1.1

What Are Counselling and ?

Colin Feltham

Definitions and Aims A brief, tentative definition of this kind offers some parameters but omits mention of the many, ever- expanding, often competing, schools of therapy, No single, consensually agreed definition of either and the arenas and the several professions (some- counselling or psychotherapy exists in spite of many times in conflict) in which they are practised. attempts across the decades in Britain, North America Discussions of all such conflicting claims can be and elsewhere to arrive at one. The question of pin- found in Feltham (1995) and James and Palmer ning down crucial distinctions arose in concrete (1996). The contention advanced by this book’s edi- terms in the UK in the first decade of the twenty-first tors is that counselling and psychotherapy, in spite century when the Health Professions Council (HPC) of partly different historical roots and affiliations, initiated preliminary steps towards legal protection have much more in common than they have serious of the titles ‘counsellor’ and ‘psychotherapist’. and demonstrable differences and that practitioners Attempts to load the former with wellbeing-associated and the public stand to gain much more from the tasks and the latter with competencies in addressing assumption of commonality than from spurious or more severe psychological problems soon broke infinitesimal distinctions. It is often acknowledged down. For the purposes of this book, the following that ‘British counselling’ much more closely resem- provisional working definition is offered: bles psychotherapy as practised in the USA and Counselling and psychotherapy are mainly, though not parts of Europe than it does the various kinds of exclusively, listening-and-talking-based methods of guidance and mentoring that it is often confused addressing psychological and psychosomatic prob- with. Certainly practitioners in this field work with lems and change, including deep and prolonged many different types of goal and expectation, human suffering, situational dilemmas, crises and implicit and explicit, each of which may call for the developmental needs, and aspirations towards the use of somewhat different skills, but arguably little realization of human potential. In contrast to biomedi- is to be gained practically from further controversy cal approaches, the psychological therapies operate about professional titles and distinctions. largely without medication or other physical interven- tions and may be concerned not only with mental health but with spiritual, philosophical, social and Development of Psychotherapy and other aspects of living. Professional forms of counsel- Counselling in the UK ling and psychotherapy are based on formal training which encompasses attention to pertinent theory, clinical and/or micro-skills development, the personal was developing psychoanalysis – development/therapy of the trainee, and supervised often considered the grandparent of most of the practice. diverse schools in existence today – in Austria in

