiritual level of
consciousness, sometimes referred to as the "higher self". Techniques such
as meditation and visualisation are often used for self-exploration and
personal growth.

Existential Therapy
Existential Therapy focuses on exploring the meaning of certain issues
through a philosophical perspective, instead of a technique-based approach.
It is appropriate for those wishing to increase their self-awareness and
broaden their views on their surrounding world.
The principles of existential therapy are based on the theories of 19th and
20th century influential philosophers, such as Soren Kierkegaard and
Friedrich Nietzsche, who were in conflict with the predominant ideologies of
their time and committed to exploring human existence in a personal
manner. Existential therapy favours the idea that we are all directly
responsible for our own lives, over the idea of meaningful existence and
predetermined destiny. Many other philosophers, including Jean-Paul
Sartre, Gabriel Marcel and Ludwig Binswanger, also contributed to the
exploration of these ideas and the therapy is aimed at making sense of
human existence.
Existential Therapy is generally not concerned with the client's past, but
emphasises the choices to be made in the present and future.

Behavioural Approach to Counselling
Behavioural Therapies are based on the way you think (cognitive) and/or the
way you behave. These therapies recognise that it is possible to change, or
recondition, our thoughts or behaviour to overcome specific problems.
Behavioural Therapy
Behavioural Therapy is effective for individuals who require treatment for
some sort of behaviour change, such as addictions, phobias and anxiety
disorders. Based on the principle that behaviour is learnt, and can therefore
be unlearnt, or reconditioned, Behavioural Therapy concentrates on the
'here and now' without focusing on the past to find a reason for the
behaviour.
The most famous examples of conditioning are those of Ivan Pavlov and B.F
Skinner.
An experiment conducted by Pavlov demonstrated how ringing a bell close to
dinner time caused dogs to associate the ringing of the bell with the
expectation of food, which made them salivate even if no food appeared. The
importance of this experiment is that the conditioned response (the dogs
salivating) decreased in intensity the more times the conditioned stimulus
(ringing of the bell) occurred without the appearance of food.
A similar technique can be used to treat phobias, for example, where an
individual can gradually be exposed to the stimuli that triggers the phobia,
and recondition their behavioural response to it.
B.F Skinner conducted an experiment that associated reconditioning with
rewards. The experiment involved feeding a rat via an automatic dispenser
until the rat leant to associate the noise of the dispenser with the arrival of
food. Once the rat had learnt this behaviour, a lever in the wall was raised
so that when the rat touched it (accidently) with its paw, the food was
dispensed. The rat then learnt to associate the lever with the arrival of food
and continually pressed it.
A similar technique can be applied to individuals by reinforcing desired
behaviour, or not reinforcing undesired behaviour.

Cognitive Therapy
Cognitive Therapy involves learning how to identify and replace distorted
thoughts and beliefs, ultimately changing the associated habitual behaviour
towards them. It is usually focused on the present and is a problem-solving
orientated treatment. Cognitive Therapy is based on the principle that the
way we perceive situations influences how we feel about them.
When individuals are distressed they often can't recognise that their
thoughts are distorted, so Cognitive Therapy helps them to identify these
thoughts and reassess them. For example, if an individual makes a small
mistake they may think I'm useless, I can't do anything right. Strongly
believing this may cause them to avoid the activity where they made a
mistake and confirm this belief deeper. Addressing these thoughts, and
reassessing them can lead to more flexible ways of thinking, allowing the
individual to feel more positive, be less likely to avoid situations and be able
to challenge their negative belief.
Cognitive Therapy was first developed in the 20th century by American
psychiatrist Aaron Beck who realised what usually held his clients back
most were negative thoughts and beliefs such as I'm stupid or I can't do
that. Beck initially focused on depression and developed a 'list of errors' in
thinking that he believed could maintain depression. The list included errors
such as magnification (of negatives), minimisation (of positives) and over-
generalisation.
Albert Ellis, another therapist, came to similar conclusions about his clients'
negative beliefs and their tendencies to 'catastrophise' or 'awfulise'. Ellis's
work also became known as a form of Cognitive Therapy, now referred to as
Rational Emotive Behaviour Therapy (REBT).
The cognitive approach came into conflict with the behavioural approach at
the time, which focused solely on assessing stimuli and behavioural
responses to it. However, during the 1970's behavioural techniques and
cognitive techniques joined forces to create Cognitive Behavioural Therapy.

Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) combines cognitive and behavioural
therapies, and involves changing the way you think (cognitive) and how you
respond to these thoughts (behaviour). CBT focuses on the 'here and now'
instead of focusing on the cause of the issue, and breaks overwhelming
problems into smaller parts to make them easier to deal with. These smaller
parts can be described as thoughts, emotions, physical feelings and actions.
Each of these has the ability to affect the other, e.g. the way you think about
things can affect how you feel emotionally and physically, and ultimately
how you behave.
CBT is based on the principle that individuals learn unhelpful ways of
thinking and behaving over a long period of time. However, identifying these
thoughts and how they can be problematic to feelings and behaviours can
enable individuals to challenge negative ways of thinking, leading to positive
feelings and behavioural changes. It is possible for the therapy to take place
on a one-to-one basis, with family members or even as a group depending
on the issue and how the individual feels most comfortable.
CBT can be useful for dealing with issues such as:
anger
anxiety
depression
drug or alcohol problems
eating disorders
obsessive-compulsive disorder
phobias
post-traumatic stress disorder
Sexual and relationship problems
The emphasis on cognitive or behaviour aspects of therapy can vary
depending on the issue. For example, the emphasis may be more towards
cognitive therapy when treating depression or the emphasis may be more
towards behaviour therapy when treating obsessive compulsive disorder.
CBT is a practical therapy, which is likely to work best treating a specific
issue as it focuses on particular problems and how to overcome them.

CBT sessions may consist of a number of activities, including:
Coping skills
Assessments
Relaxation
Challenging certain thoughts
Thought stopping
Homework projects
Training in communication

Other Approaches to counselling
Although psychological therapies generally fall into the three categories
above, there are also a number of specific therapies too.
Family/Systemic Therapy
Family Therapy, also known as Systemic Therapy, is an approach that
works with families and those in close relationships, regardless of whether
they are blood related or not, to foster change. Changes are viewed in terms
of the systems of interaction between each person in the family.
The aim of Family Therapy is to help family members find ways to help each
other, whether the issue is believed to be an individual issue or whether it is
believed to be a family issue. Family relationships are considered to be an
important factor in the emotional health of each member within that family,
and this approach to counselling emphasises that.
Being actively involved in the sessions, families can all participate in moving
forward together, and a family therapist can encourage the support of this
system of interaction. Although the sessions are usually with family groups,
family therapists can also work with members of the family on an individual
basis if appropriate.
Family therapists are experienced in a wide range of areas, including
parenting issues, child and adolescent behaviour, divorce and separation,
adult mental health and changes in family life.
Art Therapy
Art Therapy or Art Psychotherapy is a form of psychotherapy that uses art
materials such as paints, clay and paper. These tools are used to
communicate issues, emotions and feelings and can provide an insight into
any conflicts that may be present. Clients may not be able to express these
emotions verbally, and art therapists aim to foster self-awareness in their
clients, and find outlets for these emotions.
Art therapists encourage clients to communicate via their art and then take
time to work with the meaning that can be found within it. Often, clients
seeing art therapists have lost touch with their feelings and how to express
themselves verbally, and can be emotionally blocked. Art therapists provide
a secure environment in which these emotions can find a creative way of
being expressed.
Clients do not need to have any previous experience or skill in art; the
important part of the process is the art itself provides a form of
communication. Art therapists have a deep understanding of art processes,
which is supported by their knowledge of therapeutic practice.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a form of psychotherapy that was developed in the 1980s. The
therapy is used to treat a wide range of psychological difficulties that
typically originate in trauma, such as direct or indirect experience of
violence, accidents or natural disaster. EMDR is also used to treat more
prolonged, low-grade distress that originates in shock or loss in adult life
and/or issues experienced during childhood. Increasingly, EMDR is being
used in treatment of other issues including depression and performance
anxiety.
EMDR uses an eight-phase approach to address the past, present, and
future aspects of a stored memory. During this process, the client recalls the
distressing memory, while simultaneously focusing on moving their eyes
side to side following the therapists fingers. Although eye movements from
side to side are most commonly used, a therapist may also use hand-
tapping or auditory tones depending on the needs of the client. A client will
then be asked to allow their mind to go blank and see what other memories
appear; this memory usually becomes the next focus to work on in the same
way. This process is repeated many times during the session.
During this whole process, the memories seem to lose their intensity. The
effect is similar to that which naturally occurs during REM (Rapid Eye
Movement) sleep when eyes move from side to side rapidly. Clients are then
asked to focus on a positive belief, while focusing on the memory, and on
the eye movements.

Integrative
Integrative counselling means drawing on and blending specific types of
therapies. This approach is not linked to one particular type of therapy as
those practising integrative counselling do not believe that only one
approach works for each client in all situations.
Integrative counsellors can draw on and blend the different types
of behavioural therapies, psychoanalytical and psychodynamic
therapies and humanistic therapies, and the clients issue is dealt with
systematically, as it would be if only one type of therapy were being used.
Integrative counselling allows the counsellor to explore an issue from a
variety of distinct theoretical perspectives and use concepts and techniques
from each.

Counselling skills
The counseling relationship is defined as the quality and strength of the
human connection that counsellors and clients share. Listening and
showing understanding skills are central to building quality relationships
with clients. All counseling relationships consist of two relationships: the
counselor's relationship with the client and the client's relationship with the
counselor.

All systems of counseling / therapy employ various patterns of skills, known
as microskills.

Microskills are observable actions of counselors & therapists that appear to
effect positive change in the session in which active listening involves both
receiver and sender.

Complex interaction is broken down into manageable & learnable
dimensions. Once you learn these skills they can be fitted in a wide variety
of theoretical orientation. When you learn new methods of therapy, you can
build them on these skills and frame them into a variety of techniques.

Different microskills are described in the following:

Attending skills

Listening skills: "Basic listening sequence"

Focus and selective attention

Influencing skills

Confrontation & challenging

Attending skills

Attending skills is a simple phrase for a complex collection of behaviors and
abilities. Attending skills are comprised of a series of complex proficiencies
that cut across the verbal and nonverbal domains of communication. It is
rare that people receive the full attention of their communication partner(s).
When it does happen, they are keenly aware and appreciative of this fact. It
is rare that people place full attention on themselves; hence, it is not
surprising that most clients, and perhaps too many clinicians, are unaware
of, or inattentive to, their own Meta communications. Clients are frequently
unaware of communications that go beyond the verbal, and
clinicians may forget to attend to these nonverbals.


Attending refers to the focused attention that is placed on the other person
in an interchange between two (or more) people. Without attending skills,
the establishment of therapeutic rapport is most likely difficult, if not
impossible.

Attending skills: Nonverbal Communication

Nonverbal communication is important from two perspectives: Nonverbal
communication expressed by the client and picked up by the clinician.
Nonverbal communication used by the clinician for therapeutic goals.
Attending nonverbal communication is an excellent means of gaining a
clearer understanding of clients as it opens up a major area of meta-
communication:

Body language & movement

Paralinguistic

Physical space

Timing

Body Language & Movement

Kinesics can emerge from any body part. Some of the most important body
features observed involve head, face, eyes, mouth, shoulders, arms, hands,
legs, feet, and torso. Motor movement observations about all body parts are
important as they can provide a great deal of information. Motor movement
overall is often further defined as agitated, fidgety, unusual, normal, or as
including tics, tremors, or motor abnormalities. Autonomic responses are
also often included, drawing attention to physiological reactions such as rate
of breathing, blushing versus paling, or pupil dilation. All motor and facial
expressions can be assessed in terms of their congruence with verbal
content of conversation as well as the level of activity or agitation they may
suggest

Paralinguistics

The therapist attends to how high or low the client's volume is when
speaking of various contents, and whether volume or inflection changes
depending on topic. Very high volume may relate to anger, whereas very low
volume may indicate sadness.

Nonverbal or metacommnnication aspects related to voice and speech have
great communication value. A high-pitched voice may suggest anxiety;
changes in inflection may direct attention to particularly emotional topics.
Counselors direct their attention to several aspects of speech, including
voice volume, articulation, pitch, emphasis, and rate (VAPER). Speech
fluency is explored with regard to the intrusion of stuttering or similar
speech errors, as well as jerky speech that changes in clarity and fluency
across topics. For example, sudden hesitations in speech may indicate
anxiety about a topic or second thoughts about self-disclosure. Speech
errors, such as wrong word choice or inability to think of the right word,
may suggest anxiety or resistance.

Rate of speech refers to the speed with which the client communicates. It
could theoretically be evaluated by looking at the number of words spoken
per minute. Most concretely, rate ranges from slow to fast. Slower speech
rate helps you appear less nervous, and also provides more time to think of
what to say.

Use of Pauses and Silence

Use of pauses and silence enhances your capacity to be a rewarding listener.
The counselor can pause each time they stop speaking before responding to
see if they wish to continue; Good use of silence also gives clients more
psychological space to think things through before speaking. Some
counselors and clients find silence threatening; they have to work on
tendencies to interrupt too soon.

COUNSELOR'S NONVERBAL COMMUNICATION

Counselors also express nonverbal information through eye contact

and body movements.

Clients make assumptions about the therapists' kinesics based on

their own experience with how they express themselves nonverbally;
they do not usually attempt to understand the unique expression of
the counselor.

Counselor's nonverbal communication is strongly related with

building therapeutic relationship.

Nonverbal Pitfalls of the Counselor

Excessive physical closeness at outset of treatment

The client may feel crowded or overwhelmed; misunderstand the behavior as
seductiveness by the counselor

Excessive physical distance at outset of treatment

The client may feel rejected or at least not accepted; perceiving the
counsellor as arrogant or standoffish
Distancing body movements or facial expression

Examples of distancing facial expressions are bored look, yawning, lack of
consistent eye contact, etc. Similarly, examples of distancing body
movements are crossed arms or legs, chair moved away, etc. The client may
feel judged, rejected, or misunderstood; may perceive the clinician as
judgmental or reactive for personal reasons; may feel unimportant, boring,
not being accepted, not liked; may perceive the counselor as emotionally
absent

Absent/ inconsistent eye contact

The client could have following reactions in response to absent eye content
of the counselor: Feeling ignored, feeling not cared for; perceiving the
clinician as shy or insecure; feeling not attended to, feeling perceived as
boring; perceiving the clinician as distracted

Excessive eye contact

The client could have following reactions: Feeling under scrutiny, feeling
uncomfortable and intruded upon; perceiving the counselor as intrusive.

Creating barriers out of objects (e.g., desk, etc.)

The client could have following reactions if the desk between counselor and
client is too big: Feeling rejected, not feeling accepted, feeling unimportant;
perceiving the clinician as aloof

Incongruent facial expressions or gestures

The client could have following reactions: Confusion, feeling misunderstood,
feeling placated and feeling lied to; perceiving the clinician as inconsistent or
incongruent

Distracting mannerisms (e.g., twirling hair, playing with an earring,
scratching, etc.).

Feeling perceived as boring, not feeling attended to, feeling perceived as
uninteresting; perceiving the clinician as anxious or inattentive

Excessively loud voice or rapid speech

Feeling bossed around, feeling overwhelmed, being given advice or told what
to do; perceiving the clinician as angry or hostile

Excessively low voice or slowed rate of speech

Feeling insecure about the value of treatment; perceiving the clinician as
unsure of self

Impatient rate of speech, poor timing (e.g., interrupting client)

Feeling perceived as incompetent, feeling perceived as unimportant, not
feeling heard; perceiving the clinician as incompetent or unempathic.

