Professional Counselling in the UK - Essay Example

?Professional Counselling in UK OUTLINE Introduction Two organizations: Base 51 and North Tyneside PCT Differences in the environment the counsellorswork in: Resources, lighting, purpose-built Stress Comparison of confidentiality between the two settings Volunteer counsellors-- Selection Criterion-- Training (importance of transferring knowledge) Approaches- person centred - understanding of the client counsellor experience Challenges faced by counsellors in GP surgeries Guideline they work with- codes of practice in various settings co-exist with the BACP ethical framework- professional liability - equal opportunities policy (of Base 51) Conclusion Professional Counselling in UK Customer name Instructor Counselling and psychotherapy aims to relieve people of their distress due to traumatic events or other emotional problems. Such events include relationship breakups, bereavement, stress, suicidal thoughts, debilitating diseases and reduced self-esteem and self-confidence. Therapy aims to reduce the emotional turmoil the client is undergoing and to bring about lasting change for the solution of these problems. With counselling services, clients also seek to improve their health and well-being after the emotional distress that they have been through (Web Healer 2011). Counselling and psychotherapy are both focus on talking to people regarding their problems. However counselling inculcates brief sessions whereas psychotherapy focuses on the deeper issues linked to the history of the clients that concern them. Counselling sessions focus on the solutions of a specific problem in contrast to psychotherapies which are more intense. Counselling has started to rise in the UK due to increased demand, with the numbers tripling in the past decade (Counselling Directory 2011). Counsellors sit in various settings in the UK. Many of them are private while many are working with organizations that have specific premises designated for the counselling sessions. Private counsellors often set up their offices at their homes- a venue preferred by some clients. Moreover there are a number of voluntary organizations functioning in the UK that provide counselling services too. This paper compares and contrasts the counselling services being offered in two settings: a voluntary organization and GP’s surgeries. The voluntary organization chosen is Base 51, whereas the counselling that is associated with GP surgery is based in North Tyneside and is known as the North Tyneside Patient Care Trust (PCT). The North Tyneside PCT is the major leader of NHS in North Tyneside. Base 51 Counselling Service is a volunteer organization functioning in England. The organization believes in the provision of a holistic health care for children and youth aged between 12-25 years. The service is offered full time and mirrors the emotional needs of the clients. The service is available for people residing in the Nottinghamshire area. Base 51 bases its mission statement on the WHO’s definition of health that health refers to the state of emotional and social well being, and not simply the nonexistence of a disease. Keeping this in consideration, Base 51 provides counselling service that is moulded to the needs of the clients. The organization is a health-care project under the HINT (Health Information for Nottingham Teenagers)- a charitable company. Base 51 functions both as a charitable trust and as a limited company operated by HINT. The Board of Trustees regulate the various administerial matters of the trust. Moreover Base 51 receives support from a number of local and national organizations, schools, business and individual figures. These bodies and people provide Base 51 with financial gifts and other gifts such as food and toiletries (Base 51 2011). Base 51 gives equal opportunity to all of its staff- a principle co existing with those of the BACP. Also the organization placed emphasis on professional liability, another element of professional conduct as prescribed by the BACP. Where Base 51 is a volunteer organization, the North Tyneside PCT is the local leader of NHS in the area. The NHS, through the organization, ensures that the people living in North Tyneside receive health services and their health needs are satisfied. The NHS funds the fees for the range of health care professionals employed by the North Tyneside PCT, including GPs, dentists, opticians and counsellors (NHS Choices 2010). The counsellors working at North Tyneside assess the psychological state of the clients and aim to provide treatment focused at it. The counsellors seek to resolve the mental health problems that they are subject to. The code of practice at the organization is in line with the standards of professional conduct put forth by the BACP. The process is based on accountability- a quality that is taken seriously at North Tyneside PCT. A disciplinary committee is set up if the members are found involved in any type of fraud and serious action taken against it (North Tyneside PCT 2008). The environment in which the counsellors work in has a huge impact on the effectiveness of the counselling being provided. This has been documented by a number of studies. Miwa and Hanyu (2006) contend that the interior environment has a significant influence on the