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the late nineteenth and early twentieth centuries. information is available in Aldridge (2011). It is Before Freud there were certainly many kinds of usually agreed that early American vocational guid- psychologically oriented therapies and many had ance projects and associations (for example Frank already used the concept of an unconscious. Parsons’s Vocation Bureau in Boston in 1908) laid However, Freud has come to mark the historical the foundations of counselling, and guidance for the pivot when previous centuries of religious, philo- young generally was a strong element. This cer- sophical and pseudo-scientific theories and meth- tainly features in the early career of Carl Rogers, ods (from religious propitiation to shamanism, who is probably the closest to being the ‘founder’ of sleeping cures, magnetism, hypnotism, etc.) were (non-directive) counselling in the 1940s. Another challenged by serious aspirations to establish psy- player is perhaps Rollo May, who, influenced by chotherapy as a scientific discipline. Psychoanalysis Alfred Adler, wrote what many consider to be the is perched curiously between being perceived as a first counselling text in the 1920s (May, 1992). In challenge to previous faith in reason (the the USA counselling was also originally closely Enlightenment) and as itself, the new grand narra- linked with personnel management and the work- tive capable of rationally explaining all the psycho- place. In general it is true to say that counselling has logical ills of humanity. Freud is often (although not historical roots in practical guidance and problem- by all) ranked with Darwin and Marx as one of the solving issues, and was often agency based rather most significant scientific thinkers at the dawn of than associated with private practice. However, it is the twentieth century. now mainly characterized as distinctly other than Psychoanalysis moved through Europe and advice giving and as having a primarily facilitative North America in the first few decades of the twen- function. tieth century, the International Psychoanalytical Seminal events in the UK included the establish- Association being established in 1910 and the ment of the National Marriage Guidance Council in British Psychoanalytic Society in 1924. The British 1938, the importation of counselling training meth- Association of Psychotherapists (originally the ods from the USA to the Universities of Reading Association of Psychotherapists) was founded in and Keele in 1966 (to serve the pastoral needs of 1951. In spite of much public and medical resist- students), and the establishment of the Westminster ance to psychoanalysis (which was originally radi- Pastoral Foundation in 1969. The Standing cally counter-cultural), interest and support grew, Conference for the Advancement of Counselling in partly in connection with the two world wars and 1970 led to the formation of the British Association the search for remedies for ‘shell shock’ (the pred- for Counselling in 1977, renamed the British ecessor of post-traumatic stress disorder, PTSD) Association for Counselling and Psychotherapy and other problems experienced by military person- (BACP) in 2000. It should be said that a great deal nel. Concern about scientology led in 1971 to the of cross-fertilization between these developments Foster Report [C1.1Q1] which had implications for and others in psychotherapy was taking place and psychotherapy, and in 1978 to the publication of the the emergence of psychodynamic counselling, for Sieghart Report [C1.1Q1] on the statutory regula- example, demonstrates these close links. tion of psychotherapists. During the 1980s confer- Alongside these developments we should also ences regularly held at Rugby (organized by the note pertinent developments elsewhere. Originally British Association for Counselling (BAC)) led the Association of Medical Officers of Asylums and eventually, in 1993, to the now United Kingdom Hospitals for the Insane (AMOAHI, founded 1841), Council for Psychotherapy (UKCP). The British the Royal College of Psychiatrists was so named in Psychoanalytic Council (BPC), representing train- 1971. The British Psychological Society was estab- ing institutions with a strictly psychoanalytic affili- lished in 1901. Significant mutual aid and volun- ation. The UKCP, containing member organizations tary organizations such as Alcoholics Anonymous from humanistic, cognitive-behavioural and other (1935), the Samaritans (1953) and Cruse (1959) traditions, was established in 1991. In recent years should also be included in this brief portrait, as it has extended its membership categories to include should the parallel existence of the personal ‘psychotherapeutic counsellor’ and more flexible social services and its casework tradition which routes to membership. closely mirrored developments in counselling and The development of counselling is harder to psychotherapy. trace, there being no single dominant figure like Theoretically, psychotherapy and counselling Freud, or monolithic theory like psychoanalysis. develop continuously, some might say all too pro- Hans Hoxter may, however, be credited as one out- lifically, with significant departures from psycho- standing individual for his part in creating the coun- analytic theory and practice observable from its selling movement, including bringing American earliest days. Jung and Adler were among the earli- training ideas to Britain. Further relevant historical est to break away from Freud, and similar schisms,

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factions and developments are in evidence throughout Each has designated tasks that obviously differ psychotherapeutic history. Hence resulted the from those of others, depending on context and cli- growth of what is still thought to be the more than ent group. Counselling and psychotherapeutic skills 400 schools (also known as theoretical orientations, are used to degrees in all these professions and, approaches, brand names) of therapy we have where individual workers possess dual or multiple today. The question of whether such proliferation is qualifications (for example a social worker may be desirable and in clients’ interests, or not, must be trained in family therapy), they may formally pro- faced by thoughtful practitioners, and indeed the vide therapeutic services. However, BACP and integrationist movement stemming from the 1980s other clinically oriented bodies strive to emphasize represents shared concern for convergence (Cooper a distinction between casual, informal or untrained, and McLeod, 2010). On the other hand, early and uncontracted use of counselling skills, and dis- twenty-first century tensions regarding statutory ciplined, contracted, ethically protected, formal regulation sometimes appear to be pushing the psy- counselling or psychotherapy. Parry (1996), too, choanalytic, humanistic and cognitive-behavioural distinguishes between: therapy (CBT) camps further apart (see Parker and Revelli, 2008; Weatherill, 2004; House and •• type A: psychological treatment as an integral Loewenthal, 2008). A summary of some of the key component of mental health care points of this necessarily succinct history of events •• type B: eclectic psychological therapy and is provided in Table 1.1.1. Readers may also like to counselling consult Aldridge (2011), Dryden (1997), Ellenberger •• type C: formal psychotherapy. (1970) and Feltham (1995; 2007). The above-mentioned groups are also related to those involved in practising the so-called comple- Allied Professions mentary therapies (often regarding their work as holistic or mind–body integrated), including acu- puncture, , reflexology, aromatherapy, Most (but certainly not all) would agree that coun- Alexander technique, spiritual healing, osteopathy, selling and psychotherapy – in so far as they are , Bach flower remedies, etc. Again, professions or emerging professions – are part of practitioners may sometimes have dual qualifica- the health professions. Although Freud battled to tions and practise both psychological therapy and have psychoanalysis recognized as separate from somatic or sensual therapies alternately or simulta- medicine and Rogers similarly battled with psychi- neously, having due regard for appropriate contract- atric and psychological colleagues, the psychologi- ing (Sills, 2006). Debates about the rights of certain cal therapies today concern themselves largely of these groups to aspire to professional status can- with mental health promotion and mental illness not be ignored, but nor can public scepticism. In reduction even where these terms are not used and relation to distinctions between the titles of those where additional or different aims are espoused, engaged in closely related therapeutic professions, such as personal growth and development, psycho- and their putatively distinctive skills and effective- education, psychopractice, etc. (see Brown and ness, see Cheshire and Pilgrim (2004), Gask (2004), Mowbray, 2002). Counsellors are therefore often James and Palmer (1996) and Milton et al. (2011). found in health and social care settings along with Offering resistance to the professionalizing trend, psychotherapists, clinical and counselling psy- particularly via the HPC, which is sometimes per- chologists, psychiatrists and mental health nurses. ceived as unnecessarily bureaucratizing and distort- A second group of related professionals includes ing therapy, is the Independent Practitioners’ social workers, probation officers, welfare officers, Network (IPN) (see House, 2003; Postle, 2011) and personnel managers, career guidance workers, the Alliance for Counselling and Psychotherapy occupational therapists, speech and communica- (see also Parker and Revelli, 2008). tion therapists, occupational and health psycholo- gists, and so on. Teachers, nurses, priests and others in caring roles may have closely related functions. Members of the above groups, some- A Brief Overview of the Values of Counselling times known as the ‘core professions’, have been considered good candidates for counselling and and Psychotherapy psychotherapy training, and typical intakes to courses include members of all these groups. The overarching values, and the professional ethics Each professional group has its own professional that stem from these, of counselling and psychother- body, history, and traditions of training and supervision. apy were summed up in the concepts of integrity,