A Touchy Subject--Touching

Touching a client is very problematic in today's society. Touch appropriately
is a major concern for counselors. It is a powerful way to communicate
caring and empathy. It can also be easily misunderstood, misconstrued, and
damaging to the counseling relationship. Touch closes all distance between
two individuals. Although this can be a very human and caring reaction,
reaching out and touching a client can also carry negative consequences.

Not all clients appreciate touch and some may misinterpret it. The best rule
of thumb for the beginning clinicians is to refrain from the impulse to touch,
especially early on in the work with a given client. If the clinician does not
want to refrain from touch, the next-best solution is to ask the client if
touch is acceptable. If a client indicates any hint of reticence to this request,
the clinician would violate the client's personal boundaries through touch, a
disrespectful and perhaps frightening move.

Use of Space

Two most important aspects of space utilization are distance and position.
Observing how clients use personal and environmental space is often a
useful way to better understand them. Distance refers to the amount of
personal space a client appears to require. Some clients need significantly
more distance from the therapist than others in order to feel comfortable in
a counseling setting. They may go to great lengths to move their chairs as
far away as possible from the counselor. Other clients may feel most
comfortable if the distance between them and their clinician is at an
absolute minimum. Counselors need to be aware of the client's space needs
and should therefore try to accommodate these as much as possible.
Difficulty can arise if the personal space needs of the client and clinician
conflict significantly.

Gender and Cultural Differences

Although cultural differences exist that may make the need for personal
space somewhat predictable, it is generally best just to observe the personal-
space needs of each client and then attempt to honor and respect those
needs. Gender differences may be observed as well.

Timing

Timing refers to all time parameters of the session, such as starting and
ending on time, as well as the use of time within sessions, such as the
timing of important self-disclosures. Timing is an important nonverbal
means of regulation, that is, of helping client and clinician negotiate who
speaks when. If a client suddenly stops in mid-sentence and pauses, the
timing of this pause suggests that a comment from the clinician about the
last expressed thought is expected. If the clinician makes a statement and
then is silent, without breaking that silence, a clear communication is
offered that invites the client to speak.

Timing is an important nonverbal means of regulation. The timing of certain
statements by a client within the context of the therapy hour can give a
counselor hints as to whether the client wants to discuss the issue. For
example, an important self-disclosure a few minutes before the end of a
session may communicate ambivalence on the client's part about whether to
discuss this topic. However, it may also be an attempt to extend the therapy
hour beyond the established parameters. The clinician's response will have
important nonverbal-communication value. If the counselor chooses to
extend the session, the nonverbal communication is that the client can
manipulate the clinician easily into getting extra time. If on the other hand,
the clinician holds fast to the therapeutic hour, a clear communication is
made that the counselor has good personal boundaries.

Concepts facilitating Good Nonverbal Communication

Three important concepts facilitate good nonverbal communication and thus
therapeutic rapport, namely, congruence, sensitivity, and synchrony.


Congruence

Congruence refers to the clinicians efforts to keep personal verbal and
nonverbal expressions in line with each other. Achieving congruence
between what a counselor says and does is critical to good therapeutic
rapport.

Sensitivity (understanding the client's nonverbal communications)

Sensitivity refers to a mental-health-care provider's ability to receive and
understand the client's nonverbal communications. Learning how to
interpret the kinesics and paralinguistics of each individual client is a
critical component of sensitivity.

Synchrony (matching a client's lowered voice and lowered rate of
speech)

Synchrony refers to the clinician's ability to match or oppose the clients
nonverbal expressions as therapeutically indicated. For example, matching a
clients lowered voice and lowered rate of speech when the client talks about
a sad event will help the client feel heard and understood.

Mirroring Nonverbal Behavior

In a successful smoothly flowing interview, movement symmetry often
occurs between counselor and client. Client pauses in the middle of a
sentence, the counselor nods, and the client then finishes the sentence. It is
represented by a "passing" of movement back and forth between client and
counselor. Both unconsciously assume the same physical posture as if they
are following a programmed script.

Dissynchronous movement can indicate that the interview is on wrong
track. The tool should not be used manipulatively but to increase awareness
and insight

On the Topic
To attend, you must also "listen"

Example:

Client: I went for shopping this afternoon and I really got anxious. I even
wanted to run when I saw a friend. I was sweating and I felt I couldn't move.
I have been in my room until just now.

Nonattentive counselor: Did you get admission in bachelors this year?
Attentive counselor: You say you wanted to run when you saw your friend.
Can you describe the situation in more detail?

Helpful Behaviors: Nonverbal

Tone of voice similar to the helpee

Maintains good eye contact

Occasional head nodding

Facial animation

Occasional smiling

Occasional hand gesturing

Close physical proximity to the helpee

Moderate rate of speech

A Counselling Session
Counselling and psychotherapy are always undertaken at the request of
the client and no-one can properly be sent for counselling or
psychotherapy. There are many situations these days where people
with influence in our lives (perhaps a relative, manager at work, or
teacher) will suggest talking therapies as a solution to a problem. This
should be offered without any pressure or strings attached.

A consultation or session with a counsellor usually takes place in a
confidential setting (traditionally at the approved premises of the
counsellor/service provider or at the organizations premises where this is
suitably private) and will last between 50 minutes and one hour. The
duration and frequency is often dependent on the resources available and
the appropriateness of counselling (dictated by the counsellor in
consultation with any supervisor or case manager).

Traditionally, counselling happens face to face, but alternatives include
telephone, online and video-conferencing. The advantages of these
alternatives are that they improve access to counselling.
Counselling sessions are tailored to meet each client's needs, however, there
are a number of similarities between sessions. An individual appointment
with a counsellor is typically 50-60 minutes long and in all sessions a
clients personal and health information is treated with professional
confidentiality appropriate to the Code of Ethics of the Psychological Society
and the relevant Government legislation.
Counselling is a professional activity and as such it is important that at the
beginning both parties are clear about what is on offer.
So after meeting a counsellor and chatting through what the difficulties are,
the counsellor invites the client to make a contract this is basically an
agreement which can be verbal or written, it sets out clearly what the
counsellor is offering so you the client can make an informed decision on
whether to proceed or not.
A contract will usually cover the following areas;
Time and day/s of session/s.
Duration of the session (usually 50 minutes)
How many sessions are available
What approach the counsellor uses
Fee (if a paid service)
How long you notes will be kept for, who can see them, and how they will
be disposed of.
Complaints procedure
Confidentiality
Although a counsellor has to provide confidentiality, there are some
exceptions to confidentiality some which sound quite logical and others
which may sound a bit bizarre to anyone outside the world of counselling.
Exceptions are disclosures such as;
Harm to self, harm to others, (this is usually the policy of organisations who
employ counsellors). Money laundering, Acts of terrorism, Drug Trafficking
Child protection issues which the counsellor has a legal obligation to
disclose.
Typically a counsellor will conduct an assessment at the start of treatment
and give the client an opportunity to discuss how the problem he /she is
currently facing started and how it developed. During this time the
counsellor will also ask about what the client is currently doing in life and
what would he /she like to achieve from seeking counselling. Between
sessions the client may be asked to complete "homework" to help develop
understanding of the problem he /she is working on, monitor change and to
try out new ways of doing things.


Counselling in the workplace
There has been a rapid increase in compensation claims for work-related
stress in recent years. Court rulings have made it clear that employees who
feel under stress at work should inform their employers and give them a
chance to do something about it. Any employer who offers a confidential
counselling service with access to treatment may have some protection from
prosecution.
Workplace counselling may be defined as the provision of brief psychological
therapy for employees of an organisation, which is paid for by the employer.
An external service, such as an Employee Assistance Programme (EAP),
typically comprises face-to-face counselling, a telephone helpline, legal
advice and critical-incident debriefing. In an in-house service, counsellors
may be directly employed by the organisation. Workplace counselling offers
employees a facility that is confidential, easily accessed (initial appointment
normally within 2 weeks), provides a properly qualified and supervised
practitioner, does not raise the threat of a diagnosis of psychiatric disorder,
and promises to alleviate distress within a reasonably short period of time
(most services allow only 6-8 sessions in any one year). Workplace
counselling offers the employer a service that is valued by employees, has
the potential for savings by reducing sickness absence, takes pressure off
managers through the availability of a constructive means of dealing with
difficult staff or situations, and contributes to its reputation as a caring
employer. Workplace counselling is often viewed by employers as an
insurance policy against the threat of compensation claims made by
employees exposed to work-related stress.
The provision of workplace counselling has steadily expanded over the past
20 years, with more than 75% of medium and large organisations in Britain
and North America making counselling available to their staff. A review of
research into the outcomes of workplace counselling identified 34 studies,
including controlled studies, naturalistic studies in which reliable pre- and
post-counselling data were collected, and case studies. Employees presented
to counselling with high levels of psychological symptoms. Those who
received counselling were highly satisfied, and believed it had helped them
resolve their problem. Clinically significant improvement in levels of anxiety
and depression was reported in 60-75% of clients. Counselling was
associated with reduction in sickness absence and improvement in other
organisational outcomes such as more positive work attitudes, fewer
accidents and enhanced work performance.

It is important to recognise the limitations of the existing research base for
workplace counselling. This is a field in which research has been
significantly constrained by commercial considerations. There is also a great
deal of sensitivity around confidentiality; the fear that management may
learn that a person has received counselling has made many clients and
counsellors reluctant to complete research questionnaires. High attrition
rates are found in such research samples.
However, despite these methodological weaknesses, the general picture that
emerges is that workplace counselling is appreciated by its users, and
appears to have a positive impact on objective measures of distress (e.g.
sickness absence) and on self-reported measures of symptomatology.
Probably, several factors have contributed to the growth and popularity of
workplace counselling. At one level, workplace counselling can be viewed
merely as an application of methods of brief, relationship-focused
psychological intervention that have been shown to be effective in other
settings. A distinctive strength of workplace counselling is that the client is
seen by a therapist who is sensitised to the combination of personal and
work pressures that the person may present. Workplace counselling is a
systemic, as well as individual, intervention. The introduction of a
counselling service may begin to change the way that managers and other
staff think and talk about emotional difficulties and personal problems. The
costs to employers of psychological disability are clearly understood. The
acceptability of workplace counselling is certainly linked to shifts in the
meaning of work, and the movement away from collective to more individual
modes of worker resistance.

In a recent qualitative study, Millar (2002) interviewed police officers and
support staff who had received counselling for work-related difficulties. Most
of the participants reported that counselling had helped them to overcome
the problem that had led to them seek help. More striking, though, was the
finding that all of these informants described themselves as learning
something new and useful about them as a result of counselling. For
example, an experienced detective stated that I am 100% better at listening
now to a person. Although further controlled studies of the effectiveness of
workplace counselling on psychiatric symptoms are undoubtedly necessary,
it is also essential to acknowledge the relevance of a wider research agenda
(McLeod, 2001), in which the role of workplace counselling can be examined
in relation to a range of issues such as health, organisational culture and
work effectiveness.

Employment practices over the world are changing, with more people on
short-term contracts, working part-time and with less job security. An
added burden for employees, employers and the economy as a whole is the
large number of employees absent from work, sick or retired because of ill
health. Although under recognised, frank psychiatric conditions most
notably anxiety and depression but also somatoform disorders and
substance misuse account for a growing proportion of these absences.
A new diagnosis has recently emerged which is ubiquitous, not viewed
pejoratively, widely used on sickness certificates and has formed the basis of
legal claims against employers: workplace stress. It does not seem to have
an objective definition and thus any overlap with the psychiatric diagnoses
already noted is unclear. Fortunately, workplace stress is apparently
treatable; in fact, it is highly responsive to treatment. The name of this well-
tolerated and efficacious treatment is workplace counselling.
Work and workplaces are rapidly evolving and 21st-century occupational
medicine will have to manage a different set of problems from its early-20th-
century predecessor. However, where previously a link between exposure
and illness was clear and such exposure could have occurred only in the
workplace, now many complaints have vaguer, non-specific symptoms and
signs, and multi-factorial aetiology is the norm. The concept of workplace
stress implies that work is the causative factor but despite an individual
being unhappy at work and using a work-based outlet to complain,
symptoms may be explained in several other ways. There may be a
perception that appropriate help is difficult to access via more traditional
routes. Alternatively, this might represent the well-recognised phenomenon
of effort after meaning.
Treatment for such a heterogeneous group of problems with a single
therapeutic modality would seem almost impossible, yet this is what
workplace counselling claims to do. The quality of the evidence to support
this is poor. Professor McLeod, in his recent review (McLeod, 2001), failed to
find a single study showing a negative outcome for workplace counselling
a clear case for suspecting publication bias, yet an issue barely touched
upon in the review. All treatments that work have the potential for adverse
effects and this holds true for psychotherapeutic as well as pharmacological
interventions. The available studies are limited by small sample sizes, short
follow-up periods and wide variation in the form and content of the therapy
given. Even in the best evidence section only 5 out of 19 studies had a form
of non-treatment control group. Of these, two used controls who were not
seeking any form of help at all and one used those who dropped out at the
first session as controls.
The arguments for randomised controlled trials are well-rehearsed and no
less applicable to a psychological than to a physical treatment. Non-
randomised studies are more likely to produce false positive results. The
medical literature contains numerous examples of treatments that were felt
to be beneficial but when subjected to randomised controlled trials were
shown to be ineffective or, worse still, harmful. Especially in a situation
where there is a strong possibility the complaint may get better
spontaneously (as so many do) there is an onus on researchers to
demonstrate the additional benefits their treatment brings. To date, such
evidence just is not available for workplace counselling; certainly removing
the argument that randomisation is unethical. The medicalisation or
psychologisation of normal human distress is a real and unwelcome
possibility. So too is the possibility of failing to manage the other factors
involved; work may indeed be a part of the jigsaw but in all probability only
a part most stressors are external to work.

So does workplace counselling work? Well, that depends on what you want
it to do. Many studies highlight the significant client satisfaction associated
with workplace counselling. If that is its aim, then it succeeds. Studies in
closely related fields (e.g. cognitivebehavioural therapy v. relaxation for
chronic fatigue syndrome) attest to the discordance between simple
measures of satisfaction and clinical outcome (Deale et al, 1997). What data
there are on workplace counselling do not allow us to conclude that
satisfaction is allied with meaningful clinical improvement or even
consistent employment objectives such as reduced absenteeism. The cynic
might suggest that if employers want a tool that their employees appreciate
and that, in view of the recent Court of Appeal ruling (Sutherland v. Hatton,
2002), protects them from litigation, then workplace counselling does indeed
work. The objective observer looking at clinical outcomes would undoubtedly
conclude that there is no reliable evidence that workplace counselling is of
benefit.

Workplace counsellors are expected to work within a short-term framework.
Employees accessing counselling normally have a limited number of
sessions available to them, usually between two and six sessions. If further
support is required, counsellors may refer employees onwards to alternative
primary care resources, which may not necessarily be funded by the
organisation. Workplace counsellors are expected to have an understanding
of organisational cultures and workplace factors that might impact on their
work. They should be mindful of the different stakeholders involved and be
aware of potential conflict between the needs of the client, the organisation,
the counselling provision and additional parties. Although counselling is a
major component of an employee support service provision, the provider
needs to develop an understanding of, and expertise in, a number of related
activities including coaching, mediation, trauma-management services and
practical information (eg debt management, legal advice or benefits
information).

Service providers should be able to conduct routine stress audits. This will
help purchasing organisations meet their legal obligations to carry out risk
assessments. Whilst service providers can provide support to employees to
increase their coping resources through counselling, stress management
and mental health awareness training, the organisation has a duty of care to
ensure a safe and healthy working environment is provided.