treatment being offered in counselling sessions. The overall impact of interior design may contribute to the comfort level of the client. It has been documented that dimly lit environments are more pleasing and soothing and provide for greater degrees of relaxation. The soothing effect of such decor makes the client feel more at ease (Miwa & Hanyu 2006). Keeping this in consideration, Base 51 provides a safe and welcoming environment for the teenagers. The staff is welcoming and friendly, making the clients feel relaxed. The organization also does not have a waiting list. Young people can opt for both “drop-in times” and appointments (Base 51 2011). On the other hand, the counsellors working for North Tyneside PCT see clients on an appointment basis. The timings for the appointments are fixed and an average session lasts for about 40 minutes. In hospital settings, the environment may not be as pleasant as the environment of Base 51. This is because of the hospital smells and the relative dearth of personal objects (Lalor 2011). The environment available in GP surgeries and related clinical settings also differs from those of voluntary organizations in terms of the stress levels. One of the challenges that counsellors working in government settings are faced with is lack of sufficient support and skills to manage burnout amongst them (Padmanabhan et al. 2002). For instance, two counsellors who are employed in two different GP surgeries and having the same number of clients may have to face different levels of stress. One of the counsellors has been given the facilities of an amenable environment that is purpose-built for counselling. The room is adequate enough and has personalized items along with soothing conditions such as dim lighting. On the other hand, the other counsellor has a poor receptionist, improper lighting conditions, dearth of resources and space. The second counsellor is bound to be subject to greater degrees of stress than the former one. However the increased stress factor is offsetted by having social support. In a hospice the counsellors work with a number of professionals and this support can allow them to vent out their stress in a healthy way. In contrast to that, voluntary organizations such as Base 51, where counsellors do not work in teams, may not have healthy relationships or support by colleagues as their GP surgery counterparts have. Bayne and Bimrose (1996) observe that “a counsellor working in a highly demanding job in a hospice may be able to control resources and constraints more than a counsellor working with less demanding clients in the voluntary sector”. Therefore a difference in the lifestyles of a voluntary counsellor and a GP surgery counsellor is that the latter one is better equipped to deal with burnout and stress. However GP surgeries have their drawbacks in terms of the working conditions being provided. Garrett (2010) observes that for counsellors working in a GP surgery, he or she should be prepared for “less than ideal conditions”. In some settings there is little importance being given to the privacy of client information; e.g. information regarding the patient can be given to the doctor along with his tray without even enclosing it in an envelope. Where some GP surgeries have a separate room for counselling sessions, counsellors should be prepared for working in conditions which are not very perfect for counselling. The relaxing and soothing environment discussed above maybe hard to find. Counsellors at GP surgeries have found themselves working in cupboards, kitchen and the staff room (Garrett 2010). Also, some counsellors at GP surgeries observe that there counselling room was very far away from the main building. They did not have any communal area in the vicinity and the subsequent environment was not favourable to conversation. Therefore the workplace has an important effect on counselling, with GP surgeries being seen to provide less than ideal working conditions as compared to other settings. The level of confidentiality is also different for a government organization and a voluntary organization. Respect for the boundaries of confidentiality between the client and the counsellor as well as upholding the confidentiality with other members of the team is integral to counselling. Confidentially increases the degree of self-disclosure the client may engage in, thus affecting the knowledge the counsellor gains regarding the client. According to the BACP Ethical Framework, fidelity and confidentiality are vital ethical responsibilities and key components of good practice (BACP 2010). However it is difficult at times to maintain confidentiality in a hospital setting. This is because in some hospitals there is poor conformity to confidentiality (Padmanabhan et al. 2002). Also, in such settings, counsellors are required to work with other professionals. In such cases, they may discuss their plans for the coming days, and the clients that they have an appointment with. It may at times be difficult to decide upon an appropriate level of information that the counsellor is sharing with colleagues. Moreover in settings where there is a trend of divulging a lot of information amongst team members, the counsellor may have difficulty in conforming to tighter boundaries of client confidentiality (Lynch 1999). The