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Table 1.1.1 Key historical developments Appearance of schools Year Birth/growth of institutions and professional organizations Significant events (approximate dates) 1900 Freud’s Interpretation of Dreams 1907 British Psychological Society Vienna Psychoanalytic Society 1908 First (careers) counselling centre, Boston, USA (Frank Parsons) 1910 International Psychoanalytical Association 1913 National Vocational Guidance Association (USA) Analytical psychology (Jung) London Psychoanalytic Society 1919 Institute of Psycho-analysis 1920 Tavistock Clinic Behavioural psychology 1921 Psychodrama 1924 British Psychoanalytic Society 1926 London Clinic of Psychoanalysis Medico-Psychological Association (MPA; previously AMOAH I, originally 1841) 1935 Alcoholics Anonymous 1936 Society of Analytical Psychology 1937 Death of Adler 1938 National Marriage Guidance Council (now Relate) 1939 Death of Freud 1940 Client/person-centred approach 1948 British National Health Service T groups First student counselling service (University College Leicester) 1950 International Association for Vocational and Educational Guidance (IAVEG) Gestalt therapy 1951 Rogers’s client-centered therapy 1952 Group Analytical Society Diagnostic and Statistical Manual (DSM) American Association for Counseling and Development (AACD) 1st edn American Counseling Association (ACA; originally NVCA) 1953 Samaritans 1955 Rational emotive behaviour therapy (originally RT then RET)

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Table 1.1.1 (Continued)

Appearance of schools Year Birth/growth of institutions and professional organizations Significant events (approximate dates) 1959 Cruse Scottish Pastoral Association 1960 First fee-charging counsellor in private practice in UK Death of Melanie Klein 1961 Death of Jung J.D. Frank’s Persuasion and Healing 1962 Cognitive therapy 1965 Halmos’s The Faith of the Counsellors 1966 Counselling training at Universities of Reading and Keele 1969 Westminster Pastoral Foundation Association of Humanistic Psychology (USA 1962, UK 1969) 1970 First Standing Conference for the Advancement of Counselling (annual) Death of Perls and Berne Primal therapy MPA becomes Royal College of Psychiatrists 1971 Foster Report on Scientology 1975 National Association of Young People’s Counselling and Advisory Services Neuro-linguistic programming (later Youth Access) 1977 British Association for Counselling (BAC) 1978 Sieghart Report on statutory regulation of psychotherapists 1980 Association of Humanistic Psychology Practitioners (AHPP) Smith et al. The Benefits of Psychotherapy 1982 Rugby Psychotherapy Conference (set up by BAC 1983 Society for the Exploration of Psychotherapy Integration (SEPI) First BAC accreditation scheme Solution-focused therapy 1987 Death of Carl Rogers 1989 United Kingdom Standing Conference on Psychotherapy (UKSCP) 1990 Death of Bowlby Cognitive analytic therapy 1991 British Confederation of Psychotherapists 1992 European Association for Counselling BPS Charter of Counselling Psychologists First UK Chair of Counselling (Windy Dryden) 1993 United Kingdom Council for Psychotherapy (UKCP, originally UKSCP): advice, guidance, counselling and psychotherapy lead body 1994 Independent Practitioners’ Network BPS Division of Counselling Psychology UKCP Register of Psychotherapists

