Elizabeth has been the Chair of the Queensland section of the College of Counselling Psychologists since 1996. I feel honoured to be among her friends.
I was asked at a meeting recently to define counselling psychology. Many find this difficult to do. In the following brief paper I shall concentrate on the world of counselling psychologists. So much of the change and healing of a client in counselling psychology will occur because of the personal characteristics of the therapist and as the literature suggests, only 30% of change (All in the Mind, ABC, 3 March, 2007) is due to the clinical psychological skills learned in formal training. The rest is from the therapist.
Counselling psychologists are qualified and accredited professional psychologists who have additional specialist expertise in therapeutic healing through the counselling process and the client-counsellor relationship. Counselling psychologists have a complete range of clinical skills and therapies based on research, scientific literature and proven results (Rich, 2005; Hofmann,1999; Beutler,1997; DeRubeis, Gelfand, Tang & Simons, 1999; Krupnick, 1999, Antonuccio,1997; Blatt, Sanislow, Zuroff & Pilkonis, 1996; Grady, 1998). These skills include thorough assessment without labelling, appropriate testing if necessary, and the formulating of a healing action plan or strategy.
The active participation of our clients, in their own unique way, is central to the work of counselling psychologists. Counselling psychologists work to value and accept all clients with respect and without judgement. Healing and change are focussed on their own empowerment within the limitations of their environment and their abilities as well as the many systems of which they are a part. Just as the professional helps clients explore and discover meaning and engagement in their lives, the therapist also experiences meaning through his/her work. The intricate and personalised therapy process is challenging to the psychologist and requires of the professional a creative and imaginative mind, lateral thinking and a unique problem solving ability. Therefore, this work could not be done by those who find it hard to think in multi-dimensions, to visualise in three dimensions and apply this to the developmental phases of human beings and the rocky road of life's journey. Perceiving the historical framework through time and the sociogram of a client in one's head, with a multitude of discrepant or congruent facts, is essential. Counselling psychologists aim to bring a maturity, openness and a genuine empathy with the gamut of human emotions and life traumas and triumphs. They are invariably people who know themselves, having had therapy as part of their training and may have been tested to the limit, in a variety of life events and taxing circumstances. Counselling psychologists have a maturity, a stability, are highly ethical and have the ability to give 'tender loving care'. They also will have experienced the various types of love through the differing relationships of their colleagues, families and fellow men [sic].
The core competencies of counselling psychologists are a genuine acceptance of human kind of all races, colours, nationalities, religions, sexual orientations, gender and ages without judgement. Most therapists will have had a substantial liberal education and have a broad knowledge and experience of the geographical, the political and the environmental world. A liberal education gives them entry into quality literature which is frequently shared with the client at crucial turning points in therapy thereby broadening their experience and knowing. Many counselling psychologists will have a deep knowledge of a culture other than their own and may speak another language. Counselling psychologists work with language and as the German author Goethe said, "No one understands his own language until he has studied another." Effective communication is a fine art understood by counselling psychologists. It is the root of relationship breakdowns, self esteem, identity and the range of emotions both positive and negative that determine human happiness or pain. A thorough training in and comprehension of all stages of human development is part of counselling psychologists' repertoire. They are also trained to recognise when psychopathology intrudes into the lives of those struggling to function on a day to day basis.
Counselling Psychologists require a well developed 'emotional intelligence' comprising intra and interpersonal skills, knowledge and experience and outstanding listening and reflection skills. They need to be sensitive to every cue and innuendo of nonverbal behaviour, facial, voice and body expression. They are knowledgeable about a range of therapy types (Narrative, Solution Focussed, Gestalt, Cognitive Behavioural and its variations, Psychoanalytic, Humanistic, and Existential), developmental life stages, personalities and human behaviour. Counselling psychologists with their liberal education are professionals who have a commitment to helping others and to making a difference for the better.