Self-referrals versus referrals from managers

Self-referrals (where the employee chooses to refer themselves for
counselling) are most commonly made available to employees, and these are
strictly confidential. Even the fact that an employee has made contact with
the service provider is protected. The advantage of this is that employees can
take responsibility for themselves and get support freely without anyone in
the organisation being aware of their referral. It should be noted that in
some circumstances the self referred client has an option to inform
management and obtain time off from work to attend counselling.
Alternatively they may wish to keep counselling confidential and go in their
own time.

Some purchasers may wish to concentrate their efforts on those employees
who are in most need, such as those absent from work, particularly those
with stress. Manager-referrals can give this focus. These have been more
closely associated with occupational health and may occur where a manager
is concerned about an employees sickness absence (eg especially when due
to some mental health issue such as anxiety or depression). There are slight
variations on the manager-referral format, but basically each allows a
manager, supervisor or other authorised individual to refer an employee to
appropriate support or counselling. The person making the referral on
behalf of the employee may receive a summary feedback report after an
initial assessment to determine the most appropriate support.
Confidentiality needs to be taken into account here as the employee needs to
give their consent (preferably in writing) to any identifiable information
released. The advantage of this type of referral where a report is written is
that, issues originating in the workplace can be identified, giving the
organisation an opportunity to take remedial action. Also, it enables
counselling to be provided to employees who may not have considered
referring themselves.

The potential disadvantage is that employees may feel in some way that they
are being coerced into the counselling rather than freely entering it. If this is
the case, it will reduce the effectiveness and credibility of the service.
Purchasers who wish to include manager-referrals in their schemes would
benefit from assurances about how the service providers can mitigate any
potential disadvantages, including how practitioners have been trained to
write reports to managers and other feedback protocols.

Notwithstanding the maintenance of confidentiality which is paramount,
counsellors need to act in cases of apparent workplace problems, which are
in some cases a major stress contributor, by encouraging self-referred
clients to communicate their work-related problems back to the employer.
Where circumstances allow, and with client consent, the counsellor/service
provider can act as a bridge between the client and the organisation (such
as via human resources, welfare, occupational health) so that the underlying
work-related difficulties can be addressed. This should be voluntary for the
client without any penalty if they would prefer that it be kept confidential.

Counselling for work and personal/ home issues

Uninitiated organisations might assume that a counselling service is used
for work-related issues only. While this is a decision a purchaser needs to
make themselves, it is apparent that domestic or personal issues can have a
significant impact on work. For instance, with presenting issues such as
relationship difficulties, bereavement and addiction, there may be a knock-
on effect on work, including deterioration in concentration, increased
accidents and higher absence. Similarly, work-related stress, bullying and
harassment, work-related trauma, organisational change and work
performance can have an adverse affect on home life.

How counselling contributes to organisational development

Counsellors may find that clients present to them with work-related issues.
Whilst anonymity and confidentiality will be maintained, there are
opportunities to present to the organisation aggregated examples of
dysfunctional behaviours, such as bullying and harassment. Most likely,
such information may be made via usage statistics. Additionally, case
managers, service managers and/or occupational health practitioners may
be able to act as a bridge between the counsellor and the line manager or
human resources. Where manager referrals are made, the workplace
counsellor can include any work issues within the report sent back to the
organisation.
Workplace counselling and stress

Counselling is used in the workplace to solve a number of problems faced by
employees. The root cause of most of these problems is stress. Stress at
work is on the increase. This comes as no surprise given the fact that many
employers have not addressed the long-hours culture, reduced job security
or the advent of modern technologies including email communication, with
employers requiring tasks to be done faster and more efficiently with
reduced staff numbers. These can all lead to increased stress and sickness
absence.

There are many definitions of stress. The National Institute of Occupational
Safety and Health defines stress as: The harmful physical and emotional
responses that occur when the requirements of the job do not match the
capabilities, resources, needs of the worker. Alternatively, stress can be
defined as: The adverse reaction people have to excessive pressures or other
types of demand placed on them.
Stress occurs when the perceived pressure exceeds your perceived ability to
cope. Work-related stress is the natural reaction of people to being put
under intense pressure at work over a period of time. Many people are
motivated by the challenges and difficulties that normally occur with work
demands and react by improving performance. Meeting those challenges and
overcoming the difficulties causes feelings of relaxation and satisfaction.
When the pressure of work demands becomes excessive and prolonged,
however, people perceive a threat to their well-being or interests and then
experience unpleasant emotions such as fear, anger or anxiety. The basis of
this reaction comes from instinctive "fight or flight" reactions to danger.
The reactions of individuals vary according to the nature of the pressures
and the extent to which the person is directly or indirectly involved. What
may be seen as a challenge by one person may be an impossible task or
boring and repetitious to another. A person's background, motivation,
experience, skills and knowledge on the one hand and the support and
encouragement from managers, supervisors and colleagues on the other, all
play an important role in determining the stress level faced by them.
While it may be beyond the employer's or supervisor's responsibility or
expertise to overcome, it is necessary to take into consideration that people
will come to work with various character traits and in various moods.

Problems outside of work can also contribute to stress, e.g. relationship
problems and financial pressures. Non-work problems can make it difficult
for people to cope with the pressures of work, and their performance at work
may suffer. A death or sickness in the family, a temporary setback or other
personal problems may exacerbate the situation and influence the way
people cope with work pressures.
The causes of stress (often called stressors) can be many and varied, and
can occur as a result of combinations of more than one stressor. Most
stressors can be grouped into one of three areas. For each group of stressors
are suggestions for managers and supervisors to consider when dealing with
those triggers. As stated by the Canadian Mental Health Association: Fear of
job redundancy, layoffs due to an uncertain economy, increased demands
for overtime due to staff cutbacks act as negative stressors. Employees who
start to feel the "pressure to perform" can get caught in a downward spiral of
increasing effort to meet rising expectations with no increase in job
satisfaction. The relentless requirement to work at optimum performance
takes its toll in job dissatisfaction, employee turnover, reduced efficiency,
illness and even death. Absenteeism, illness, alcoholism, "petty internal
politics", bad or snap decisions, indifference and apathy, lack of motivation
or creativity are all by-products of an over stressed workplace.
Some stress is normal. In fact, it is often what provides us with the energy
and motivation to meet our daily challenges both at home and at the
workplace. Stress in these situations is the kind that helps you "rise" to a
challenge and meet your goals such as deadlines, sales or production
targets, or finding new clients. Some people would not consider this
challenge a type of stress because, having met the challenge, we are
satisfied and happy. However, as with most things, too much stress can
have negative impacts. When the feeling of satisfaction turns into
exhaustion, frustration or dissatisfaction, or when the challenges at work
become too demanding, we begin to see negative signs of stress.
In the workplace, stress can be the result of any number of situations. Some
examples include:
Factors unique to the job
workload (overload and under load)
pace / variety / meaningfulness of work
autonomy (e.g., the ability to make your own decisions about our own job
or about specific tasks)
shift-work / hours of work
skills / abilities do not match job demands
lack of training and/or preparation (technical and social)
lack of appreciation
physical environment (noise, air quality, etc)
isolation at the workplace (emotional or working alone)
physical danger, or the threat of it;
in contact with human suffering and people's reactions to it;
single incident such as armed robbery or a workplace fatality;
organisational change, such as restructuring;
Role in the organization
role conflict (conflicting job demands, multiple supervisors/managers)
role ambiguity (lack of clarity about responsibilities, expectations, etc)
level of responsibility
Career development
under/over-promotion
job security (fear of redundancy either from economy, or a lack of tasks or
work to do)
career development opportunities
overall job satisfaction
Relationships at work (Interpersonal)
poor relationships with colleagues;
bullying or harassment;
discrimination;
lack of communication or consultation between manager and employee;
negative culture based on blame for and denial of problems; or
misguided practical jokes or initiation ceremonies;
threat of violence, harassment, etc (threats to personal safety)
lack of trust
lack of systems in workplace available to report and deal with
unacceptable behaviour

Organizational structure/climate
participation (or non-participation) in decision-making
management style
communication patterns (poor communication / information flow)
lack of systems in workplace available to respond to concerns
not engaging employees when undergoing organizational change
lack of perceived fairness Feelings of unfairness magnify the effects of
perceived stress on health.
Work-Life Balance
role/responsibility conflicts
family exposed to work-related hazards
Stress may arise from sub-standard performance resulting in
disciplinary action but an employee is eligible for workers'
compensation if the action by the employer can be demonstrated to be
unreasonable and harsh. Stress issues will need to be dealt with
appropriately as part of good management practices.
The signs of stress
Personal signs of stress include:
immediate body changes that may be associated with distress, such
as changes in heart rate and breathing rate, muscle tension, nausea
or vomiting;
feelings of anger, protest or frustration;
feelings of anxiety or being out of control;
feelings of guilt or embarrassment;
irritability and loss of concentration, poor memory, learning
difficulties; or
prolonged sleeplessness and disturbing dreams.

Outward signs of stress in individuals that could be noticeable to colleagues
and managers include:
deteriorating relationships with colleagues;
irritability, indecisiveness, absenteeism, reduced performance;
demand for more precise instructions;
increased smoking or alcohol consumption, or drug taking;
complaining about ill-health; or
actual ill-health such as frequent headaches, gastro-intestinal
disturbance, ongoing minor illnesses, skin rashes, deteriorating
immune response.
Signs of stress across an organisation that represent a business cost
include:
high staff turnover, increased absenteeism, reduced work
performance, poor timekeeping and more customer complaints;
stress appearing in those people who cover for the stressed colleague
who is absent from work;
increased rate of workplace accidents;
compensation claims from people whose unchecked stress results in
ill-health;
reduction in output, product quality, service or morale;
increased wages/overtime payments;
deterioration of industrial relations; or
organisational sabotage.
The effects of stress indicated above could each be signs of a range of other
health problems. The diagnosis of severe stress generally requires a trained
professional. Stressors cover a large range of symptoms: from poor
performance, boredom and deteriorating relationships to aggressive
and threatening behaviour, or single shocking incidents.
Stress becomes an occupational hazard if it adversely impacts on safety and
health in the workplace. Often a number of factors from the workplace and
home combine to increase stress to the point where a person may put their
own or another person's safety at risk. As a result, both employers and
employees have a special duty of care role to play in making sure risks that
are caused by stress from all sources are minimised and staff are fit for
work.

Employers have a duty to provide a workplace where, so far as practicable,
employees are protected from hazards in their workplace. This includes
providing safe systems of work, information, instruction, training and
supervision. There is also a requirement for employers to consult and
cooperate with safety and health representatives and other employees.
Employees must take reasonable care for their own safety and health and
avoid adversely affecting the safety and health of others in the workplace.
They must also cooperate with employers in safety and health matters so
that employers can act responsibly.
The Occupational Safety and Health Regulations 1996 require employers,
where practicable, to adopt a systematic approach to identifying, assessing
and controlling hazards at work. Employers should identify factors in the
workplace that cause stress (a number of which are have already been
listed). They should then assess the likelihood of stress causing injury or
disease. If the risks are significant, they should put in place controls to
minimise them.
Employers have a duty to provide safe systems of work, information,
training and supervision and to consult and cooperate with employees.
Employees have a duty to take reasonable care of themselves in the
workplace and to cooperate with the employer on safety and health
matters.
It is difficult to objectively measure the level of stress in the workplace. For
example, there are no simple tests to measure how much pressure a person
can work with, before the stress adversely affects their health and safety.
There are consultants who can measure the sources of stress and develop
appropriate solutions for your workplace, using subjective measures.
The design and appropriate solutions identified from will vary according to
the size and complexity of the organisation, available resources and
especially the unique types of stress problems faced by the organisation.
Minimising stress in the workplace does not have to be costly.
In spite of difficulties in measuring stress, both employers and employees
regularly make judgements about levels of stress and the level of associated
risk. The absence of objective tests does not remove the need to do a risk
assessment nor does it mean that the assessment is invalid.
Responsibility for risk assessment rests with the employer, main contractor,
self-employed person or person with control over the workplace or access to
it, and involves:
identifying pressures at work which could cause high and long-lasting
levels of stress;
identifying people who might be affected by these pressures;
deciding whether preventative action in place is sufficient;
taking action to prevent pressure growing to an unacceptable level;
and
reviewing the success of the control measures.
It is important that there is early intervention if stress is identified. Risk
assessment should determine the likelihood of stress resulting in ill-health
which will prompt actions to deal with those pressures. For example, a
supervisor needs to consider whether an employee has too many competing
deadlines before asking that person to do an additional task. The employee
needs to clearly understand the pressure they may already be under when
deciding whether to refuse the extra work or not.
The risks arising from stress may also vary depending on the task. Some
tasks require a higher level of concentration, coordination or strength in
order to carry them out safely. As a result, the level of pressure that may be
tolerated will vary between industries and occupations.
Mechanisms should be in place to ensure the risk of stress is identified as
early as possible, followed by a risk assessment and the introduction of
controls appropriate to your workplace.
Stress management systems should only be developed in organisations in
which a need is identified. They should be developed in conjunction with
grievance procedures to cover both preventative strategies and the provision
of help.
Otherwise, the application of good management practices that include
appropriate organisation of work, a healthy corporate attitude, successfully
managed change and an appropriate management style will all contribute
towards reducing unwanted stress levels in the workplace.


The roles of a workplace counsellor

A workplace counsellor has to play a myriad of roles in an organisation. To
be effective in an organisation they need to multi-task the range and
demand of these tasks in tandem with our counselling role. The issue of
multitasking comes in many forms and we each experience them in our own
particular workplace ways. They have to adjust to and integrate a host of
other skills, roles and responsibilities in addition to and alongside their
therapy task.
A few established workplace counsellors like Pickard, Towler, Orlans, Coles,
Carroll, Schwenk and Kinder, to name just a few, have all reflected on the
wider perspective of work that incorporates the relationships and obligations
with a range of stakeholders. One of the main features that distinguishes
employee counsellors from counsellors in other contexts is the requirement
that they fulfil a number of roles, writes Michael Carroll. He goes on to say:
little consideration has been given to how workplace counsellors combine
the roles and responsibilities that characterise their work.
We know it is imperative to recognise that counselling work is not just
confined to the tight boundaries of a one-to-one relationship with
supervision once a month. There is a necessity to consider counselling from
a broader, systemic point of view: that the essence of what makes workplace
counselling different is the tangled relationships and roles counsellors
undertake within the organisation.
In a recent article Kinder writes: Workplace counselling is different to
traditional counselling or therapy in the sense that whenever a client is
seen, there is one other person present the organisation. And we are well
acquainted with the delicate balance between the needs of the client and the
needs of the organisation and the possibility for conflict within this triadic
relationship. But in what other ways does this systemic paradigm affect our
work and what we do?
Core training and practical experience
A counsellors training teaches them to explore themselves from an internal
perspective. It enables them to begin to develop new listening skills and
enter the journey of theoretical understanding that underpins their work.
We they go on to gain practical experience, to learn how to use supervision
and to monitor their work on a number of levels relating to duty of care,
fitness to practise, ethics, outcomes, organisation perspective, contract, and
so forth. More often than not, they undertake yet more study and specialise
in a particular theory or field of working, eg brief solution-focused therapy or
systems theory or CBT, to enhance their work; and by so doing, they
continue to develop their clinical skills.
It is rare that employee counsellors have one single role with clients; rather,
they are often asked to be trainer, welfare officer, home visitor, information
giver, advocate, consultant to managers, personnel adviser, organisation
change agent, as well as being counsellor. Carroll outlines a list of diverse
and multiple roles experienced by workplace counsellors. These are listed
below
Advising line managers on approaching troubled employees
Employee counselling - face to face, by phone or online
Training and health education - proactive intervention
Advising the organisation on policy matters in relation to welfare and
emotional/psychological health
Managerial responsibilities - in relation to counselling service
provision and operation
Facilitating organisational change
Critical incident support and other trauma management
Advising on equal opportunities and other related employment policies
and procedures
Publicising the service to staff and managers
Monitoring effectiveness and service evaluation
Administration of notes and reports to managers from business
referrals
Procedures for referring on
Mediating between client and organisation
Managing conflict situations between people at work, using mediation
and facilitation skills.

