Reading A

Introduction

Counselling is an activity that emerged during the twentieth century, and reflects the pressures and values of modern life. We live in a complex, busy, changing world. In this world, there are many different types of experiences that are difficult for people to cope with. Most of the time, we get on with life, but sometimes we are stopped in our tracks by an event or situation that we do not, at that moment, have the resources to sort out. Most of the time we find ways of dealing with such problems in living by talking to family, friends, neighbours, priests or our family doctor. But occasionally their advice is not sufficient, or we are too embarrassed or ashamed to tell them what is bothering us, or we just do not have an appropriate person to turn to. Counselling is a really useful option at these moments. In most places, counselling is available fairly and quickly, and costs little or nothing. The counsellor is someone who does his or her best to listen to you and work with you to find the best ways to understand and resolve your problem. Counsellors do not diagnose or label people, but instead do their best to work within whatever framework of understanding makes most sense for each client. For some people, one conversation with a counsellor is sufficient to make a real difference to them. Other people will need to see their counsellor on a regular basis for months or years. These can be precious hours. Where else in our society is there the opportunity to be heard, taken seriously, understood, to have the focused attention of a caring other for hours at a time without being asked to give anything in return?

Being a counsellor is also a satisfying and rewarding work role. There are times when, as a counsellor, you know that you have made a profound difference to the life of another human being. It is always a great privilege to be allowed to be a witness and companion to someone who is facing their own worst fears and dilemmas. Being a counsellor is endlessly challenging. There is always more to learn. The role of counsellor lends itself to flexible work arrangements. There are excellent counsellors who are full-time paid staff; others who work for free in the evenings for voluntary agencies; and some who are able sensitively to offer a counselling relationship within other work roles, such as nurse, doctor, clergy, social worker, or teacher.

This book is about counselling. It is a book that celebrates the creative simplicity of counselling as a cultural invention that has made a huge contribution to the quality of life of millions of people. The aim of this book is to provide a framework for making sense of all the different aspects of counselling that exist in contemporary society, while not losing sight of its ordinary simplicity and direct human value.

Counselling in Action

The following paragraphs reflect some typical examples of counselling, in terms both of different problems in living that can be tackled through counselling, and the different counselling processes that can occur.

Donald's story: coming to terms with the pressure of work

As a manager in a local government department, Donald continually felt himself to be under pressure, but able to cope. Following a series of absences for minor illnesses, the occupational health nurse within the authority suggested to Donald that it might be helpful for him to see one of the counsellors contracted to the occupational health service. Initially, Donald thought it would be a sign of weakness to see a counsellor. He was also worried that other people in the organization might view him as having mental health problems, and begin to see him as unreliable. Following further discussion with the occupational health nurse, Donald accepted that counselling was completely confidential, and might have something to offer. In the eight counselling sessions that he attended, Donald made two important discoveries about himself. First, he realized the extent to which he was driven by his father's ambition for him, to the extent of never being satisfied with his own achievements, and as a result being very reluctant to take holidays from work. He also reflected, with the help of his counsellor, on his unwillingness to accept support from other people, not only at work, but also in the context of his family life. With the encouragement of his counsellor, Donald began to make some shifts in his behaviour, in relation to arranging time off, and making opportunities to speak about his concerns to his wife, and to another close colleague. At the end of the counselling, he described it as having given him an opportunity to 'sort himself out'.