There is an enormous need in Australia for mental health services. Unfortunately, prior to March 2006, most people needing help were referred by a Medical General Practitioner to a Psychiatrist and would be placed on medication (Zoloft, Prozac, Effexor, Valium, Cypromil, Stelezine, Lovan, Tegretol, Zyprexa etc.). The 'patient' was invariably given a psychiatric label or diagnosis from the DSM IV (Diagnostic and Statistical Manual), which could remain with them for life and could be perceived as a stigma by themselves and others. Some had up to fourteen different diagnoses over the years. Many would be on and off medication for decades and some hospitalised.
Australia has a well qualified 'manpower' of professional human capital. We have an 'army' of psychologists who are now beginning to address the current mental health problems including the anxiety, depression and mood disorder plague in our society. Counselling psychologists are well placed to address the ennui and anomie of modern "Affluenza" (Clive Hamilton, 2006).
Psychologists do not medicate. They obtain their results without the use of drugs and they have the skills to make long lasting changes in the clients' lives. They can change the way clients think; they don't merely reduce the symptoms (see all references).
The major weakness of counselling psychology is the shortage of courses to train professionals in this specialty. In Queensland and New South Wales, there is no university degree in counselling psychology, those that were available having been changed to clinical courses in 2006. Around Australia, there are only three Masters programmes currently running in Counselling Psychology.
A second drawback appears to be a general lack of knowledge by the populace, including policy makers, about the profession. In Western Australia, private health fund rebates were paid only to those who called themselves clinical psychologists or clinical neuro-psychologists. Fortunately, this does not apply since November 2006.
Counselling psychologists are competent therapists who have often developed in a counselling work environment and have had many years of professional development and training in the healing process possible through the use of their counselling psychology skills. Counselling psychology would benefit from a high quality public relations push and marketing exercise. Federal Government policy makers and General Practitioners need to be educated about this valuable resource in the community.
Currently in Australia, billions of dollars are being wasted on medicalising anxiety and stress, which invariably develops into a medical diagnosis if the symptoms are not nipped in the bud. Medication rarely changes anything in the patient's life unless the underlying causes of the stress are addressed and altered. Drugs and medications can contribute to putting the clients down the slippery slope to debilitating psychiatric disorders when many could have remained functioning individuals with suitable psychological intervention. Clients who have been too heavily medicated frequently lose their own inner resources and strength. Counselling psychologists are no longer able to work with them and effect significant change if this has happened. Counselling or clinical psychologists may need to see some of them before they are heavily sedated.
The Australian Psychological Society executive has been assertive in raising the profile of all psychologists in the media. The Federal Government has been convinced that the army of psychologists is ready and waiting to address the mental health 'plague'. The counselling psychologist has to make a case for having not only the basic clinical psychological skills of the clinician but in addition, their powerful healing ability through the Art and Science of their unique work. The old 'Aussie battler' who used to be the working class family, has sometimes transmogrified into middle class battler who is struggling to keep abreast of their affluent lifestyle, credit card payments and "MacMansion" (Hamilton, 2005). This can induce stress symptoms. Counselling psychologists are well experienced in dealing with these complex mental, social and relational problems.
Already technology has made an impact on the profession as well as on potential clients. On-line counselling, for example, Kids Help Line, Lifeline, Centacare and specialised mental health websites, are being tapped into in a big way. At the same time technology is creating more clients. Those who develop a computer addiction or PIU (Pathological Internet Use; Tindle, 2005) or those who use their computers for sinister purposes, such as child pornography, pose new problems. Relationships that develop online can break up families and leave a trail of family devastation. At the same time, computer dating is real and beneficial for many thousands who use RSVP, Abbey escorts or similar. Intervening appropriately is a skill that many counselling psychologists have.
Counselling Psychologists are experts in communication and relationship issues. I can not see an end to this need. Family courts use them in mediation and other relational matters where families are in crisis during separation, divorce and custody battles.