Apart from this list there exist other tasks that counsellors routinely
undertake but even from this list it is apparent that workplace counsellors
and supervisors need to develop, and be prepared to develop, a substantial
raft of skills in addition to their therapeutic acumen. For example, such
responsibilities as PR and marketing the service, IT and administrative
skills, strategic thinking, staff management and recruitment, being able to
defend and justify the service, budget keeping and so forth. This broad
range of tasks is acknowledged by BACP in its information sheet on the
challenge of working in a multitasking job.

Some counsellors may come with these skills while those attracted to the
field of counselling because of its therapeutic focus may feel a little
dismayed at having to divide our time and deploy our energies thus.
However, because of the therapeutic nature of counselling, it is not simply a
matter of adjusting or accepting this additional aspect of the workload it is
essential that we develop an understanding of the practical and ethical
implications and the relationship between our counselling and this other
duties aspect of our employment. This brings into sharp relief that
challenging questions who is my client? and whose side is the counsellor
on? in Kinders6 recent article. He offers a series of challenging questions
about the workplace counsellors role and task, and beneath this lays both a
sophisticated skill set and a clear ethical and contractual understanding.
Report writing, for example, is a prime situation when we need to carefully
consider our contractual responsibilities and obligations, ethical framework,
duty of care and so forth. Sometimes it is difficult to square the circle and
hold together the polarities of the various interested parties while
maintaining service neutrality.

Additional skills and CPD
For those counsellors already involved in service management and the IT
technicalities of evidence based counselling, data protection, and the range
of PR/marketing, policy making and training demands, they already
appreciate how they have either rapidly begun to develop these skills or re-
engineered skills gained in a previous occupation.
Either way, perhaps it is time to acknowledge the broader remit of a
workplace counsellor and/or supervisor and the implications this has on
counsellor training and CPD. Since these other duties can consume a
considerable portion of our time and workload, they need to be more fully
acknowledged and integrated into core training and advanced training. It is
no longer sufficient to have highly developed counselling skills and
theoretical understanding without the capacity to deliver on these other,
increasingly essential and frequent, aspects of our work. It is time now to
consider creative and accessible ways of providing bespoke CPD that
enables practitioners to gain these essential skills and introduce a greater
awareness of this growing element of our work during training and
professional development.

Having taught counselling from certificate to diploma level for many years, I
can well appreciate that making room in the curriculum for a
nontherapeutic module on this topic might not be well received. However, as
we consider fitness to practise and fit for purpose against the backdrop of
our ethical framework, these issues do come into focus. If we are to
contribute to organisation policy on employee wellbeing, be called upon to
prepare proposals and bid for new work, defend our service, participate in
areas of possible litigation and manage the service and thus represent the
profession of counselling and psychotherapy to other disciplines, then we
must take on board the seriousness of these tasks and not eschew them in
favour of our therapeutic preferences.
While this topic seems mundane and detracts from our core sense of
identity and raison detre as a counsellor, counsellor-manager or supervisor,
we would be wise to take a long hard look at the total package of our work
and put in place training and development that will equip us for the whole
job, and not just a part of it. Certainly service managers have their time and
efforts well deployed in these non-counselling tasks, but individual portfolio
practitioners, and workplace counsellors in non-management roles, will find
themselves undertaking several of these tasks quite frequently. Coles3
draws our attention to some of the systemic relationship issues that are
deeply embedded within this context of counselling work: I believe that
counsellors may have a certain fixed lifespan within an organisation and
then they move into something else through promotion or demotion,
through change of interest or when they finish their useful life in one
organisation and leave to find another ...
Working within organisations can feel like a struggling octopus where each
of the eight arms grapples with a different problem. In order to cope with the
different demands the workplace counsellor needs to have eight powerful
arms, each with different skills, suckers and muscles. He or she is not just a
counsellor but has to be many things to many people in the organisation.
Copeland10 picks up on this remarkable multitasking as she explores the
role or task of the workplace counselling supervisor, where links have been
made with the roles of mentor, coach and consultant.

Copeland places the organisation as the central dynamic that impacts upon
the work of both counsellor and supervisor ... She examines roles and
responsibilities; ethics and the unique dynamics associated with the
potential demands and dilemmas of workplace counselling; the systemic
impact of culture, business, and management conflicts; the contractual
process; the supervision rhombus; and finally, she outlines the task of
reporting, evaluation and assessment.
She advocates a more proactive role for supervisors working within
organisations; promoting a developmental approach whereby supervisors,
working initially through the supervisee and their line manager, can
influence processes and systems that will not only benefit the clients but the
organisation too.

Why do organisations offer Counselling to employees?
For the vast majority of counsellors, core training revolves around you and
me in the room. Quite often, the only person who is addressed outside this
dyad is the clinical supervisor. Although the existence and relevance of
others is acknowledged, they are rarely seen as partners in the counselling
relationship. Addressing counselling in or around the workplace, however,
involves examining the precise nature of the consumer and the professional
relationship with whoever that may be.
Increasingly, clients access to counselling is though a work-related service,
whether this is an Employee Assistance Programme (EAP), an in-house
counselling service or a hybrid of the two. A workplace counsellor needs to
identify the issues that are relevant and discuss issues of polarity whether
it is in fact possible to meet the needs of different consumers within the
same service; this would be in contrast to other views that can place the
employer and the employee at such different places in the spectrum that
their needs cannot be met within a service that does not allow fine detail to
be exchanged between the two.
Right Corecare is one of the largest employee assistance providers in the UK.
In 2005, it provided counselling to over 6000 clients mostly employees but
sometimes family members and worked with over 200 employers. In doing
so, it trod a careful path of confidentiality, ensuring that the employers
received sufficient Management Information (MI) to satisfy their need to
understand what issues were addressed by the EAP, in what way their staff
were affected by work-related pressures, and in what way they received
value for money in their relationship with the EAP, while at the same time
providing clients with very tight boundaries of privacy and confidentiality. In
addition, they also carried out a survey of employers, asking them what
their key reasons were for purchasing an EAP for their staff in 2005.
This enables us to look at the employer as consumer, to identify the key
issues that they see as determinants of a successful relationship. As an EAP
provider we are quite clear that unless we meet the needs of employers, the
service will remain unpurchased, the employees and their dependants will
not have access and as a result no workplace counselling will be provided.
Understanding and meeting the needs of purchasers and commissioners in
these case employers is paramount in the creation and delivery of services.
Whether this is done in a workplace setting or elsewhere, someone is footing
the bill and that person wants to know whether value is being delivered and
whether the service is meeting identified needs.

Turning to the employer, they identified nine frequently occurring reasons
that were cited as key determinants in the decision to purchase a service.
The figure below shows these, and it is quite clear what the key priorities
are. The top five purchasing reasons are:
To provide additional support for employees
To meet the employers duty of care
To support employees through times of organisational change
To help alleviate stress
To enhance employees welfare package.
The ninth most commonly quoted reason was to help address the problem of
sickness absence. The employer, as consumer, has therefore identified some
key components that need to be met in order for them to deem the
enterprise worthy of investment, and the workplace counselling service,
whatever its format, needs to address these factors in the implementation of
whatever programme is to be delivered. Further questionnaire responses
gave a clear indication that employers felt that their needs were being met
by their service, at a level far beyond 95 per cent success. This data,
showing clearly why the employer is purchasing and how they evaluate a
workplace counselling service, clearly enables us to make firm statements
about the employer as consumer.
Having identified the employer as consumer, we now turned to the
employee. With over 6,000 individual clients it was possible to identify some
key factors in what employees looked for in a workplace counselling service.
Without going into fine detail, the presenting problems and issues at
assessment were examined to identify the key patterns prevalent. These fell
into 10 categories, reflecting the headline figures we use in some of our
management information reporting. The top five reasons for accessing the
service were relationships; health; work/career issues; family issues; and
bereavement.
One of the striking features of this data is the relative positions of health
and work/career issues. Over 20 per cent of people using the counselling
service (this research only looked at people engaging in face-to-face
counselling as opposed to all the other EAP users) cited health issues as
their reason for seeking help, and about 18 per cent cited work issues.

Breaking this latter figure down by looking more closely at the work issues
that clients brought, we found that only a very small minority (1.5 per cent
of all users) presented workplace changes as their reason for seeking help.
Of course, it is readily acknowledged that change pressure can manifest
itself in other areas of life, so that relationships become intolerable because
of additional pressure caused by changes at work, but the fact still remains
that the area clients chose to work on was seldom workplace change. On the
other hand, with over 20 per cent of all users citing health issues, this does
not sit comfortably with employers seeing it as their ninth highest priority. It
may indeed be the case that workplace counselling is more closely involved
with sickness issues than employers have appreciated. The employee the
client as consumer clearly has different priorities to the employer.
One feature of the work carried out in 2005 was a change in the severity of
risk in the cases that counsellors encountered. At the beginning of the year,
high-risk cases were appearing at a rate of about one per cent of all cases.
This category is slightly fluid in order to allow all high-risk features to be
included but includes clients with one or more of the following:
Suicidal intent
Current child sexual/emotional abuse
Domestic violence
High risk of harm to self or others.
During the course of 2005, the percentage of such cases increased steadily
until by the end of the year they were appearing at a rate of four per cent, a
fourfold increase during the year. As an aside, the rate has continued to
climb so that at the time of writing (October 2006) it is running at six per
cent.
This increase in severity, in risk, suggests two things. First, it seems that
increasingly clients are seeing their workplace counselling service as the
place to bring such issues. Second, the fit with the employers need to
demonstrate and exercise a duty of care is quite close. Expanding on the
first point, thinking of the employee as consumer, it is already well
established that employees will only access the service in any numbers
when they feel that confidentiality has been well proven. One of the features
that bedevils workplace counselling is a fear that somehow some detail will
find its way back into the management knowledge pool and that information
will leak out. The fact that people are bringing such a high level of problem
suggests they now trust the confidentiality of the service.

On the other hand it can also be argued that workplace counselling has set
its performance levels so high that it is increasingly becoming the only way
clients can access a speedy and responsive counselling service. With
client/patients in the NHS routinely waiting three to six months for an
assessment for short-term counselling, the fact that workplace counselling
is available normally within a fortnight (and often much more quickly)
clearly makes it an attractive service to both sets of consumers. This is
particularly true of high-risk cases, where a timely and effective intervention
is required in order to deal with the risk, and to help have an immediate
impact on dealing with an otherwise intolerable situation. Feedback from
clients as consumers is very positive. Rating the service as better than 95
per cent, they say their needs are being well met, and that although some
would like open-ended counselling they feel the benefit of the limited session
work they have done. In fact, although their needs are different, clients and
employers report similar levels of satisfaction. This is remarkable when
considering the apparent difference in the consumer needs of both groups. It
suggests that meeting the needs of the employees enables a workplace
counselling service to meet the needs of the employers. By supporting and
helping clients, we enable employers to achieve their goals.
What then of the counsellor, who started off with the me/you dyad? In
providing counselling to people whose means of entry is that their employer
(or partners employer) has paid for the service, does the counsellor need to
pay heed to the employers needs in the relationship? It can certainly be
argued that there are aspects of the work that do lend themselves to this. If
someone is absent from work, is the absence (which the employer would like
to minimise) a legitimate matter of concern for the counsellor? If workplace
relationships are the source of a clients discomfort, should the counsellor
be involved in addressing these relationships, no matter how obliquely?
Certainly, these are elements that the EAP would see as central to the
service, but they call for counsellors to think a little more broadly about
what it means to provide workplace counselling. The relationships in
workplace counselling are extremely complex, and the fact that differing
consumer needs can be so readily identified is an indication that all of us
who work in this field need to be willing to address a broader consumer
framework.

Benefits of counselling services

Research suggests a positive correlation between the provision of
counselling and net workplace benefits (McLeod, 2001). Analysis of
counselling at work and its associated activities has found a range of
additional benefits, including:

Organisations that ignore the welfare of employees will suffer reduced
productivity

Eighteen per cent of employees are affected by personal problems on the job
- these personal problems can decrease their productivity by 25 per cent.

Counselling support can have a significant positive impact on sickness
absence

Counselling interventions have been found, in the majority of studies that
have examined this factor, to reduce sickness absence rates in clients by 25-
50 per cent. (McLeod, 2001)

Over a quarter of employee difficulties and problems were work related

Twenty-eight per cent of problems identified by clients were work related. Of
these, 62 per cent referred to difficulties in relationships at work.

Counselling can have a dramatic impact on positive work effectiveness

Counselling contributed to significant improvements on most attitude-to-
work factors: opportunity for control, skill use, job demand, clarity, feeling
valued, interpersonal contact, competence, work spill-over, adequacy of pay
and job satisfaction. (Firth-Cozens & Hardy, 1992)

An internal counselling service can save the organisation money

In an evaluation by the University of Manchester Institute of Science and
Technology (UMIST), Cooper et al (1990) found that the counselling service
saved the Post Office 102,000 over six months.

Confidential counselling services for employees may reduce the risk of
litigation

An organisation that provides confidential help to employees who fear that
they may be suffering from harmful levels of stress is unlikely to be found in
breach of duty. (Sutherland & Hatton, 2002)

EAPs can reduce sickness levels

Employee Assistance Programmes . . . have been shown to reduce sickness
levels and are cost effective. (National Audit Office, 2006)
Evaluating and auditing a counselling service

The evaluation process, usually conducted by the service provider, seeks to
understand why employees access the service. Usage statistics may identify
data split by gender, location, division, department, presenting issue,
frequency of usage etc. This helps to explain why and how the service is
being used (or not). (As an aside, some service providers rate usage by issue
rather than by employee, which can inflate perceived usage, as one
employee may use a service for several reasons. Purchasers should clarify
how the counselling provider analyses and presents data.) Auditing,
however, refers to an independent assessment of how the service is run. An
audit might also be used in advance of purchasing a counselling provision,
to assess the various organisational requirements and to assess specific
employee and management needs.

Purchasers are increasingly demanding higher levels of transparency and
accountability from service providers, requiring that services have in place
robust systems for evidencing their quality and effectiveness. In the fields of
health and social care, the Department of Healths (DH) White Paper - Our
Health, Our Care, Our Say (2006) - encourages purchasers to use
benchmarking data when assessing service quality. There appears to be
evidence that routinely evaluating service quality and effectiveness over time
brings improvements in both - probably due to the conscious reflective
opportunities that this type of information offers.

Key areas for service audit and evaluation

Service audit and evaluation should aim to address three main areas
(drawing from guidance produced by the Royal College of Nursing, 2006):
Routine audit of service usage
Routine audit of key aspects of service quality, such as waiting times,
equity of access to the service, risk assessment, efficient delivery of
therapy and overall effectiveness
The contribution of the service to work performance and attendance
(ie cost benefit analysis).



Effectiveness, wider service quality and benchmarking

Simple outcomes and effectiveness data are helpful in assessing quality,
except that not all clients complete the therapy journey. For instance,
clients may not progress from assessment into therapy and, if they do, may
terminate therapy prematurely. Even if they complete therapy, they may not
show demonstrable improvement. Underlying this may be a range of factors
that reflect clients experiences of services, positive or negative, and which
are related to service quality. To properly address wider areas of service
quality, therefore, services should consider having complementary data that
can help to illuminate clients various journeys through therapy and reflect
on aspects of service quality.