risk of a confidentiality breach is particularly high for counsellors in a GP’s surgery. In order for a newly–inducted counsellor to settle in the organization, he or she may try to break confidentiality rules or time limitations. This allows the counsellor to be received by the family of professionals including the general staff and the GPs (Garrett 2010). A significant proportion of people working at a volunteer counselling organization are volunteers. In order for them to become qualified to practise as counsellors in the company, they are recruited, trained and inducted. Moreover support programs are provided to them to hone their skills and inculcating the know-how for dealing with youngsters. In Base 51, the process of recruiting is continuous with volunteers being accepted any time of the year. The organization provides support by staff to the volunteers. They are also given guidance by the senior professionals working at the company. Appropriate training opportunities are also available for the volunteers. The staff at Base 51 is supportive and welcoming, as volunteers working there report (Base 51 2011). On the other hand, in a GP setting, the counsellor may not find such a welcoming or informal environment. Where at Base 51 the volunteer received guidance from seniors and were trained, counsellors at a GP setting need to take a more proactive approach. This entails that the counsellor asks the GP at the site or the main coordinator to introduce him or her to the staff working over there and to gain information regarding the building. The counsellor needs to inform the receptionist where he or she is going to be sitting. At times the counselling room is well-spaced from the main part of the building. There may even be a separate waiting area for clients who are seeking counselling. Therefore it is important for the counsellor to inform the receptionist about his or her whereabouts (Garrett 2010). For an organization, there are both implicit and explicit dynamics that influence its overall functioning. There are certain aspects that are common to every setting, while some are unique (Lees 1997). The explicit values of the organization, be it the North Tyneside PCT or Base 51, remain essentially the same. The explicit values encompass knowledge about the traditions of the place and the organizational dynamics. By introducing oneself to the staff, a counsellor in a GP surgery is able to gain some idea about the workings of the place such as if people use their first or last names to address each other. A counsellor is able to know more about implicit values by experience. It is observed that there is consistent interaction being carried out between members of a group. This helps to give the counsellor knowledge about the “unconscious system” that is at work in the setting (Garrett 2010). Implicit values manifest themselves through cultural impacts on the behaviours of the individuals. This means that the individuals behave differently when outside the GP surgery while they show different attitudes when working. This may be attributed to the transgression of limits being set in the workplace such as gossip in the staffroom (Garrett 2010). Moreover counsellors at GP surgeries are exposed to people from an assortment of professions. The interprofessional team that counsellors will have to work in include professionals such as doctors, nurses, psychiatrists, osteopaths, receptionists and pharmacists as well as delivery men, cleaners, patients’ families and phlebotomists (Garrett 2010). The implicit values vary from organization to organization and hence are going to be different for Base 51 and North Tyneside PCT. For a volunteer organization, one can see that the environment is more welcoming than at a GP surgery. It is the managers in a volunteer organization which aim to make the newly-recruited volunteers aware of the ethos and culture of the place. Moreover volunteers are very committed to the work that they are going to perform and the levels of enthusiasm maybe higher compared to counsellors working in a GP surgery. Volunteers are encouraged to converse with each other and support those who are new to the organization. However this may at times prove to be less productive as is expected because of personal clashes between the volunteers. A solution to this is more number of opportunities for direct communication. For this purpose, support groups can be set up to give reflection time to the staff members. At Base 51, the volunteers are supported by all means possible. One of the volunteer counsellors at Base 51 observes that there is a high degree of enthusiasm amongst the staff members. Another talked about how the Counselling service and Base 51 are highly supportive, working together as a team in concert to promote the health of youngsters. The volunteers are of the view that the environment at Base 51 is conducive to learning (Base 51 2011). The counsellors at Base 51 aim to provide moral support to people who are in dire need of it. For this purpose they use patient-centred approach to encourage self-esteem and confidence amongst the clients. The intention of the counsellor and the non-directive means employed are essential features of patient-centred counselling. The counsellor focuses on encouraging the strengths and capabilities