Changes in population profiles, especially the demographic top heavy pyramid with the proportion of the population being in the older age bracket, result in a need for retirement and transition counselling and the finding of meaning in the sunset years of life. This is a time when the danger of depression lurks. The use of Counselling psychologists in bereavement and grief counselling could be greatly expanded.
Practitioners could include more group work and experiential sessions in their repertoire. This in itself can be very therapeutic for clients, allowing them to take behavioural risks with others and practice their assertiveness and other communication skills in an interactive situation.
Counselling psychologists could play a major role in family courts, educational institutions, hospitals, prisons and in family and couple therapy and relationship counselling.
Counselling psychologists, like Clinical psychologists, are clinical in their foundation but also have the ability to heal and change clients through a powerful and effective counselling experience. Good communication is powerful and this is one of the great strengths of counselling psychologists. Their authenticity can make them leaders in certain spheres. "The pen is mightier than the sword." Words can be influential. They can educate and train clients to problem solve by means of language. It is the glue which cements people or blows them apart. Messages, scripts, inner critic, self talk, put downs, abusive language can be the source of a range of negative emotions or moods. Counselling psychologists can encourage and teach love, altruism, kindness, forgiveness, peace, caring, generosity and hope in a world where these qualities are often not valued. By so doing, Counselling psychologists may be able to counteract the individualistic materialism and ultimate value put on possessions and money that has gripped many of those who are searching for some meaning in their lives, other than acquisition. In order to make some sort of impact, it is necessary to work on a bigger scale. Maybe both counselling and clinical psychologists need to use the media more. An Oprah type of programme could be effective. Or maybe they need to write more popular self-help books.
There is no simple answer to the problem of how to educate the public about what Counselling and Clinical psychologists can offer. However, it does appear that most of the clients who are currently medicated and are not receiving therapy are not being given the best mental health treatment available. In addition, research suggests that some medications cause thirty percent weight gain and contribute toward a diagnosis of diabetes ( ABC, 3 march 2007). Medicating clients is wasteful and on compassionate grounds, the pain of many of these people is not being healed. It can not be described as world's 'best practice'.
In this brief paper I have outlined my understanding of the complex nature of counselling psychology in comparison to clinical psychology and some of the issues that counselling psychologists are preoccupied with today. In summary counselling psychologists offer a unique clinical service to the public and use their clinical skills and their unique liberally educated selves in a professional and complex healing process.
Bedi, N., Chilvers, C. and Churchill, R. (2000) Assessing the effectiveness of treatment of depression in primary care. The British Journal of psychiatry, 177, 312-318.
Beutler, L.E. (1997). Fact and fiction about prescriptive privileges. Psychotherapy Bulletin, 32(2), 4-6.
Blatt, S.J., Sanislow, C. A., Zuroff, D. C. and Pilkonis, P. A. (1996) Characteristics of effective therapists: Further analysis of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Project. Journal of Consulting and Clinical Psychology, 64 (6), 1276-1284.
DeRubeis, R. J., Gelfand, L., Tang, T. and Simons, A. (1999) Medications versus cognitive behavioral therapy for seriously depressed outpatients. American Journal of Psychiatry 156(7), 1007-1012.
Grady, D. (January, 1998). Personal therapy for schizophrenia. New York Times.
Hofmann, S.G. (1999). Panic control and its applications. Journal of Therapeutic Practice and Research, 8(1), 3-11.
Krupnick, J.L. (1999) The role of therapeutic alliance in psychotherapy and Pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64 (3), 532-539.
Rich, B. (2005) Extended primary care, a survey of Psychologists, unpublished paper, APS.
Shulberg, H. C., Pilkonis, P. and Houck, P (1998) The severity of major depression and choice of treatment in primary care practice. Journal of Consulting and Clinical Psychology, 66 (6), 932-938.
Tindle, L. E. (2005) Pathological Internet Use in University Students. Journal of Guidance and Counselling, 2005