Maria's story: Moving on from abuse

At the age of 25, Maria's emotional life and relationships were still dominated by her memories of having been subjected to physical and sexual abuse in her childhood. She found it very hard to trust other people, or to speak up in social situations. For the most part, Maria had decided that the best course of action for survival was to be as invisible as possible. Although at various stages in her life she had tried to talk about her experiences to various doctors, psychiatrists and nurses, she had always felt that they did not really want to know what had happened to her, and were more interested in prescribing various forms of drug treatment to control her anxiety and self-harming behaviour. However, she had made enough progress in her recovery to decide to go to university to train as a nurse. Once started on her course, she found herself confronted by a variety of frightening situations – talking in seminar groups, making new friends, being on placement in busy hospital wards. Maria decided to visit the university student counselling service. This was the first time in her life that she had ready access to any form of psychological therapy. Maria formed a strong relationship with her counsellor, who she occasionally described as 'the mother I never had', and attended counselling weekly throughout the entire three years of her training. Together, Maria and her counsellor developed strategies that allowed her to deal with the many demands of her nurse training. As Maria gradually built up a sense of herself as competent, likeable, and strong, she became more able to leave behind much of her fearfulness and tendency to engage in binge eating.

Arva's story: Whether to leave a marriage

Having been married for five years to a man whose family were prominent members of a leading family within the Asian community in her city; the idea of marital separation and divorce was terrifying for Arva. Although she was no longer willing to accept the physical violence of her husband, she was at the same time unable to envisage that any other life might be open to her if, as she put it, she 'walked away' from her community. Eventually, Arva made an appointment to speak to a counsellor at a domestic violence helpline. Reassured by the acceptance she felt from the counsellor, she agreed to come in for a face-to-face appointment. Initially, Arva was very unsure about whether her counsellor could help her, because it did not seem that the counsellor understood the meaning and implications, within Arva's cultural group, of leaving marriage or publicly accusing a husband of mistreating his wife. Over time, the counsellor developed a sufficient understanding of Arva's experience to allow the counselling to proceed. The counsellor also helped Arva to make contact with an Asian women's support group and a legal advice centre, both of which were helpful to her in providing a broader perspective on her position. Eventually, Arva courageously confronted her husband about his behaviour. To her surprise, he agreed to join her in joint counselling, in which they agreed on some better ways to resolve the conflicts that sometimes arose between them.

Anita's story: Dealing with loss

Married to Bill for 40 years, Anita was devastated by his sudden death within six months of his retirement. Although Anita felt herself to be fortunate, in enjoying regular contact with her son and daughter and several grandchildren, she increasingly felt that her life was meaningless, and that she would never get over the loss of her beloved Bill. Nine months after his death, she visited her GP, who suggested a course of anti-depressants. Unhappy about the idea of possibly becoming dependent on drugs, Anita asked if there were any other alternatives. The GP then referred her to a bereavement counselling service. Anita only attended the counselling on two occasions, and did not find it helpful. When asked afterwards about why she thought that the counselling had not been useful for her, she said: 'he was a nice man, but he just sat and listened, and I felt worse. I couldn’t see any point in it'.

Simon's story: Creating a new self-image

By the age of 13, Simon had acquired a reputation as a 'difficult' student. Often required to attend detention on the basis of aggressive and uncooperative behaviour, Simon was on the edge of being suspended from school. His form teacher persuaded him that it would do no harm to see the school counsellor. In his first counselling session, Simon sat with his arms crossed, reluctant to talk. However, on the basis that speaking to someone who genuinely seemed interested in his side of things was better than attending maths class, he gradually allowed himself to open up. From Simon's perspective, he felt trapped in an image that other people had of him. Physically strong and mature for his age, and from a family that believed in the value of standing up for yourself, Simon felt that he had made the mistake, early in his career at the school, of challenging one teacher who had (in Simon's eyes) unfairly accused him of a misdemeanour. Ever since that day, it seemed not only other teachers, but also his classmates, seemed to expect him to 'rise to the bait' whenever a teacher reprimanded him. He admitted that he felt 'fed up and stuck' with this pattern, but could not find any way to change it. With the counsellor's help, Simon identified some key trigger situations, and ways of responding differently when they occurred. He also began to cultivate a subtly different image within the school, and within his own imagination – the 'joker' rather than the 'troublemaker'.

The case vignettes presented above give some brief examples of what can happen when someone goes to see a counsellor. But what is counselling? What are the ideas and principles that link together the very different experiences of these counselling clients? How can we understand and define counselling? These are some definitions of 'counselling' formulated by professional bodies and leading figures in the field.