Some service providers choose to develop their own outcomes and
effectiveness data, perhaps by way of a client feedback questionnaire. This
can allow for the questionnaire to be tailored to the more specific needs, and
delivery components, of the organisation and service managers. However, as
this is likely to be a unique set of criteria, it cannot readily be benchmarked
and compared with other industry-standardised service data.

Whatever system is used, purchasers should be able to see how the service
provider monitors effectiveness. Assessment against published benchmarks
can aid this process. Standardised systems, where data are available across
different services, give a service provider the opportunity to highlight and
calibrate areas of service strength and identify areas for potential
development.

Cost benefit analysis

Some service providers seek to measure the cost benefit of implementing
their counselling through the collection of company performance data such
as employee productivity, cost of absence etc. Whilst this can provide an
indication of the type of organisational benefits that may be achieved, some
caution is needed in the interpretation of such data. For instance, whilst the
introduction of the EAP may generate improved company performance,
saying that the EAP has directly contributed to the improvement is open to
challenge, given that there are likely to be other variables that could create
an effect within the organisation.




Form of Counselling Service
The following models of counselling provision seek to illustrate the different
ways in which counselling can be delivered in an organization although
other variants can also be designed. The preferred format will depend on a
range of criteria, including what best suits the organization and specific
counselling needs.

In-house service (counsellors employed by the organisation)

The Employee Support Line service at Hampshire County Council

Hampshire County Council is a non-profit making local authority employing
approximately 37,000 employees.

The internal counselling service was created in 1992 and provides
counselling and support to employees, including senior managers and the
members of the county council (councillors). It supports the county councils
Wellbeing Strategy and its commitment to reducing workplace stress.

The esl team of counsellors is highly trained and experienced in dealing with
most issues for which clients refer for counselling, whether work related or
personal. They are able to engage with staff experiencing difficult issues
either at home or work, such as harassment and bullying, disciplinary,
stress, trauma, critical incident, bereavement, depression, anxiety,
relationship difficulties.

How the service works:

Service promotion: The service is promoted regularly by: leaflet inclusion
in payslips, Hampshire County Councils intranet, articles in newsletters,
induction pack for new starters, and reference is made to the availability of
esl in relevant employment policies. Presentations are delivered to teams in
various departments throughout the county as requested. Further leaflets,
wallet cards and posters are distributed to departments, units and schools
as required.


Confidentiality and feedback protocol: Esl has a strict code of
confidentiality within the boundaries of the BACP Ethical Framework
(2006b), the law and the Data Protection Act 1998. No one outside esl,
including the organisation, has access to records. Statistical information is
produced for Senior Management - in particular, issues for which staff seek
help. Regular monthly one-to-one and group supervision is provided
internally for each counsellor and attendance is mandatory. The clinical
supervisors are each responsible for monitoring counsellors work with
clients to maintain and enhance good practice within the British Association
for Counselling Psychology (BACP) Ethical Framework at all times. The
supervisors, who are not line managers, deliver feedback regularly to the
strategic manager, ensuring that any training needs are identified.

Access and referral process: Access is by self-referral via a dedicated
helpline number and email. Callers are initially assessed by a helpline
coordinator and, if appropriate, allocated to a counsellor for face-to-face
assessment and counselling, normally up to a maximum of six sessions.
Staff may re-refer if new issues arise.

Measurement and evaluation: An evaluation form is given to all clients at
the first session for completion at the end of counselling. These are
anonymous unless the clients wish otherwise. Statistical data are fed into an
internal database. Reports inform service development and counselling
outcomes. The evaluation includes client feedback regarding their
counsellor. This feedback is used within the clinical supervision framework
and helps to inform the professional development needs of each counsellor.

Proven benefits to the organization:

The service evaluation consistently shows that over 96 per cent of esl clients
report significant improvement in their wellbeing as a result of receiving
counselling, thus supporting one of Hampshire County Councils Corporate
Strategy priorities, maximising wellbeing. McLeod reported that counselling
interventions have been found, in the majority of studies which have
examined this factor, to reduce sickness absence in clients by 25-50 per
cent. Hampshire County Council is committed to reducing sickness
absence.


Key points of learning

`The service is committed to continuous professional development informed
by national and international counselling research, and organisational
needs and changes. For instance, in response to the National Institute for
Clinical Excellence (NICE) guidelines recommending cognitive-behavioural
therapy (CBT) for mild to moderate anxiety and depression, esl
commissioned Certificated Advanced CBT training for many of their
counsellors. Trauma/critical incident response training is planned for 2007
as per recent NICE guidelines (2005), and mediation training is also being
researched and planned for 2007. Improvements have been made to the
service structure since the service began, in particular the status of the
counsellors from volunteers to employees with all the normal staff benefits.
A career progression structure within the service is currently being
researched.

In-house service (with counsellors externally contracted by the
organisation)

The CALM programme at AstraZeneca

AstraZeneca is a major international healthcare business engaged in the
research, development, manufacture and marketing of prescription
pharmaceuticals and the supply of healthcare services, with healthcare
sales of $23.95 billion in 2005. AstraZeneca is listed in the Dow Jones
Sustainability Index (Global) as well as the FTSE4Good Index. The company
employs 65,000 people globally, with 10,500 working in the UK at eight
locations. The CALM programme supports employees in the UK only.

In the mid 1980s, Occupational Health and Human Resources (HR) began
noticing an increase in the numbers of employees presenting with stress-
related symptoms. This led to the introduction of training in stress
management. This training continued until the beginning of the 1990s when
it was decided that a more comprehensive method of implementing stress
management interventions was required.


After reviewing a number of employee assistance programme models, CALM
(Counselling And Life Management) was established in 1996, the component
parts being reactive ie counselling; and proactive ie life management. The
objectives are to:
Provide programmes promoting balanced Living and Life Management
Provide a professional and confidential counselling service in a
workplace setting
Listen to people and the organisation to best match activities to needs
Contribute to a culture of wellbeing in AstraZeneca globally.

The confidential counselling service is designed to help employees deal with
personal problems, some of which may be affecting performance at work.
Within the business, most people are fairly well balanced. Occasionally,
however, employees may need additional support, which is provided by
counsellors .The counsellors are external consultants, available within the
workplace, to assist individuals who feel they need support or the chance to
talk things through in an informal and strictly confidential manner. The
programme also provides support for managers to identify and manage
work-related stress, change management, and deal with employees who are
suffering from depression and anxiety.

How the service works:

Service promotion: The CALM programme is promoted by a variety of
media: posters, website, self-help leaflets, presentations at group meetings,
inclusion in staff induction packs, articles in local and national newsletters.
To ensure that the whole organization is involved with the programme,
Steering Panels have been established at each major site where the
programme operates. Representatives from senior management (usually the
site manager), Occupational Health, Human Resources and a union or staff
committee representative, along with a CALM team member, constitute the
Panel. The broad spectrum of membership encourages feedback from all
areas of the business, ensuring that concerns can be raised and discussed.

Confidentiality and feedback protocol: The CALM programme considers
confidentiality its highest priority. The CALM counsellors are external
consultants who are not part of AstraZenecas management structure. They
will not pass personal information to managers, HR or Occupational Health
unless specifically asked to do so by the client. There are exceptional
circumstances when disclosure of confidential information is necessary eg
risk of harm to self or others etc. All counsellors adhere to the AstraZeneca
CALM Code of Practice and ensure that all clients are aware of the content.
The UK Wellbeing Manager and/or a relevant internal occupational health
professional manage clinical governance and all CALM counsellors are
required to undertake supervision in line with their professional body
regulations.

Access and referral process: There are a variety of acceptable ways in
which an employee can access the service. Line managers, Human
Resources or Occupational Health professionals encourage employees to
utilise the programme on the understanding that attendance is voluntary.
The majority of employees self-refer and can utilise the service in company
time with no requirement to make up the hours. Managers are not
informed when an employee attends for a counselling session but employees
are encouraged to discuss any work-related issues with their manager.

Measurement and evaluation: Key service satisfaction data are collected
through a quality evaluation questionnaire, enabling employee concerns to
be addressed. Of CALM service users who provided feedback during 2005,
86 per cent specified that the issue that brought them to counselling was
affecting their work. Thirty-six per cent of these stated the service had
reduced the time they would have taken off work, and 57 per cent stated
utilising the service had made them more productive.

A survey in 2002 of 643 UK employees to examine their attitudes towards
the CALM programme found that 92 per cent supported the provision of
workplace counselling and considered it important that employers provide
such services: 95 per cent agreed it could help people in distress; employees
did not associate any stigma with workplace counselling; 83 per cent of
employees were aware of the support available and users viewed
management support positively.

Proven benefits to the organization In addition to the direct benefits of
improving the health and wellbeing of our employees, there are additional
cost benefits from providing the CALM programme. The CALM programme
contributes to a reduction in health insurance spend for psychological
illness. The health insurance provider ascribes this reduction as being due
to the on-site counselling and training initiatives in place ie the CALM
programme, where cases are dealt with early, reducing the need for referral
and possible time off work. In the 12 months to the end of June 2005, this
resulted in a direct saving of 80,000.


Along with service satisfaction data, the CALM questionnaire gathers data
on potential reduced sickness absence and improved productivity.
Extrapolation from this data indicates cost savings, based on an average
cost of a sickness episode due to psychological illness of:
450,000 in direct cost of absence
850,000 in direct and indirect cost of absence
Estimated cost savings due to improved productivity after counselling
equated to 600,000.

Key points of learning: The CALM programme has been established for 10
years and has benefited from a number of improvements over this time
including the introduction of web-based material, a dedicated telephone link
with the Citizens Advice Bureau, self-help literature on issues raised in
counselling sessions and a survey of employee attitudes to workplace
counselling. To enhance the impact of the counselling data, in 2003 the
statistics were linked to the stressful characteristics of work defined by the
European Agency for Safety and Health at Work. Counsellors report against
these criteria in addition to nonwork related concerns eg home
relationships, bereavement, and psychological problems. We have learnt
that promoting wellbeing is a sound business ideal. If we are to expect
peoples continued energy and commitment at work, we must provide the
right environment in which they feel positive and enthusiastic about what
they are doing, have a clear sense of purpose, confidence in their ability to
meet the challenges and pride in their individual contribution to the
companys success. The CALM programme undoubtedly contributes to this
philosophy.

External provision (Employee Assistance Programme)

The Right Corecare Employee Assistance Programme (EAP) at Petersons

Petersons is a national retail chain with some 15,000 staff. They share many
of the problems suffered by other retail chains, such as high staff turnover,
significant wastage (including theft), higher-than-average sickness absence
and some variable management skills leading to localized hot-points of
workplace bullying. Annually, they carry out a staff survey, and in 2003
were dismayed to find fewer than 25 per cent of staff said they felt allegiance
to the company. Reasons for establishing a provision, plus the aims and
objectives As part of their strategic approach to these issues, Petersons
recognised that they needed to look closely at the employment experience of
their staff, and realised that the issues facing them were complex and
difficult to address from within the existing corporate structure. Having
looked at various options, they decided to tender for an Employee Assistance
Programme (EAP). From the receipt of the staff survey, it took a full year to
identify the solution, define the service they were looking for, publish an
Invitation to Tender, evaluate the responses and award the three-year
contract. They decided on an initial three-year contract because they
recognised that embedded problems were going to require a longer-term
solution. They believed they would probably need a permanent EAP (giving
service continuity) yet wanted to monitor the market regularly.

Although many people think of an EAP as a workplace counselling service, it
offers many additional services. During the first two years of the contract,
the Petersons EAP showed that almost 50 per cent of calls were for legal
problems (not necessarily work related). Although employment law was well
used, other employee problems included divorce, child access, tenancy,
consumer and motoring issues. During this period the stores experienced a
number of incidents (leaving staff distressed and in need of support), from
armed robbery to customers having heart attacks. Through the EAP, the
employer was able to ensure that managers were sufficiently trained to
respond to such incidents and, where appropriate, encourage staff to access
the EAP support services. This enabled the managers to delegate support to
those better qualified to provide such help and left them to concentrate on
their core managing roles.

How the service works:

Service promotion: All staff receive a credit card-sized information card
giving a service summary along with contact details. Posters are placed in
every workplace location (within sight of staff but not customers!) and these
are replaced regularly, to keep theimages fresh and the message current.
The EAP provider provides both an intranet and a website for Petersons,
with company-specific information.

Staff are encouraged to view this regularly. On-site employee briefings are
given by the EAP provider and a DVD about the service is used at all staff
induction sessions. A briefing, specifically aimed at managers, not only
explains how the service works but also helps them understand how they
can receive management support and how they can help their staff access
the service.

Confidentiality and feedback protocol: Evidence has shown that staffs
access a service more freely when they believe that their confidentiality is
not compromised, yet the employer who pays for the service understandably
expects and needs feedback. Management Information is agreed during the
setting-up of the contract. In this case, Petersons receive a quarterly report
showing service usage across eight regions in the UK. They do not receive
individual store feedback, because fewer than 50 employees work in most of
their stores and 50 is the minimum size of pooled data permitted by the EAP
provider. The information provides an analysis of the numbers of people who
accessed the service and the issues they presented with. It identifies how
many progressed to face-to-face counselling and how many sessions these
people used. It also highlights any trends and patterns that may be relevant
for the employer.

Access and referral process: Staff can access professional support and
advice through the freephone telephone service run by the EAP provider.
Because this is available 24 hours, staff can phone when it suits them.
Employees self-refer to counselling with a range of problems, the most
frequent of which could be classified as relationship issues, encompassing
everything from the breakup of a marriage to difficulties with teenage
offspring. These issues have a real effect on peoples ability to focus at work,
yet the issues were not specifically work related. Prior to purchasing an EAP,
Petersons had no resources to support staff in these areas.

Measurement and evaluation: The Management Information provided to
the employer also analyses the workplace issues that are impacting on staff.
The EAP is able to show some regional variation, so that with some
presenting issues, such as bullying, the organisation can better direct
training resources or take appropriate remedial action. Another example of
the positive use of this MI featured recent usage data identifying staff
affected by change the stores were going through a major refit, and this left
some staff feeling more vulnerable and anxious, for several reasons,
including greater exposure to assault from customers. By sharing this trend
with the employer, the provider was able to identify the support which staff
needed and introduce consultation and training activities to help staff adjust
to the changes. In this way, Petersons finds that the counselling service not
only meets the needs of individual employees but also helps corporately -
bringing value from the shop floor to the boardroom.

Proven benefits to the organization: After two years, the company feels
that the EAP purchase cost has been more than justified. Sickness absence
has reduced and staff are staying longer (when asked whether Petersons is a
good employer, more than 80 per cent responded positively - even though
only 15 per cent of all staff had used the EAP over the two years). Awareness
of the service is high across all staff groups - and there is some evidence
that wastage has also declined. Furthermore, the company feels it has a far
better understanding of the psychological make-up of their workforce, so
can now plan strategically with more accurate assumptions about the
impact of developments on the workforce.

Key points of learning: From a counselling perspective, over the first two
years almost seven per cent of staff received face-to- face counselling and
this was something the company could never have contemplated prior to the
implementation of the EAP. Staff could access help knowing that it was
entirely confidential, and were content that their employer would be helped
to understand the big picture by way of generalised usage data. The total
cost to Petersons added less than one thousandth to their staffing costs -
the cost benefit was very clear. Now, in the third year of the service,
Petersons is planning to invite tenders for a further three years, taking the
opportunity to look at innovation and efficiency in the EAP sector, and their
HR director has declared that if she were forced to reduce the benefits
offered to staff, the only one she would be adamant must stay is the EAP
service.