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Table 1.1.1 (Continued) Appearance of schools Year Birth/growth of institutions and professional organizations Significant events (approximate dates) 1995 BCP Register NHS Psychotherapy Services in England Review 1996 United Kingdom Register of Counsellors (UKRC) (individuals) NHS Psychotherapy Services in England, World Council for Psychotherapy Department of Health (DoH) Strategic Policy Review 1998 Association of Counsellors and Psychotherapists in Primary Care (CPC) Data Protection Act UKRC (organizations) CORE introduced 1999 National Institute for Health and Clinical Excellence (NICE) 2000 BAC renamed British Association for Counselling and Psychotherapy (BACP) BACP’s Ethical Framework for Good Universities Psychotherapy Association (UPA) adds ‘Counselling’ to its title, Practice in Counselling and becoming UPCA Psychotherapy 2001 Lord Alderdice’s Psychotherapy Bill Treatment Choice in Psychological Therapies and Counselling: Evidence- Based Clinical Practice Guidelines (DoH) BACP’s Guidelines for Online Counselling and Psychotherapy 2002 Health Professions Council (HPC) is identified as the regulatory body for all health professions, including counselling and psychotherapy (‘talking therapies’) 2003 UKCP establishes its Psychotherapeutic Counselling Section BACP Service Accreditation Scheme Telephone counselling (contractual) is accepted by BACP for accreditation hours 2004 College of Psychoanalysts Graduate mental health workers in primary care British Psychoanalytic Council British Confederation of Psychotherapists (BCP) renamed British Psychoanalytic Council (BPC) 2006 Improving Access to Psychological Therapies 2007 Death of Albert Ellis 2008 BACP represented on HPC’s Professional Liaison

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impartiality and respect (Bond, 2010). These were clients (while remaining necessarily detached to developed and related by BACP (2002) to tenets of varying degrees), and that their aim is the ultimate moral philosophy: fidelity (honouring the trust good of the client balanced by respect for the cli- placed in the practitioner); autonomy (the client’s ent’s own choices. Due to the weight placed on right to be self-governing); beneficence (concern respect for self-determination, most therapists are for the greatest good); non-maleficence (to cause opposed to people being coerced into therapy and least harm); justice (concern for fairness); and the into remaining in therapy when they wish to leave, and practitioner’s self-respect (self-knowledge and care actively support the principle of informed consent to of self). Such principles are not without problems, therapeutic procedures. however, since in practice there sometimes are con- All professional bodies in this field have their flicts between, for example, the wishes of a client own codes of ethics and practice – BACP’s Ethical and possible damaging consequences. Also, it is Framework for Good Practice in Counselling and sometimes the case that what may be professionally Psychotherapy (2002) being a mature example – ethical and desirable will be challenged as socially usually addressing issues of safety, contracting, undesirable or questionable by others. Hence, the competence, confidentiality, boundaries, law, adver- goals of individual autonomy and self-actualization, tising, complaints and so on. There are few specific which are held by many writers as central values in prohibitions, although sexual contact with clients, psychotherapy (e.g. Hinshelwood et al., 1998), exploitation of clients and breach of confidentiality have been criticized by some sociologists as leading are prohibitions shared by all professional bodies. to an ‘autonomy obsession’, an undermining of Nevertheless, often genuine and valid differences in social responsibility and a cultural insensitivity. It is values do exist between members of different pro- therefore important to bear in mind that what we fessional bodies (and networks, such as the IPN, often call professional ethics (as advocated in pro- which oppose professionalization) and different fessional codes) are not necessarily coterminous theoretical affiliations. Understanding and elabora- with social ethics. tion of the foundational philosophical assumptions It follows from basic principles that counsellors of therapists are an area of theory and training that and psychotherapists value non-judgementalism is taking a long time to mature (Bennett, 2005; vis-à-vis clients, that they owe a duty of care to Erwin, 1997; Feltham, 2010; Howard, 2000).

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