… a professional relationship between a trained counsellor and a client… designed to help clients to understand and clarify their views of their lifespace, and to learn to reach their self-determined goals through meaningful, well-informed choices and through resolution of problems of an emotional or interpersonal nature.

(Burks and Stefflre 1979: 14)

... a principled relationship characterised by the application of one or more psychological theories and a recognised set of communication skills, modified by experience, intuition and other interpersonal factors, to clients' intimate concerns, problems or aspirations.

(Feltham and Dryden 1993: 6)

Counselling and psychotherapy are umbrella terms that cover a range of talking therapies. They are delivered by trained practitioners who work with people over a short or long term to help them bring about effective change or enhance their wellbeing.

(British Association for Counselling and Psychotherapy website 2013)

Counselling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

(American Counseling Association website 2013)

These definitions share one important feature in common: they are primarily framed from the point of view of the counsellor. They are definitions that primarily seek to define counselling as ‘something done by a counsellor’. In taking this perspective, these definitions reflect the aim of professional bodies to establish counselling as a professional specialism within contemporary society. However, a profession-centred definition of counselling runs the risk of ignoring the basic fact that counselling is always a two-person (or multiperson) activity, which arises when one person seeks the help of another. In order to reflect a more inclusive meaning of the team ‘counselling’, this book espouses a user-centred definition:

Counselling is a purposeful, private conversation arising from the intention of one person (couple or family) to reflect on and resolve a problem in living and the willingness of another person to assist in that endeavour.

The key assumptions that underpin, and are implied by, this definition include:

Counselling practice is therefore grounded in a distinctive set of values, and moral position, based on respect and affirmation of the worth of the individual person.

1. Counselling is an activity that can only happen if the person seeking help, the client, wants it to happen. Counselling takes place when someone who is troubled invites and allows another person to enter into a particular kind of relationship with them. If a person is not ready to extend this invitation, they may be exposed to the best efforts of expert counsellors for long periods of time, but what will happen will not be counselling. The person seeking counselling is regarded as actively engaged in finding ways of overcoming his or her problems, and as a co-participant in the counselling process, rather than as a passive recipient of intervention.
2. A person seeks a counselling relationship when they encounter a 'problem in living' that they have not been able to resolve through their everyday resources, and that has resulted in their exclusion from some aspect of full participation in social life. The concept of 'problem in living' can be understood to refer to any situation or perceived difficulty or impediment that prevents a person from getting on with his or her life. Counselling is not focused on symptom reduction, but on enabling the person to live their life in a way that is most meaningful and satisfying to him or her.
3. Counselling is fundamentally based on conversation, on the capacity of people to 'talk things through' and to generate new possibilities for action through dialogue.
4. Counselling depends on the creation of a relationship between two people, which is sufficiently secure to allow the person seeking help to explore issues that are painful and troubling.
5. The person seeking counselling possesses strengths and resources that can be channelled in the service of resolving a problem in living. The act of seeking counselling is not viewed as an indicator of personal deficiency or pathology.
6. The person in the role of counsellor does not necessarily possess special training or knowledge of psychological theories – counselling is grounded in ordinary human qualities such as a capacity to listen, sensitivity to the experience of others, personal integrity, and resourcefulness in solving the difficulties that arise in everyday life.
7. The person seeking counselling invites another person to provide him or her with time and space characterized by the presence of a number of features that are not readily available in everyday life: permission to speak, respect for difference, confidentiality, and affirmation.
   1. Encouragement and permission to speak. Counselling is a place where the person can tell their story, where they are given every encouragement to give voice to aspects of their experience that have previously been silenced, in their own time and their own way, including the expression of feelings and emotion.
   2. Respect for difference. The counsellor sets aside, as far as they are able, their own position on the issues brought by the client, and his or her needs in the moment, in order to focus as completely as possible on helping the client to articulate and act on his or her personal values and desires.
   3. Confidentiality. Whatever is discussed is confidential: the counsellor undertakes to refrain from passing on what they have learned from the person to any others in the person's life world.
   4. Affirmation. The counsellor enacts a relationship that is an expression of a set of core values: honesty, integrity, care, belief in the worth and value of individual persons, commitment to dialogue and collaboration, reflexivity, the interdependence of persons, and a sense of the common good. 
      