Outsourced provision (via occupational health services provider)

The Counselling Service at Royal Mail Group, outsourced to Atos Origin

Transport sector with annual sales in excess of 8 billion and approximately
193,000 employees

Royal Mail Group (RMG) has a long history of having a welfare/counselling
service (traced back to 1944). Over the years, it has significantly developed
this provision and five years ago it outsourced this provision along with its
occupational health service.

The aim of the counselling service is to support RMG in its strategy to
transform its business and to provide one of the best counselling &
employee support service available in the UK so its employees receive help
and advice to boost health & wellbeing.

The service provides support in counselling not just for self-referrals but
also for manager referrals under the occupational health arm of the
provider, to help reduce sickness absence of the company. The service also
has an important role in helping RMG deal with harassment and bullying,
trauma at work, organisational stress audits and health promotion, such as
through stress management awareness.


How the service works:

Service promotion: The services are constantly promoted through manager
briefings to their teams, posters, e-channels and leaflet drops. Articles are
frequently distributed which pick out a particular issue (eg debt,
bereavement, trauma at work etc) and talk through how an employee was
supported with this, in order to make the service come to life.

Confidentiality and feedback protocol: A clear clinical governance system
operates within the service provider whereby there are clinical leads that are
separate from line-management reporting. These clinical leads ensure that
all practitioners (full time or contracted in) receive appropriate professional
supervision (one-to-one plus group), have updated training, and that their
client notes and reports to managers are fully audited. They are also
responsible for mentoring support for practitioners where any training needs
are identified through the audit and CORE systems.

Access and referral process: The service has three elements:

1. Workplace counselling which focuses on management referrals and works
in conjunction with the occupational health service

2. Employee assistance which gives free self-referred, confidential access
24/7 to all employees (and resident family) for counselling and practical
issues. This is promoted as an independent company called HELP through
posters, leaflets, e-channels, home mailings etc

3. Consultancy/training where stress management training, mediation,
trauma policy support and stress audits are carried out. Managers can
request these through a bespoke referral.

Measurement and evaluation: Client satisfaction shows 97 per cent
satisfaction. CORE is used to evaluate the impact of counselling as well as
to monitor service effectiveness through benchmarking.

Proven benefits to the organization: In an evaluation by the University of
Manchester Institute of Science and Technology (UMIST), Cooper et al (1990)
found that the counselling service saved the Post Office 102,000 over six
months. Dr Steve Bormann, Chief Medical Adviser of RMG stated recently:
In just 18 months . . . stress-related absence at Royal Mail, Parcel force
Worldwide and Post Office Ltd was cut by a third. This tremendous
achievement resulted from a series of businesswide initiatives designed to
make our organisation a more rewarding and attractive place to work,
combined with a new approach to workplace counselling provided by Atos
Origin. The company and our employees are stronger as a result.

Key points of learning: The service has participated in some innovative
research on which early interventions are effective when trauma occurs in
the workplace. The EAP has recently been improved by launching an
expanded legal advice service which includes personal injury representation
and employment representation.

Public Sector - Healthcare

Amica Staff Counselling and Psychological Support Services -
University Hospitals of Leicester NHS Trust

Amica is an NHS-based service; all the counsellors and psychologists are
employed by the University Hospitals of Leicester NHS Trust. It provides
services to a number of other NHS and Public Sector organisations.
Currently 60,000 staff are covered by its services.

The service started in the late 1980s and has grown from a piece of research
by Professor Tom Cox, who researches workplace and organizational stress
for the World Health Organisation. The Human Resources framework for the
NHS made explicit in Working Together - Securing a Quality Workforce for
the NHS (NHSE, 1998) that all NHS staff in England should have access to
counselling services by April 2000. The service has developed, reflecting the
ever-changing needs of the staff and organisations. Today Amica is one of
the largest providers of a broad range of psychological support services to
NHS staff.

Counselling and psychological support for all NHS staff is the basis of the
service. The range of services includes telephone counselling, face-to-face
counselling, psychological debriefing, group support and legal and debt
advice. The key element is to support staff through any difficulties that
impact on their working lives. Core to the service is the ability to work with
organisations and their staff at all levels. Amica is included in all
organisational change plans and decisions. The head of service is
responsible for advising the Trust Executives and Medical Director on how
best to set up support for both patients and staff after adverse events and
major incidents.


How the service works:

Service promotion: All staff are covered by the service provision and have a
card with a confidential, direct telephone number that gives them access to
a qualified and experienced workplace counsellor. The line is open 365 days
a year, from 8.30am to 8.30pm. All NHS staff can self-refer to face-to-face
counselling. The counselling offered is short-term (eight sessions) crisis-
focused, with all counsellors and psychologists trained in cognitive-
behavioural therapy (CBT). At present, staff can see a counsellor within 10
working days or earlier if clinical assessment requires. Staff can request
group support, mediation and psychological debriefing. The service links
with the Improving Working Lives scheme within the NHS. Because the
service is now core within the NHS organisation, promotion is mostly by
word of mouth. The high profile which the Head of Service and counsellors
have in the organisation promotes the services through their presence at
various key meetings. Outside the NHS, promotion is via Occupational
Health, Human Resources and other key managers. There are regular
update meetings and annual reviews.

Confidentiality and feedback protocol: The service maintains
confidentiality in line with British Psychological Society (BPS) and BACP
guidelines, and through the guidance from the NHS Trust and the
Department of Health. Feedback is an important part of developing the
organisational client. Feedback data are given with all identifying
information removed. Written reports and verbal feedback are given. All
organizations purchasing the service have ongoing contact with the Head of
Service.

Access and referral process: All staff access the service via a confidential
telephone counselling line. NHS staff can self-refer to face-to-face
counselling, group support or debriefing.

Measurement and evaluation: There are a number of employee evaluation
systems, which include feedback forms for service users, CORE and clinical
case studies.

Proven benefits to the organizations: Success with staff returning to work
and help through traumatic events has now seen a 40-60 per cent yearly
increase in demand for the service. Growth outside of the NHS continues to
increase as other public sector organisations see the benefits of referring
staff with psychological difficulties.


Key points of learning: The key learning point is to listen to the service
users and the organisations purchasing the service. The service has to work
closely with both. As a service, we have to be not afraid to review and
change the services as and when needed.

Contracting with a local counsellor - for small and medium enterprises
(SMEs)

The Counselling Service at Tamar Science Park Ltd provided by Optima
Workplace Ltd

Science Park provides a complete environment for knowledge-based
businesses, employing team of 12 to look after about 50 client companies.

To enhance the provision of support services to employees, to maintain staff
retention and promote a workplace culture that aims to endorse professional
and personal wellbeing. The employee environment is fast paced, as the
Science Park is on a high-growth path. Therefore an ability to identify and
resolve any employee issues prior to them impacting on performance or
results is seen as important.

The service provides support through both self referral and management
referrals to enable individuals to access support when required and for the
management to take a systemic view of healthy working practices and health
promotion.

How the service works;

Service promotion: The service is promoted through an initial briefing to all
employees, which includes a folder of information for each individual and
credit card-sized contact information. Briefings to new employees are
provided on an ongoing basis as required. Maintaining awareness of the
service is through emails and educational information included in feedback
reports.

Confidentiality and feedback protocol: Confidentiality is maintained
within the British Association of Counselling Psychology guidelines, and
discussion with line managers happens only with explicit client consent.
Individual clients are invited to complete a feedback form anonymously.
Feedback on general service use is reported to the company on a six-
monthly basis.


Access and referral process: The service has three elements:

1. Management referral which supports the companys systemic
approach to a healthy workforce and enhances their duty of care.

2. Individual self-referral which gives free access for all employees for up
to six face-to-face sessions, via a telephone helpline accessible on
weekdays from 8am to 8pm.

3. Coaching and training where personal development and stress
management awareness is available through management referral.

Measurement and evaluation: The principle measurement tool is CORE,
used to evaluate and monitor the counselling process and service
effectiveness. Individual clients are invited to complete evaluation forms
anonymously and the company participates in service evaluation at six-
monthly intervals.

Proven benefits to the organisation: The presence of such a service which
is supported by management has had a positive impact on the whole
organisation. Easy access and a quick response to referrals has
demonstrated the efficacy of taking action sooner rather than later. Early
return to work from sickness absence has been a principle element of
investment return. Whilst intangibles such as perceived motivation and
general happiness levels amongst the small team was not an issue,
management has recognized early signs of improvement.

Key points of learning: The service has adapted to the unique needs of a
small organisation where confidentiality around service use has been
paramount. This is particularly challenging when developing reporting,
evaluation and feedback procedures. Continuing areas for development are
increasing and encouraging service use.


Hybrid provision (mix of internal and external service)

The service provision at the Department for Constitutional Affairs

The Department for Constitutional Affairs (DCA) is a central government
department with 26,000 employees.

DCA established its Welfare Service 35 years ago; since then the service has
grown and evolved. It has transformed from its early days as a purely staff-
focused counselling service to become a resource for staff and managers
alike, offering a wide range of services, including mediation.

Since June 2006, the in-house service, now known as Workplace Support
and an integral part of the HR Directorate, has worked in partnership with
Atos Origin to further enhance the service provision. This means our service
provision is a hybrid model, blending the internal in-house service with the
supplementary external support. The overriding aim of the service is to help
keep staff effective at work. A large proportion of the work done is in the
arena of absence management or grievance and disciplinary issues.

Counselling is one of the functions that help the service meet its aims. This
part of the service is largely delivered by Atos Origin, and is used by staff
needing that further level of support to help them return to work or to help
them deal with issues that would otherwise have impacted on their
attendance or performance.

How the service works:

Service promotion: The service is promoted widely across the DCA. Regular
articles about the service appear in DCAs in-house magazine, and the
helpline number is advertised in the weekly newsletter. In addition,
Workplace Support Advisers (the in-house team) promote the service at
training events, workshops and road shows. There is also an infonet site and
leaflets/posters that are readily accessible.

Confidentiality: The partnership service operates a clear confidentiality
code that is specific about the instances when confidentiality would have to
be broken. Mechanisms have been agreed to enable the confidential transfer
of client information between the DCA and Atos Origin elements of the
partnership. Both Atos Origin counsellors and DCA Workplace Support
Advisers have access to regular professional supervision.


Access and referral: All access to the service is via the DCA Workplace
Support helpline, where cases are triaged for onward referral. The helpline is
staffed during working hours and out-of-hours callers are diverted to the
staffed Atos Origin service centre.

The helpline provides information and takes self-referrals for support, advice
and counselling, requests for management support and consultancy
services, and referrals for mediation.

Measurement and evaluation: The service is measured through the annual
HR customer service survey. Statistical data are provided monthly by both
DCA and Atos elements of the partnership to show levels of take-up and
trends.

Benefits to the organisation: Key benefits include the provision of
expertise to managers on handling welfare-related issues, including
workplace stress; provision of counselling and support services to employees
that help them come back to work after long periods of absence; and
mediation to prevent minor workplace issues becoming lengthy, disruptive
and destructive grievances. Further, the service handles the DCA eye care
scheme, and so helps the DCA meet its legislative duty of care, and is the
central point for contact for advice on DDA workplace adjustments.

How the service has improved and adapted: Over recent years, the service
has introduced a helpline and a wider range of services, including
mediation, stress support and trauma support. Since June 2006, as a result
of the new partnership provision, the service has changed from being
available only during working hours, to being a 24/7/365 resource. This
has enabled Workplace Support to deliver high-quality proactive and
responsive services to a rapidly changing organisation that has doubled in
size since 2005.

Ethical Issues in Counselling
Ethics are the beliefs an individual or group maintains about what
constitutes correct or proper behaviour or actions. To put it simply, ethics
are the standards of conduct an individual uses to make decisions. The term
morality is often confused with ethics; however, morality involves the
judgment or evaluation of an ethical system, decision, or action based on
social, cultural, or religious norms.
It is important to remember that ethics must prevail over a counsellors
personal values when value conflicts exist. As discussed, counsellors are
bound to the ethical duty to not act as moral authorities and force their
values upon others. The professional relationship exists to benefit the client
and fulfil the client's needs. A counsellors needs, such as the need to feel
adequacy, control, and clients' change toward values similar to one's own
values, will harm the relationship. It is unethical to put personal needs
before clients' needs.
Counsellors, like all professionals, have ethical responsibilities and
obligations. The principal rule supporting ethical obligations is that the
counsellor must act with full recognition of the importance of client's rights,
the ethics of the profession. Counselling is not a value-free or neutral
activity.

"It is a profession based on values, which are orienting beliefs about what is
good...and how that good should be achieved" (Bergin, 1985), the
relationship of moral standards and values, individual or cultural, in the life
of that client.

Counsellors should always work to serve the client's best interest in a
manner that is culturally sensitive. The primary goals of the counsellor are
to help people in need, to advocate, and to link clients to services that best
fit their needs. However, a counsellors commitment to these goals is tested
when presented with a client who may be unable to afford services. The code
encourages pro bono work, when possible.

Informed consent is a prominent issue in health care. It is especially
important to make all information about evaluation results, treatments, and
what to expect from the counselling relationship, including the benefits and
limitations of counselling, available to clients. The counsellor must honestly
and accurately represent their training, abilities, and experience to clients.


When conducting group work, each client's needs must be met in a way that
also benefits the group; in turn, the client should benefit the group.
Counsellors must always do no harm and should avoid imposing their
personal values upon others. Sexual or romantic relationships are strongly
discouraged and are prohibited for a period of 5 years after the professional
relationship is terminated.

Some of the ethical principles expressed in this section include autonomy,
beneficence, nonmalficence, and competency. The values are honesty,
responsibility, self-control, and helpfulness.

Trust is perhaps the most important aspect of a counselling relationship. A
client's trust is earned by maintaining boundaries and respecting privacy.
Information relating to client care should be shared with other professionals
only with the consent of the client whenever possible. When counselling
minors or people with diminished capacity, all local and federal laws must
be obeyed and a third party should be consulted before sharing any private
information. All records and correspondence, including e-mail, should be
protected to within reason. Ethical principles that apply to this section are
fidelity and veracity.

The responsible counsellor values honesty and is competent. Professional
competence is an ethical standard, meaning counsellors should only
practice in areas in which they have the requisite knowledge and abilities.
One can only help if he or she has the proper tools and the skills to utilize
them effectively. Counsellors must also improve their knowledge and
abilities so they can further assist clients and contribute to the
advancement of their profession. Advocating for positive social change and
engaging in self-care activities are also highly recommended. The principles
represented in this section are nonmaleficence, ordering, and universality.
An important value is self-awareness.

When a network of colleagues is developed both inside and outside of the
counsellors field of practice, different perspectives can be gained and
shared. Having a support system of professionals in related disciplines can
help to inform decision making, and ultimately, clients can benefit from
these interrelationships. Counsellors are also encouraged to alert the proper
entities to ethical concerns, and a professional attitude should be
maintained toward someone who exposes inappropriate behaviours, policies,
or practices. Fidelity and veracity are ethical principles that apply in this
section.


Appropriate assessment instruments should be used when evaluating a
client. This includes educational, psychological, and career assessment tools
that provide qualitative and quantitative information about abilities,
personality, interests, intelligence level, achievement, and performance. It is
important not to use the results of any test to the client's detriment and to
make the results known to the client. In addition, one should note that in
many instances, these tests were standardized on a population that may be
different from the client's population or identity. Clients are to be given
autonomy, and the counsellor must apply the ethical principles of
nonmaleficence and confidentiality.

