Counselling & Change - A Therapeutic Model
This article argues for transparency within the counselling room with regard to outcomes and objectives. It also highlights the importance for many clients of achieving change through counselling work. The article introduces a model intended to encourage clients to reflect on their standing and strengths with regard to the change process.
Rather like visits to the dentist that have been put off for too long, some potential clients may view the counselling room as a place of last resort. The counsellor or therapist is often someone who is only turned to when discussions with well meaning friends have started to become repetitive, when family members show irritation at continually hearing the same refrain or when the effort of suppressing unwelcome thoughts has just become too great to sustain.
There are good reasons for that delay. The counselling room is not always an easy place to be in. It takes courage to enter into therapy. It is important therefore that both counsellor and client do all they can to ensure that there is an effective outcome from the counselling work.
A key challenge for many clients is to identify exactly what she or he wishes to achieve. Counselling can be expensive not just with regard to fees but also because of the considerable emotional energy and time invested in the work. If there is no clarity on what is to be achieved, it may be difficult for the client to evaluate effectiveness and to maintain an overall sense of ownership over the counselling process. Yet an attempt to try to clearly delineate key goals at the start of the therapy process may not always be possible. Sometimes such an active approach at the beginning of the counselling work demands too high a level of functioning and understanding at a difficult time.
That conundrum is not easily solved. Indeed some counsellors may not even see this as a problem. There are therapists who will see the counselling process as a journey which should not be hurried. An acknowledgement of the unknown will be regarded as playing an important part in allowing some clients to safely experience unease and distress as they try to find a way forward. Perhaps it should also be expected that a confusing fog which may have developed over many years, will take some time to dispel.
An alternative argument suggests that if the client is able to more fully understand and question the counselling process from the outset, the greater her or his commitment to the work. That in turn is more likely to lead to a successful outcome.
The recent furore concerning the leaking of diplomatic cables has also ignited a general debate about the right to know and within therapy we should acknowledge the importance of that debate. As counsellors we should surely provide our clients with as much information as they wish to take in, about the process we are to follow. Informed consent means just that - and the provision of information on method is fundamental to the granting of meaningful consent. The suggestion that the counsellor knows best is as arrogant as it is misplaced. The counsellor provides a view and a recommendation for work based on knowledge, competency and experience. It is up to the client to agree to or to question that recommendation.
There is however a contingent responsibility on those counsellors who identify with this more open stance, to try to facilitate an easier understanding by clients of the forces at work within their emotional world. The complexity of the emotional world raises barriers to understanding. It is often these complexities and the contradictions of the emotional challenges we face, that are instrumental in bringing many clients into the counselling room in the first place.
Some therapists may prefer to encourage clients into a prolonged and unstructured process of gently unravelling these concerns. Alternatively, those who see potential benefits in a more active and collaborative approach, may wish to help clients develop a better understanding of both the process involved in the work and their personal position. For some, the use of conceptual models can promote that better understanding. The attempt to make concrete what can otherwise remain a difficult abstraction, can often help clients place their experience within a comprehensible framework.
Some models such as those used within CBT work, are already well known. These form the basis for the introduction of useful tools which clients are encouraged to take with them from the counselling room. There are a myriad of other models which are constantly being developed. The following is an example of a model which is intended to provide a structured interpretation of a fundamental challenge faced by many clients - the challenge of dealing with change.
Yallom argues that 'Change is the business of Psychotherapy' (1). Clients come into a counselling room because they wish for something in their lives to be different. Much client work is therefore driven by a concern to understand that which is unclear in order that meaningful and lasting change can then be brought about. Yet even if understanding has been achieved, the change process does not always follow on in an automatic way.
Clients still have to wrestle with complexities around implementation. It is important to recognise that simply having the wish to change does not mean that the ability to change is also present. Comprehension and competence are different attributes. For change to be achieved and sustained, it is important for both desire and ability to be present. That suggests that clients may need to reflect on their standing against each attribute and this is reflected in the following model.
It is self-evident that if the client holds both the desire to change and the ability to change, there is a strong likelihood that change can be successfully brought about. Conversely, even when a client can acknowledge a deep rooted problem which is causing distress and calling out for resolution, if there is no real accompanying desire for change and if the client also lacks the ability to create change, it is obvious that lasting change will be very difficult to achieve.
This model suggests a further level of complexity to be considered. There may be situations where the client has a strong desire to change but lacks the ability to actually bring about significant variations, perhaps in her/his thoughts or behaviours. In this case the process of change will be more complex and that may be reflected by the client within the therapy room.
Similar challenges will exist where the reverse occurs. This can be apparent in situations where the client is able to demonstrate an ability to bring about change by referring to significant events occurring earlier in their life but continues to express ambivalence about the current need or the desire to introduce change.
Models exist as a framework for thought to be developed and extended. An additional tool which can be used within this model is some form of scaling or weighting which can help clients and counsellors identify the areas of greatest concern.
Clients will come into the counselling room having recognised the need for something to alter in their life but may continue to be uncertain at the thought of actually seeking that change. For those clients, the initial work in the counselling room may have to be about supporting the individual as they nurture and grow their desire for change.
There may also be a need to develop the actual ability to bring about change. A change in habit, whether that is an emotional or a behavioural habit, may first require the development and practice of new ways of thinking, feeling or acting. The initial important step in that process will be for the client to recognise that there is work to be done to improve that change competency.
This paper has reflected onthe importance of clients being able when possible, to consider at the beginning of the work, on what it is they wish to achieve. For some clients, just to attain an understanding of 'why', will be sufficient. For others, the key work within the counselling room will be targeted on achieving a fundamental change in their actual way of being with regard to thoughts, feelings and behaviours.
Achieving that change can be a difficult process. The more fully the individual understands the forces at work within their psyche, the greater the chances of realising the desired life change. This model provides the client with a framework to aid the understanding of their current position and is offered as a tool to encourage clients and counsellors to focus on areas of work which will lead to the achievement of lasting change.
(1) Irvin D Yallom Existential Psychotherapy