Chapter 66 What counselling is

Counselling resembles psychotherapy and life coaching in that similar techniques are used across these interventions, but counselling is more often provided to those who are worried and/or upset about their lives, rather than those suffering from mental illness or those seeking ‘personal growth’. Counselling is also provided for patients to help them make medical decisions and cope with illness.

The immediate goal of counselling is to promote and protect individuals’ psychological welfare, which generally means promoting an individual’s contentment, happiness and life satisfaction. Although influenced by many things, people’s happiness crucially depends on how well adjusted they are to the situations and relationships they regularly encounter. Counselling typically involves exploring ways of changing the interaction between situations and people’s feelings, actions and thoughts.

The relationship between objective situations, perception of those situations and affective and behavioural responses to those situations is critical to the counselling endeavour. No matter how dire or favourable people’s objective circumstances may be, the functionality of their affective, behavioural and cognitive responses will often have a great influence on how well those people suffer or thrive.

Counselling approaches

Most counselling approaches broadly fall within or across three types: (1) psychodynamic; (2) person-centred; and (3) cognitive-behavioural.

Psychodynamic approaches

Psychodynamic approaches suggest that psychological problems start when young children’s needs or desires are either excessively frustrated or excessively indulged, usually by a parent and often in ways that infants come to associate with either the presence or the prevention of danger. In later years, reminders of such early events can cause people to regress to functioning in much the same way that they did as children. This usually results in dysfunctional adjustment to their adult circumstances, often with detrimental consequences that further increase their distress. This can lead to a vicious circle of perceived threat–anxiety–infantile response–dysfunctional interaction with situation-renewed, sustained or enhanced perception of threat–further anxiety, and so on.

To illustrate, imagine a young girl tentatively expressing curiosity about her father’s penis and then being (or simply feeling) punished by her parents for ‘being inappropriate’. Anything that as an adult reminds her of this early trauma may cause her anxiety and to react in a relatively immature way. She might feel uncomfortable contemplating sex, for example, and attempt to cope with this by avoidance of and withdrawal from sexually charged situations.

Psychodynamic counselling involves identifying infantile anxieties and defences that are being dysfunctionally manifested in subsequent situations. A major technique for doing this is identifying instances of transference, where clients react to others in ways that seem likely to reflect their emotionally loaded childhood interactions with their parents. Because such interactions are associated with childhood trauma, people are likely to have little or no conscious awareness that this is occurring. Psychodynamic counsellors will typically interpret what is going on, thus bringing it into people’s conscious awareness. As people move towards insight, they re-experience their childhood traumas (i.e. experience catharsis) and come to realize that as adults they have the option of responding in different ways – ones more functional to their current circumstances.

Person-centred approaches

Person-centred approaches to counselling suggest that psychological problems start when people internalize the idea that they are worthwhile only if they behave in certain ways or achieve particular goals. This can lead people to stop having faith in their own sense of what is good and bad or even about what is personally pleasant or distasteful. If this happens, people can find themselves grimly pursuing goals that may be insatiable and which rarely lead to a sense of sustained satisfaction.

Parents frequently set conditions of worth for their children, for example when they insist that children are valued only whilst they are being ‘nice’ or ‘successful’ – in whatever ways the parents define such terms. Throughout life, other social influences either reinforce or contradict people’s early beliefs about conditions of worth. Laws, political and religious systems, education and the media provide obvious examples. Such messages can undermine people’s sense of intrinsic worth. At extremes, people can come to feel that they are valuable or worthwhile only to the extent that they make money, achieve status or have successful relationships. As conditions of worth in a society are pervasive and often contradictory, this can lead people to feel confused and irredeemably worthless.

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