      Counselling practice is therefore grounded in a distinctive set of values, and moral position, based on respect and affirmation of the worth of the individual person.
8. Counselling represents an arena for support, reflection, and renewal that is unique within modern societies. Within this arena, the client and counsellor make use of whatever cultural resources come to hand (conversation, ideas, theories, rituals, altered states of consciousness, problem-solving algorithms, discourses, technologies) to achieve a satisfactory resolution of the initial problem in living that initiated the decision to engage in counselling.
9. The potential outcomes of counselling can be understood as falling into three broad categories:
   1. Resolution of the original problem in living. Resolution can include: achieving an understanding or perspective on the problem, arriving at a personal acceptance of the problem or dilemma, and taking action to change the situation in which the problem arose.
   2. Learning. Engagement with counselling may enable the person to acquire new understandings, skills, and strategies that make them better able to handle similar problems in future.
   3. Social inclusion. Counselling stimulates the energy and capacity of the person as someone who can contribute to the well-being of others and the social good.
10. Counselling always exists within a social and cultural context: 'counsellor' and 'client' are social roles, and the ways in which participants make sense of the aims and work of counselling are shaped by the broad cultural and specific community and organizational contexts within which they live. The practice of counselling is informed by awareness and appreciation of social, cultural, historical, and economic factors. The meaning of 'counselling', and the forms of practice associated with this term, continually evolve in response to social and cultural change.
11. Counselling is readily accessible. It is a ‘frontline’ service, that is located within the community or organization where the person lives, works or studies. There is minimal ‘gatekeeping’ that needs to be negotiated in order to see a counsellor.

It can be seen that a user-centred description of counselling highlights a range of factors that are partially hidden in profession-centred definitions. User-centred language characterizes the person seeking counselling as active and resourceful, and purposefully seeking to resolve problems in living, rather than merely a recipient of 'treatment'. It also emphasizes the connection between counselling and the social world of which the person is a member. It characterizes counselling as a relationship, a space, or an opportunity that is sought by a troubled person, rather than as any particular form of practice (e.g. two people sitting talking to each other face to face) – thereby inviting creativity and exploration in relation to how this space and opportunity might be constructed. It makes no claim that a professional qualification, or formal knowledge of psychology, is necessary in order to practise counselling – effective counselling can take place both within and outside professionalized networks.

How Does Counselling Help?

The concept of diversity is central to an understanding of what counselling is about. Counselling is a form of helping that does its best to respect and work with the diverse needs and learning styles of different clients. Because counselling is a frontline service, counsellors are not specialists in one single approach to therapy. Instead, counsellors need to be able to work with whatever and whoever walks through the door, or makes contact by phone or by other means. Effective counsellors are responsive and creative in their capacity to find out what will be most helpful for each individual client. There are many ways in which counselling can help people to move on in their lives:

• Insight. The acquisition of an understanding of the origins and development of emotional difficulties, leading to an increased capacity to take rational control over feelings and actions.
• Relating with others. Becoming better able to form and maintain meaningful and satisfying relationships with other people: for example, within the family or workplace.
• Self-awareness. Becoming more aware of thoughts and feelings that had been blocked off or denied, or developing a more accurate sense of how self is perceived by others.
• Self-acceptance. The development of a positive attitude towards self, marked by an ability to acknowledge areas of experience that had been the subject of self-criticism and rejection.
• Self-actualization or individualization. Moving in the direction of fulfilling potential or achieving an integration of previously conflicting parts of self.
• Enlightenment. Assisting the client to arrive at a higher state of spiritual awakening.
• Problem-solving. Finding a solution to a specific problem that the client had not been able to resolve alone. Acquiring a general competence in problem-solving.
• Psychological education. Enabling the client to acquire ideas and techniques with which to understand and control behaviour.
• Acquisition of social skills. Learning and mastering social and interpersonal skills such as maintenance of eye contact, turn-taking in conversations, assertiveness or anger control.
• Cognitive change. The modification or replacement of irrational beliefs or maladaptive thought patterns associated with self-destructive behaviour.
• Behaviour change. The modification or replacement of maladaptive or self-destructive patterns of behaviour.
• Systematic change. Introducing change into the way in that social systems (e.g. families) operate.
• Empowerment. Working on skills, awareness and knowledge that will enable the client to take control of his or her own life.
• Restitution. Helping the client to make amends for previous destructive behaviour.
• Generativity and social action. Inspiring in the person a desire and capacity to care for others and pass on knowledge (generativity) and to contribute to the collective good through political engagement and community work.

Counselling should be flexible enough to make it possible for the client to use the therapeutic relationship as an arena for exploring whatever dimension of life is most relevant to their well-being at that point in time.

What is the Difference Between Counselling and Psychotherapy?

The degree of similarity and difference between counselling and psychotherapy has been the focus of considerable debate. This issue is made more complex by the fact that, while all English-language societies employ both terms, there are many countries in which only the term 'psychotherapy' is used (e.g. Sweden) and other countries in which 'psychotherapy' is mainly used but where there are ongoing attempts to create a distinction between counselling and psychotherapy (e.g. Germany, where there is a movement to use 'Beratung' as the equivalent to 'counselling'). Within the English language community, two contrasting positions have dominated this debate:

• A clear distinction can be made between counselling and psychotherapy. The argument here is that, although there is a certain amount of overlap between the theories and methods of counsellors and psychotherapists, and the type of clients that they see, there is nevertheless a fundamental difference between the two, with psychotherapy representing a deeper, more fundamental level of work, over a longer period, usually with more disturbed clients.
• Counsellors and psychotherapists are basically doing the same kind of work, using identical approaches and techniques, but are required to use different titles in response to the demands of the agencies that employ them. For example, traditionally psychotherapy has been the term used in medical settings such as psychiatric units, and counselling the designation for people working in educational settings such as student counselling services.

One of the difficulties with both of these positions is that each of them portrays counselling in a 'little sister' role in relation to psychotherapy. In the 'clear distinction' position, counselling is explicitly described as less effective. In the 'no difference' position, counselling is still placed in a lesser position, by dint of the fact that psychotherapy jobs are higher status and better paid than counselling posts, even when they involve doing equivalent work.

Many people who work as counsellors are dissatisfied with the 'little sister' image of their professional role because they know that they work with some of the most damaged people in society, and believe that what they do is as effective as any form of psychotherapy. In recent years there has emerged a view that counselling and psychotherapy comprise alternative approaches to responding to the needs of people who experience problems in living. Some key points of contrast between counselling and psychotherapy are summarized in Table 1.1.