Supervising counsellors must be aware of supervisees' training, methods,
and ethics while respecting their styles and values. Supervisors should
foster an environment of openness and continued learning and should seek
to minimize conflicts. Training sessions should be inclusive and positive.
Romantic or sexual relationships with supervisees are prohibited; however,
it may be beneficial in some circumstances to engage with supervisees in
friendly or supportive ways (e.g., formal ceremonies, hospital visits, during
stressful events). Ethical principles that apply in this section are autonomy,
respect, and universality.

A main goal of research in counselling is to improve society, as many of the
personal problems that counsellors are enlisted to solve arise from clients'
experiences in flawed social environments. Counsellors should help with
and participate in research. Research should not cause harm or interfere
with participants' welfare. Informed consent must be maintained throughout
the process, and all data must be kept private. Justice and confidentiality
are paramount ethical concerns. When conducting research it is important
to ensure that the benefits and risks are distributed equitably. Often, any
benefits from research groups will only be short lived; it should be made
clear that after the study has concluded, counselling interactions related to
the study will cease. Also, participants must be confident that collected data
will remain secure.

Counsellors should be familiar with their agency's or institution's rules and
regulations; these should be accepted and upheld or employment should be
sought elsewhere. When ethical dilemmas arise, they should be resolved
using communication with all those involved. When a conflict cannot be
resolved among the parties involved, consultation with peers may be
necessary. Ethical codes should be followed, but in some cases, this may
conflict with laws (e.g., subpoena). It is advised that laws prevail over ethics
when all other means of resolution are exhausted. Counsellors who become
aware of colleagues' ethics violations that are not able to be resolved
informally are obligated to report them provided it does not violate client-
counsellor confidentiality. The ethical resolution of dilemmas or issues
requires the application of the ethical principles of ordering, respect,
reparation, and veracity. Values of honesty, courage, independence, and
intellect, among many others, determine positive outcomes in adverse
situations.

In simpler point form:

1. A counsellor offers professional service to anyone regardless of race,
religion, sex, political affiliations, social or economic status or choice of life
style. When a counsellor cannot offer service for any reason, he or she will
endeavour to make a suitable referral.

2. A counsellor will not use his or her counselling relationship to promote
personal, religious, political or business loyalties or interests.

3. A counsellor will not accept or offer payments for referrals, apart from the
ordinary counselling fee charged to clients for interview.

4. A counsellor will not attempt to diagnose, prescribe for, treat or advise on
problems outside the recognised boundaries of that counsellor's
competence.

5. The essential obligation of counsellors is to respect the integrity and
protect the welfare of persons with whom they are working.

6. While offering support, the counsellor is cautious in prognosis and
realistic in the counselling contract he or she makes with the client.

7. Where a person has been assured, or can reasonably expect, that
information given by him or her will be treated confidentially, no counsellor
may divulge such information without written permission granted by the
client(s) involved. Confidentiality may be waived only to prevent immediate
physical danger to a person or persons, or to divulge information, which if
withheld may put the counsellor at risk.

8. A counsellor shall not misuse any client relationship for personal
gratification.

9. It is unethical to use undue persuasion or to attempt to enforce the
acceptance of any counselling service or procedure by any individual.

10. Counselling activities should be undertaken only with professional
intent and not casually and/or in extra-professional relationships.

11. Every counsellor has an obligation to continue self-education and
professional growth in all possible ways including active participation in the
meeting and activities of the Association.

12. A counsellor will actively seek regular suitable supervision for his or her
counselling and will use such supervision to develop his or her counselling
skills.

13. Counsellors are committed to protect the public against unethical,
incompetent and dishonourable practices and will be prepared to challenge
these practices. The Association encourages counsellors to affiliate with
relevant professional groups, clinics and agencies operating in the field of
marriage and family life. Interdisciplinary contact and co-operation are also
encouraged. Any member advertising, conducting training programmes
and/or group work shall act in accordance with these ethical principles.

Ethical Codes

Ethics are suggested standards of conduct based on a consensus value set.
Ethical standards are generally formalized in terms of a code of ethics. As
the group emerges in its development toward professionalism, it requires
formulation of code of ethics for safe practice of the profession. Professional
bodies of counselling have developed ethical standards which they have
made available to the practitioners.

Professional organizations for practicing counselling and psychotherapy are:
American Psychological Association (APA)
British Association for Counselling (BAC)
American Counselling Association (ACA)

In each case, members who were directly involved in writing the code
reviewed and examined a wide range of ethical behaviour and problems of
professional practice that were of concern to a broadly based membership.
All codes stress adherence to rigorous professional standards and to
exemplary behaviour, integrity, and objectivity toward clients.


Development of Codes

APA Code: Two codes of ethics guide counsellors for the practice of ethical
counselling:

General Code of Ethics, "Ethical Principles of Psychologists", can also

be applied to the practice of counselling. On violation appropriate
action is taken, which includes dismissal from the membership.

In the "Specialty Guidelines for the Delivery of Services by Counselling

Psychologists", APA has printed a casebook for the service providers.

ACA Code: Codes of Ethics & Standard of Practice

ACA also provide a casebook containing 8 major sections. Based its first
standards on APA code of ethics, this code does not contain any
classification of misbehaviour nor does it attach penalties to the violation of
the standards. Initiated by Donald Super and approved in 1961. These
standards focus on guidelines for professional conduct. The fundamental
rule is that the human being must be respected and protected at all times,
which can be done only by counsellors who manifest honesty, integrity, and
objectivity in their behaviour toward their clients.

Unethical behaviour usually occurs when the counsellor communicates in a
way that establishes one set of expectations and then behaves in a way that
is inconsistent with those expectations. For example, the counsellor
structures the counselling situation verbally or nonverbally to imply mutual
trust, concern, and confidentiality. The counsellor then behaves in a way
that upsets these expectations because the counsellor then assigns greater
value to another societal role.

Reasons for Ethical Codes

Help professionalize and protect an association by government and

promote stability within the profession.

Help control internal disagreement.

Protect practitioners from the public.

Protect clients from incompetent counsellors especially in malpractice

issues. Clients can also use codes to evaluate questionable treatment
from the counsellor.


Unethical Behaviour

Unethical behaviour can take many forms:

Violation of confidentiality.

Exceeding one's level of professional competence: Competence refers

to the ability to perform effectively. Therapists must limit their service
to their training and experience. Claiming expertise one does not
possess relates to the violation of this ethical standard.

Imposing one's values on a client.

Creating dependency in a client.

Certain conflicts of interest: No multiple or dual relationships are

allowed, for example it is unethical for a therapist to have a sexual or
business relationship with the patient outside the therapeutic
relationship.

Questionable financial arrangements such as drawing excessive fees.

Improper advertising regarding one's potentials or credentials.

Client Rights: Informed Consent

Involves the rights of clients to be informed about what their

relationships with the counsellor will entail and to make autonomous
decisions.

Starts with intake interview and continues for the duration of the
relationship.

Usually comprehensive written statements are used (ACA Code of

Ethics).

Client Rights:

Confidentiality

Confidentiality is considered as a central concept in the client-helper

relationship. The greatest single source of ethical dilemma in
counselling results from questions of confidentiality.

Confidentiality needs to be discussed with clients from the onset of

the relationship.

Minor or incompetent clients: Counsellors act in the best interest of

those unable to give voluntary consent.


Records

Provide access to records when requested by clients

Disclosure of transfer

Permission to record

Anonymity in research

Respect for privacy in consultation

Principles Govern Confidentiality

Schneiders (1963) terms the information revealed in counselling an
"entrusted secret". He provided seven general principles governing
confidentiality and communication:

Obligation of confidentiality is relative rather than absolute since there are
conditions which can alter it.

Confidentiality depends on the nature of the material.

Harmless material does not bind the counsellor to confidentiality.

Material necessary for a counsellor/agency to function effectively is often
released from the bonds of confidentiality.

Intrinsic right of the counselee to his integrity and reputation:
Confidentiality is always conditioned by the intrinsic right of the counselee
to his integrity and reputation, to the secret, and to resist aggression. Such
rights can be protected by the counsellor even against the law.

Confidentiality is also limited by the rights of the counsellor to preserve his
own reputation and integrity, to resist harm or aggression, and to preserve
privileged communication.

Limited by the rights of an innocent third party/community.

Limitations of Confidentiality:

a. Suspected child abuse must be reported.
b. Threats to harm others must be reported.


Rationale for Confidentiality:

Need for balance between the rights of the individual and the safety of
society (Denkowski & Denkowski, 1982) with specific attention to the
importance of counsellors keeping up-to-date with the legal status of
confidentiality.

In special circumstances, it is the "Duty to warn whenever the counsellor
has reasonable knowledge that a client's conduct may be harmful to self or
to another (Gehring, 1982).

Professionals inform clients of the limits of confidentiality prior to the onset
of helping relationship (National Organization for Human Service Education,
1995).

Obligations to Warn & Protect

In the case of special circumstances, it is the obligation of the counsellor to
warn the related people/ family members. A few examples are given below:

Incest and Child abuse

Serious danger to others

Runaway plan of a child client must be reported to the parents.

Students' violation of confidentiality.

Harm-to-self:

Most suicides can be prevented if we learn to recognize, evaluate, and
intervene effectively in crises situations (Fujimura et al., 1985). Wubbolding
(1996) suggests a few questions to identify danger, for example, usually
suicidal look hopeless; this knowledge can be used to detect such cases.

Client Rights: Respecting the Client's Autonomy and Diversity

Following problems can occur, if client's rights for freedom are not
respected:

Fostering dependence in clients

Counsellor having a hard time terminating a case

Challenging clients to do for themselves what they are unable to do

Keeping helping process mysterious

Discrimination.


Two important ethical issues in the practice of counselling are described
below:

a) Keeping Relationships Professional

Dual relationships

Bartering

Multiple clients

b) Professional Responsibility

Advertising & Soliciting Clients

Credentials

Evaluation, Assessment, and Interpretation

Keeping Relationships Professional

Dual Relationships:

Dual relationship refers to professional's assuming two or more roles
simultaneously or sequentially with the person seeking help, such as
friendship and business deals. Judgment is likely to be affected, impaired,
as the relationship of counsellors and clients in power and status are
unequal, thus exploitation may occur.

Emerged from debates in the 1980s in the nature of client-counsellor

sexual relations.

Questions were raised about other types of relationships in 1990s.

Conflict of interest and exploitation can occur even in harmless

relations.

Such relationships are inherently exploitive as reciprocity element applies
here that we desire to return the favour because human relationships are
assumed to be reciprocal.

Counselling is also avoided in Superior/ subordinate relationships because
of unequal status of both. Studies about time limit for establishing
relationships with current and former clients were conducted. In this
reference, Salisbury & Kinnier (1996) surveyed 500 therapists. A minority
(33%) of counsellors surveyed and believed that sexual relationships with
former clients might be acceptable after 5 years, while the majority (70%)
accepted such a relationship after 2 years. In another study, majority did
not hold the opinion of "once a client, always a client" in nonsexual relations
with the former clients.

Although apparently it appears that the rates of sexual relationships are
declining with the passage of time, obtaining accurate data on prevalence of
such an issue is difficult.

Bartering

The practice of counselling for goods or other services, cleaning house,
secretarial service, etc.:

This is an accepted practice in some cultures and subcultures. Even if the
helper's intention is good it has the potential for conflicts.

Case example: An unemployed client offers counsellors car service. Car's
engine fails due to chance or inferior work of the client, what will happen to
helping relationship?

Though some behaviours have potential are not by themselves dual
relationships, e.g., accepting an invitation, accepting a small gift, engaging
in nonerotic touch when appropriate during counselling. Such behaviours
will be the boundary crossing rather than violation boundary crossing is
departure from standard practice, while violation is a serious breach that
causes harm to the clients.

Although there is a considerable disagreement on this issue, blending of
relationships is not recommended by most of the professional agencies.
Recent codes of ethics (APA, ACA) deal more specifically with setting
appropriate boundaries. However, in small communities helpers are more
likely to be involved in multiple relationships like the local pharmacist,
physician, carpenter, or beautician might be the clients. Thus dual
relationships are inevitable.

Research on Dual Relationships

Herlihy and Corey's decision-making model:
Herlihy and Corey have suggested a few guidelines to deal with dual
relationship issues:

Secure informed consent of clients

Seek consultation

Document and monitor this practice

Obtain supervision

Borys & Pope (1989):
Borys and Pope described in Professional Psychology: Research and Practice
the results of a survey of 4800 psychologists, psychiatrists and social
workers. That survey was conducted to understand the beliefs and
behaviours of mental health professionals about dual relationships.

Legal Recognition of Counselling

Counselling gained professional recognition and acceptance through the
legal system. As early as 1960, counselling did not have enough identity as a
profession to be recognized legally. In 1960 a debate on legal issues started
on the decision of a judge that a PhD counsellor cannot be held responsible
for a client's suicide if trained in a Department of Education. The 1974's
definition of counselling stated it to be different from psychology and it was
basically a process through which a trained counsellor assists an individual
or group to make satisfactory decisions concerning personal, educational,
and career development. A restriction on practice of counselling for all
except doctoral level psychologists has been imposed in some states of USA.
However, according to Swarson (1983), counselling is often seen as a generic
profession, which may be adopted by people working in health settings after
obtaining some theoretical and practical training.

Ethical Dilemmas

Ethics are a code of conduct that should be followed by all treatment
providers. It implies the highest standard of care and protects the
community and the treatment provider. Some believe it implies the
difference between right and wrong. Ethical issues are inevitable in the field
of counselling. The possible scenarios are so diverse that it is likely every
therapist has faced an unanticipated ethical dilemma.

An ethical dilemma arises when two or more of the values found in the
ethical principles conflict. Resolving an ethical dilemma requires identifying
the relevant values and weighing those competing values against one
another to determine which receives priority.

Counsellors are often faced with situations, which require sound ethical
decision-making ability. Determining the appropriate course to take when
faced with a difficult ethical dilemma can be a challenge. There can be a
potential risk to the client and counsellors if the situation is handled
inappropriately.


A few examples of Ethical dilemmas:

1. Disclosure of secrets in therapy
One client in couples counselling discloses to therapist an affair or
another secret not known to the partner
Client discloses behaviour that has harmed, or may harm another
person, adult or a minor; such as having unprotected sex despite
positive HIV status, or sexually exploiting someone.
Client discloses illegal behaviour.
Family member requests information about a former client, now
deceased.

2. Payment
Setting the fees according to the clients socio-economic status or
setting the fees according to therapists competence.

3. Confronting a colleague or senior
To confront a colleague or senior doing something unethical.

Ethical Decision-Making Model

When counsellors are faced with ethical dilemmas that are difficult to
resolve, they are expected to engage in a carefully considered ethical
decision-making process.

Identify the Problem.

Gather as much information as you can that will illuminate the situation. In
doing so, it is important to be as specific and objective as possible. Writing
ideas on paper may help you gain clarity. Outline the facts, separating out
innuendos, assumptions, hypotheses, or suspicions. There are several
questions you can ask yourself: Is it an ethical, legal, professional, or
clinical problem? Is it a combination of more than one of these? If a legal
question exists, seek legal advice.

Apply the ACA Code of Ethics.

After you have clarified the problem, refer to the Code of Ethics (ACA, 2005)
to see if the issue is addressed there. If there is an applicable standard or
several standards and they are specific and clear, following the course of
action indicated should lead to a resolution of the problem.

Determine the nature and dimensions of the dilemma.

There are several avenues to follow in order to ensure that you have
examined the problem in all its various dimensions. Consult with
experienced professional colleagues and/or supervisors. As they review with
you the information you have gathered, they may see other issues that are
relevant or provide a perspective you have not considered.

