Ask a counsellor: What works?

This is a question that I, as a counsellor get asked quite a lot. And the answer(s) are frustratingly - from the client's point of view - probably not as easy to gain as they would like.


I'd like to reassure any clients who are accessing counselling or even thinking of accessing it, that you are not alone with this question. I asked it myself as a client, and now as a therapist, I still ask it after most sessions, sometimes before a session, and often during it. Bear with me.

An integrative counsellor is used to blending together different approaches towards the difficulties clients are going through. For some, the need is to examine relationships and how they came to be as they are, and a type of counselling called transactional analysis (TA) has been very effective for many clients. For others there is so much healing and growth just in having that person, the therapist, sat with them - hearing, understanding, caring about where this thing called 'counselling' goes.

So far so good, but I can almost anticipate the next question which goes something like, "but is there any type of order that runs through all of that? Is there one thing you can grab on to that has helped all of your clients?". Some recent clinical work has fortunately coincided with some CPD ('continuing professional development'; all counsellors keep a log of this, and it helps to keep us informed, and committed to improvement) and since then, there is something that all my recent clients have found incredibly useful.


It is the concept of neuroplasticity; the theory that we can update and relearn our mental programming, and that regardless of age the brain retains this ability (except in certain medical conditions) that has proven to be so helpful to my clients.

Therapists can form deep relationships with their clients, for example, a client may disclose a very powerful, historic, power issue that has never been spoken before. A therapist might meet this with what we call 'core conditions', and a look at configurations of self, facilitating a person's inner dialogue. A therapist might also meet this with their own genuineness. I'm always humbled to work with people and regard the trust they place in me as something incredibly precious. The safe relationship and the presence of trust, combined with that gentle permission from me that its OK for them to tell their story, has really helped.

When I have been able to explain neuroscience research to my clients I have seen something else happen. I explain the way the brain is structured, followed by introducing meta-cognition; literally 'thinking about thinking', how we think, and completing this with the explanation that neuroscience tells us of this plasticity, that we absolutely can re-programme our thinking, and that their difficulties are not fixed within them forever. The response when the client understands this is positive.

It is as though my client suddenly believes that change is not only possible, but that it is actually very present.

They can see that every counselling session, every time we encounter what may be a cognitive bias, and the client then evaluates this, is helpful to them. I really observe that traction that passionate therapists love to see. I see my clients begin to make sense of what has, for so long, held them back from where they want to be.

So what was it that worked then? And how? Once the relationship has the conditions of trust and respect (where we both feel that, in the same innate way we do when we have met a person who truly wanted to help us) then I look to introduce the concepts of neuroscience into our work together. One example is a client who was really struggling with a specific type of anxiety. The first few sessions were all about our relationship, hearing their difficulties and showing that I had heard and cared about it, which then led to my first explanation of how the mind works.

A great tool for this is the 'Chimp Paradox' model of professor Steve Peters and I encourage all clients or potential clients to have a read of this. Once I explained how the mind worked I drew on some more recent academic work to introduce the concept of paradolia - a cognitive bias within which there is a tendency in humans to look for patterns and recognise them. This really allowed my client to see that the constant scanning of their environment to look for patterns of threat (the mind holds this in attention far more than pleasant, or non-threatening thoughts for obvious evolutionary reasons; if we hadn't scanned our environments in very great depth we'd now be extinct) was keeping them trapped within an anxiety loop.

The fact that research showed this as a tendency within all humans was an immeasurable relief to my client - it was as though I had said to them, "you're not going mad!". I always conclude sessions like this with a thorough mindfulness check-in where we concentrate on our breathing together, and just being present with our breath and allowing ourselves that calm place that really does give us a break initially, and when used regularly, heals us.

One of my counselling motto's is "with understanding and knowledge people are capable of anything!" and I think the combination of neuroscience, along with the long gained, professional, presence of a caring counsellor, is truly what has worked for many clients. People will always need that professional person, who is not connected to their experience, who can maintain appropriate confidentiality to support them towards their recovery, and if that person knows how to use neuroscience to compliment the therapy they already deliver, we are then facilitating the client to use their neuroplasticity. 

As this approach evolves, therapists can continue to give clients traditional care and understanding, together with some new knowledge that will really change their lives.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Chesterfield, Derbyshire, S42
Written by Alex Doram
Chesterfield, Derbyshire, S42

I am an integrative counsellor who qualified in November 2019 currently in voluntary practice, and also running my own private practice in Chesterfield. I have remained as a volunteer for the local charity and support clients and their families through the effects of life limiting illnesses and its effects.

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