of the clients. The strategy wholly encompasses the notion of self-actualization and seeing the problem from the vantage point of the client (Stewart 2005). On the other hand, counsellors in GP surgeries can use any of the approaches that they feel comfortable with. For Payne (2010), solution-focused counselling did not seem to provide productive results. Therefore when working in the GP surgery, he changed his counselling style to that of narrative therapy. This was a combination of the values of both the solution-focused counselling and patient-centred counselling. Narrative therapy brought together the Rogerian therapy, which focused on giving consideration to and exploring the client, with the practical character of the solution-focused strategy. One of the salient features of solution-focused counselling is the shift away from the problems to its solutions. Regulation is different for volunteer organizations and those under the NHS in the UK. For private counsellors, there is no statutorily regulation in the UK. However since 2007, the government has been working on a White Paper which focuses on the introduction of statutorily regulation for counsellors in the country. The consequence of having no regulation is that anyone can claim to be a counsellor although he or she may not have any training at all to begin with. However there are professional bodies in the UK that provide a list of accredited counsellors for people to refer to. One of the main professional bodies is the British Association for Counselling and Psychotherapy (BACP). The body is responsible for ensuring if proper training has been given to the counsellors and for supervising training sessions later on. For a GP surgery, the counselling sessions are time limited. For majority of the GP surgeries, there are six sessions organized for each client. In contrast to that, counselling at voluntary organizations is longer-term and some of the services are provided without any fee (Evans 2007). Since North Tyneside PCT falls under the NHS, the NHS may pay for the services sought by the clients. Also there are a number of training paths for budding counsellors to follow. Counselling is not a graduate entry profession in the UK. They may do a diploma in counselling or choose from a range of introductory counselling skills courses. In volunteer organizations such as the Base 51, specialist training is offered depending on the segment of the population that it is catering to. For Base 51, this is the younger population. On the other hand, North Tyneside caters to people with a range of mental health problems, coming from various backgrounds and ages. This entails that the GP surgery is receiving more number of patients that Base 51 (Payne 2010). There are more problems that the counsellors in GP surgeries are faced with compared to those in private practice or other settings. These problems arise out of different frames of counselling. A frame of counselling refers to counselling boundaries that the counsellor draws in order to distinguish and outline a counselling experience. The frame is usually tight but it is also characteristic of being insecure. In GP surgeries the frame becomes more permeable to outside forces compared to other settings such as that in Base 51. There are several external forces that affect the work of the counsellor. Such external factors include the differing expectations of the clients and the staff, more referrals, developing an isolated space for practising etc. Other problems that the counsellor may face are inadequate information being given by the GP, resolving the disputes that emerge in the setting, problems of having counselling sessions in the GP’s room etc (Garrett 2010). Moreover, with time the changes in the needs of the clients have also changed. For instance, the counsellors who worked with refugees report that they have more complex needs and the process requires the counsellor to go beyond the normal model of counselling (Century, Leavey & Payne 2007). Keeping this into consideration, the BACP has devised good practice guidelines for improving counselling and equipping counsellors with the skills that they need to cater to the changing needs. References BACP 2010, Ethical principles of counselling and psychotherapy, BACP, viewed 30 April, 2011, Base 51 2011, Welcome to the BASE 51 Website, viewed 30 April, 2011, Bayne, R & Bimrose J 1996, New directions in counselling, Routledge, London. Century, Leavey & Payne 2007, ‘The experience of working with refugees: counsellors in primary care’, British Journal of Guidance & Counselling, vol 35, no 1, pp. 23-40. Counselling Directory 2011, Frequently Asked Questions, Memiah Limited, viewed 30 April, 2011, Evans, G 2007, Counselling skills for dummies, For Dummies. Garrett, V 2010, Effective Short-Term Counselling Within the Primary Care Setting: Psychodynamic and Cognitive-Behavioural Therapy Approaches, Karnac Books, London. Lalor, D 2011, Creating a Therapeutic Environment, Cottesloe Counselling Centre, viewed 30 April, 2011, Lees, J 1997, 'An approach to counselling in GP surgeries', Psychodynamic Practice: Individuals, Groups and Organisations, vol 3, no 1, pp. 33-48. Lynch,G (ed.) 1999, Clinical counselling in pastoral settings, Routledge, London. 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