Generate potential courses of action.

Brainstorm as many possible courses of action as possible. Be creative and
consider all options. If possible, enlist the assistance of at least one
colleague to help you generate options.

Consider the potential consequences of all options and determine a
course of action.

Considering the information you have gathered and the priorities you have
set, evaluate each option and assess the potential consequences for all the
parties involved. Determine which option or combination of options best fits
the situation and addresses the priorities you have identified.

Evaluate the selected course of action.

Review the selected course of action to see if it presents any new ethical
considerations. If you are satisfied that you have selected an appropriate
course of action, then you are ready to move on to implementation.

Implement the course of action.

Taking the appropriate action in an ethical dilemma is often difficult. The
final step involves strengthening your ego to allow you to carry out your
plan.

If your response to the situation seems to have been wrong or has caused
unnecessary trouble, pain, loss, or problems, we need to assume personal
responsibil ity f or the consequences.


Workplace Counselling in India
Tata Consultancy Services is Asias largest software company. It houses
more than 120,000 employees, including 4,500 foreign nationals, working in
offices spread across 42 countries around the world.

Maitree, was an initiative started by Mala Ramadorai in February 2002 to
connect and support the spouses of TCSers, many of whom had to move
outside India and adjust groups, involving employees, their spouses,
children and even parents. Maitree serves as the companion, counsellor and
guide to the employees of TCS in various locations around the country.

The initiative was started with a view to increasing the Subjective wellbeing
among its works and to maintain and increase levels of productivity. Apart
from its counselling service it aims at providing its employees a chance to
pursue various extracurricular activities that are experienced to be
enjoyable and relaxing. It also offers its employees a chance to indulge in
their hobbies which may have taken a backseat because of work life.

The services offered by this initiative are as follows:

Maitree Counselling Service:

TCS-Maitree's counselling service has won the organisation plenty of praise.
The service has a very informal approach, employees are encouraged to see
a counsellor and do not have to formally approach their department heads,
making this service popular among the employees. The information shared
in counselling sessions is highly confidential. However, since most of the
issues brought up by employees were work related. It was found that the
organization would benefit if the counsellors share some of these concerns
(keeping confidentiality in mind) with the TCS administration, so that issues
can be resolved quickly.

Extra-curricular:

The extra-curricular initiatives include
yoga classes,
theatre workshops,
flower-arrangement sessions,
ballroom dancing classes,
computer workshops.

These activities give them an opportunity to bring out their creativity and
express their talents. Events such as festive celebrations or Kaleidoscope, a
fair for children, bring the TCS family closer together. The events and
activities also provide TCS associates a strong platform to leverage
leadership abilities and develop team skills.

Over the years, the organisation realised that many of its employees showed
an inclination towards community development activities, however they did
not have the requisite knowhow to execute their intentions. A team under
Maitree identified areas for them where they could invest their time and
skills towards the betterment of the community.

Through its many interventions, TCS-Maitree is helping its employees and
their families contribute towards less privileged communities at all office
locations worldwide.

Volunteering their time and effort in initiatives of their liking has helped
young IT professionals to mitigate stress levels and gain a measure of
personal meaningfulness. It also fosters a bonding with the organisation and
an opportunity to interact with colleagues on a social level. The skills learnt
in the volunteering sphere by employees are sustained and carried over to
the workplace, ensuring nurturing managers and leaders.

Hexaware Technologies Limited (HTL) is an information technology
and business process outsourcing service provider company based
in Mumbai. The company provides software services in airlines, banking and
financial services and health care insurance sectors. The company is
currently assessed as a CMMI level 5 company and since
2005, NASSCOM has ranked Hexaware as India's 11th IT company in list of
top 20. In a separate survey of 2006, it was rated the sixth Best IT
Employers from India. Current employee strength is above 7000 with over
175 clients. Company operates from multiple offices in countries like Japan,
USA, Canada, Singapore, Netherlands, Belgium and Germany apart from
India.

The IT company saw the need for a counselling service as it watched its
employees deal with the effects of the economic down turn. Employees were
seen to experience financial and social pressures that caused stress and
lowered their sense of well being. Many employees saw their strong
relationships getting stretched and strained to the breaking point.
Employees were seen to be unable to gather support for themselves from
spouses, parents or siblings as most of them were facing the same
difficulties. The inability of employees to handle such a situation themselves
became clearly evident. All this and much more pressure made it almost
necessary for HR to bring in professional counselling at the workplace.

At Hexaware, the first type of counselling is regular internal counselling,
which is done by the immediate supervisor, senior managers or by HR. This
is very effective if the problems are more related to internal environment,
e.g. peer-superior relationship, career progression, any kind of on-the-job
harassment, etc. The HR also goes a step ahead and helps employees by
offering a platform for them to express their general life grievances.

The employees are then referred to certified counsellors whom the
organization makes available for the employees, either on the premises or
somewhere outside. These can be individual or some special organization
which are known for giving professional help while maintaining privacy.

Computer Sciences Corporation (CSC) is an American multinational
corporation that provides information technology (IT) services and
professional services. In addition to its headquarters in Falls Church,
Virginia, USA, and three other major offices in Australia, Asia and Europe.
The company houses 90,000 professionals who serve clients in more than
70 countries. CSC employs about 98,000 employees (as of March 30, 2012)
in 90 countries and ranks among the largest outsourcing companies in the
world. It has about 2,500 Clients, among which are almost every agency of
the U.S. Federal Government and nearly half of the Fortune 500 financial
services companies.
CSC is acknowledged as the world's fourth most admired IT Services
company. The company also figures in the Forbes Global 2000 list.

While offering counseling services is considered a common practice in its
branches abroad the company offers such service in India as well
"Counseling helps employees to manage their own problems, using their
own resources. An organization can earn competitive advantage through
workplace counseling as this is a powerful tool for maximizing work
performance and attracting and retaining quality workforce" says Laveena
Bhatia Senior Manager, Human Resources, CSC in India. SPARSH is the
name of the employee assistance program offered by CSC. The Program is in
association with an organization called 1to1.

The service aims at identifying challenges in their professional and personal
lives and providing assistance in resolving those challenges. The service is
made available to the immediate families of these employees. The service is
comprehensive and is provided by qualified and experienced counsellors at
1to1help. Strict confidentiality measures are adhered to for the employees
and their families. The service is offered free of cost to the employees and
their immediate families.

NetApp, Inc., formerly Network Appliance, Inc., is an
American multinational computer storage and data management company
headquartered in Sunnyvale, California. It is a member of the NASDAQ-100,
and it was ranked on the Fortune 500 list for the first time in 2012. NetApp
has more than 12,000 employees in 150+ offices around the world.

Today, NetApp is the number one storage provider to the United States
government as well as the number one storage market leader in Germany.
NetApps products and solutions are currently powering 96% of FORTUNE
100.
NetApp offers counselling services to not just the employees but their
immediate dependent family as well. The company does not force its
employees to utilize the services. However, if the management comes across
any signs that an employee would need counselling, the employee is referred
to the counsellor. The process for referral by managers is as follows:
Recognize signs
Meet in private
Determine if referral is required
When in doubt, consult HR
Suggest counsellinginformal or formal
Follow-up

Wipro Limited (formerly Western India Products Limited) is a
multinational information technology (IT) consulting and outsourcing service
company located in Bangalore, Karnataka, India. As of March 2013, the
company has 145,000 employees with a presence in 54 countries. Wipro is
the third largest IT services company in India. Its subsidiary, Wipro
Enterprises Ltd., offers consumer care, lighting, healthcare, and
infrastructure engineering.

Mitr is an in-house counselling initiative organized by Wipro in the year
2003. The service interestingly focuses on peer counselling where they train
individuals from the work place in skills that they can use to listen and be of
aid to their colleagues. This initiative aims at creating a pool of employees,
trained in counselling, who can help other colleagues in distress.
Other services that have been initiated by Wipro in order to promote well
being and to increase group cohesiveness are:
Wipro Cares - Is an initiative by employees towards social development
where their family members and friends can contribute in the areas of
education, community and social development by attaching themselves
to a specific project / cause or even make monetary contributions.

Kids@Wipro - A monthly initiative for kids of employees to be a part of an
interactive experience with presentations, book-reading, games, group
activities and some take-away to soak in the experience.

Channel W - The employee portal has been creating a de facto Wipro
Community by allowing Wiproites to interact, and disseminate
informationon things they most cherish.
JPMorgan Chase & Co. is an American multinational banking and financial
services holding company. It is the largest bank in the United States by
assets,
[4]
and as of 2012, it ranks as the second largest bank in the world by
assets with total assets of $2.509 trillion. It is a major provider of financial
services, and according to Forbes magazine is the world's second largest
public company based on a composite ranking. The hedge fund unit of
JPMorgan Chase is one of the largest hedge funds in the United States.
JP Morgan in India offers professional counselling, consultation, and referral
service to help employees and their family members find solutions to the
many challenges faced in managing work and personal lives. The program
includes referrals for professional, confidential, and free counselling. EAP
services are free, confidential and available 24 hours a day, seven days a
week.







Infosys Limited (formerly Infosys Technologies Limited) is an Indian
multinational provider of business consulting, information technology,
software engineering and outsourcing services. It is headquartered in
Bangalore, Karnataka. Infosys is the third-largest India-based IT services
company by 2012 revenues, and the second largest employer of H-1B visa
professionals in the United States, as of 2012. On 28 March 2013, its
market capitalisation was $30.8 billion, making it India's sixth largest
publicly traded company.

The Samaritans network at Infosys is a peer group of volunteers trained in
barefoot counselling, spending time in listening to and counselling fellow
employees, helping them cope with challenges, mostly of a personal nature.
The Samaritan volunteers perform this activity over and above their roles
and responsibilities at work.

Apart from this Infosys also has a program called, Hearing Employees and
Resolving (HEAR): This provides a channel for employees to get their
grievances addressed. Health Assessment and Lifestyle Enrichment program
(HALE): This program is designed to increase awareness about health
issues, help with better lifestyle management, encourages regular medical
checks and provides immediate professional assistance in times of crisis.

Marlabs Inc. is a provider of Information Technology and Knowledge Process
Outsourcing services. Marlabs was founded in 1996 with headquarters in
Piscataway, New Jersey, US. The company has offices and solution delivery
centers across the US, Canada, Latin America, India, and Malaysia. In-
house data centers in the US and in India are used to provide hosting and
other managed IT services to their clients. The company also offers its
employees counselling services in order to help them deal with problems in
their personal lives and the workplace.

Fujitsu in India through its subsidiary Fujitsu Consulting India Pvt Ltd.
addresses the IT Services and Software market in India and also operates
Fujitsus largest Global Delivery Center in the world from India.

The company offers its employees counselling services to address issues of
marital discord, personal grievances as well as problems in the work place.



Companies Offering Counselling Services in India
1to1help.net Pvt. Ltd. was set up in Bangalore in 2001 by Archana Bisht,
Karuna Baskar and Anil Bisht with the intention of providing counselling
services and training in areas related to counselling, especially tailored for
the Indian corporate setting.

Clientele
As pioneers and leaders of EAP services in India, covering close to a million
lives,1to1help is currently partnered with over 80 Indian and International
organizations who are leaders in their respective fields. Our clientele come to
us from some of the following industries:
Information Technology Insurance
IT Enabled Services FMCG
Pharmaceutical Media & Entertainment
Telecommunication Retail
Banking & Finance Mining & Chemicals
Hotel Cement & Aluminum
Petroleum Manufacturing
Airlines


Employee Assistance Programs

1to1help's unique Employee Assistance Programme, developed over decade
of corporate counselling experience in India, offers a combination of services
ideally suited to the Indian setting.


Counselling Services

Counselling is provided by a team of professionally qualified, trained
counsellors, widely experienced in dealing with the whole gamut of problems
faced by 'normal' people. (Their profiles are available for registered users to
view on the 1to1help.net website). The team approach makes it possible to
offer a very high quality of service to large numbers across the country.



A range of counselling options are available:
Face to face counseling: is available by prior appointment in Bangalore,
Chennai, Delhi, Mumbai, Pune and Kolkata at the 1to1help premises.

Telephone Counseling: provides a certain degree of anonymity and is also
suitable for those who are constrained by time or distance.

Online counseling: a concept pioneered in India by 1to1help, utilizes secure
web-based messaging. (Employees log on to a secure web page and send a
message via a password-protected, secure form.) This option provides
convenience, accessibility, security and relative anonymity (extremely
important in the Indian scenario).

Legal and Financial Information services: 1to1's EAP provides you access to
both Legal and Financial experts. This service gives you easy access to a
network of lawyers and financial experts who can assist you and clarify any
query you may have. This service entitles you to a first time free 30 minute
telephonic consultation with a lawyer in your area and/or financial expert
as per your requirement.

Other Features and Services

Online Self Assessment Test: developed by psychologists assist individuals
in understanding themselves. This could then be followed up with personal
interaction with a counsellor.

Articles: A wide range of articles on self-development, relationships, work
and parenting are available on the website. These are based on issues
frequently encountered in our counselling practice. Reading the articles
provides information, insight and assistance and also prompts many to seek
counselling.

Talks and Work shops: on Work-life balance, Marriage, Parenting,
Counselling skills, Working Women's issues and Shiftwork lifestyle
management, supplement the counselling services as well as increase
awareness.


A primary research was carried out in the year 2002 at a manufacturing
company based in Mumbai, India. This public limited company has five
manufacturing sites across the country and four sales divisions. This
research aimed at investigating the (felt) need for employee counselling in
the organization. The design of this research study was exploratory in
nature. The primary source of data collection was structured interviews, the
sample being one hundred and ten (110) employees which is 20 % of the
employee strength five hundred and fifty three (553) of the corporate office
of the company. The interview schedule comprised of both closed and open
ended questions. A random sampling technique was used. The employee
sample was 20 % of each of the divisions operating from the corporate office
and was a perfect mix of managerial level employees, staff level employees
and worker level employees.
Some important conclusions that were derived from the research study are:
Majority of the employees of the company (61% of the sample) were unaware
of the concept of Employee Counselling. Those employees who had a
partially correct idea (25 % of the sample) about employee counselling knew
that it was related to helping an employee in distress, advising, creating self-
awareness and personality development. The remaining 14 % had an
incorrect understanding about the concept.
After the researcher had explained what employee counselling was all about,
69 % of the sample agreed that there was a (perceived) need for employee
counselling in the company. The reasons were many, most common ones
being to assist employees solve their personal and/or work related problems
and to improve the employee relationships and overall culture of the
workplace. Among the 31 % who were of the viewpoint that employee
counselling as an institutionalized process was not needed in the company,
57 % of this group felt that the company had a family culture and the
informal relationships between the employees could be leveraged upon.
Only 22 % of the sample disagreed on the importance of employee
counselling as a part of HR systems while 78 % of the employees felt that
counselling is an important HR function. 83 % of the employees were
unaware of the companies practicing Employee Counselling in India.
The research results indicate that majority of the sample under study
responded positively to the hypothesis i.e. a need for Employee Counselling
was felt and that it would benefit the organization. However, the awareness
about the concept of counselling and employee counselling, particularly so
was found to be exceptionally low.
References
1. BAPC
2. A model of work stress - Stephen Palmer, Cary Cooper and
Kate Thomas
3. Workplace Counselling in Hong Kong: A Pilot Study - Fung
Kei Cheng
4. Counselling & Psychotherapy John & Rita Sommers
5. Introduction to Counselling & Psychotherapy- Stephen
Palmer
6. Zeepedia
7. www.counselling-directory.org.uk/counselling.html