TABLE 1.1 Similarities and differences between counselling and psychotherapy

Psychotherapy	Counselling
Similarities Provides the person with a confidential space in which to explore personal difficulties	Provides the person with a confidential space in which to explore personal difficulties
Effective practice depends to a great extent on the quality of the client-psychotherapist relationship	Effective practice depends to a great extent on the quality of the client-counsellor relationship
Self-awareness and personal psychotherapy are valued elements of training and ongoing development	Self-awareness and personal therapy are valued elements of training and ongoing development
Differences A wholly professionalized occupation	An activity that includes specialist professional workers, but also encompasses paraprofessionals, volunteers, and those whose practice is embedded within other occupational roles
Public perception: inaccessible, expensive, middle class	Public perception: accessible, free, working class
Perception by government/state: given prominent role in mental health services; strongly supported by evidence-based practice policies	Perception by government/state: largely invisible
Conceptualizes the client as an individual with problems in psychological functioning	Conceptualizes the client as a person in a social context
Training and practice focuses on delivering interventions	Training and practice involves not only delivering interventions, but also working with embedded colleagues, and promoting self-help
Psychotherapy agencies are separate from the communities within which they are located	Counselling agencies are part of their communities – e.g. a student counselling service in a university
Treatment may involve the application of interventions defined by a protocol, manual or specific therapy model	The helping process typically involves counsellor and client working collaboratively, using methods that may stretch beyond any single protocol or manual
Treatment has a theory-derived brand name (e.g. interpersonal therapy, CBT, solution-focused therapy)	Often has a context-derived title (e.g. workplace counselling, bereavement counselling, student counselling)
Many psychotherapists have a psychology degree, which functions as a key entrance qualification	Counsellors are likely to be drawn from a wide variety of backgrounds; entrance qualification is life experience and maturity rather than any particular academic specialism
Predominant focus on the pathology of the person	Predominant focus on personal strengths and resources

It is essential to acknowledge that none of the statements of difference in Table 1.1 represent an absolute difference between counselling and psychotherapy. In reality, the domains of counselling and psychotherapy are fragmented and complex, and embrace a multiplicity of forms of practice. It would not be hard to find examples of psychotherapy practice that correspond to characteristics attributed in Table 1.1 to counselling (and vice versa); there is a huge degree of overlap between counselling and psychotherapy. It is best to regard these differences between counselling and psychotherapy as indicative of a direction of travel that is occurring within the therapy professions, rather than as constituting any kind of fixed map of what is happening now. Nevertheless, a conception of counselling as a distinctive contextually oriented, strengths-based and pragmatic form of practice reflects a trajectory that is clearly visible within the international counselling community. This book seeks to acknowledge the substantial similarities and overlap between counselling and psychotherapy, while at the same time reinforcing the distinctive nature of counselling.

Where Can I Find a Counsellor?

There are several occupational titles that refer to people who are practising counselling. A term that is sometimes used is counselling psychologist. This refers to a counsellor who has initial training in psychology, and whose work is specifically informed by psychological methods and models. There are also several labels that refer to counsellors who work with particular client groups: for example, mental health counsellor, marriage/couple counsellor, bereavement counsellor or student counsellor. These practitioners possess specialist training and expertise in their particular field in addition to general counselling training. There are also many instances where counselling is offered in the context of a relationship that is primarily focused on other, non-counselling concerns. For example, a student may use a teacher as a person with whom it is safe to share worries and anxieties.

A community nurse may visit a home to give medical care to a patient who is terminally ill, but finds herself also providing emotional support. In these situations it seems appropriate to describe what is happening as embedded counselling (McLeod and McLeod, 2011). Embedded counselling is, or can be, an aspect of a wide range of professional roles: clergy, teaching, health, social work and community work, legal and justice work, personnel, human resources and management, and much else. Embedded counselling also takes place in a variety of peer self-help networks, such as Alcoholics Anonymous and Weightwatchers. In recent years, some counsellors have started to describe their work as life coaching or executive coaching. Coaching is an activity that draws on much of the skill and knowledge of counselling, but is focused on the promotion of positive effectiveness and achievement, rather than on the amelioration of problems. Finally, there is a large degree of overlap between the use of the terms ‘counselling’ and ‘psychotherapy’, as discussed in the preceding section of this chapter.

There also exists a wide diversity in counselling practice, with counselling being delivered through one-to-one contact, in groups, with couples and families, over the telephone and Internet, and through written materials such as books and self-help manuals. Counselling is practised in a range of different settings, and offered to a wide array of client groups.

This diversity of theory and practice can be attributed to the fact that counselling emerged and grew during the twentieth century in response to a mix of cultural, economic and social forces. In essence, because it is targeted at individuals and small groups, and focuses on the personal needs of each client, counselling represents a highly flexible means of responding to societal problems. For example, many counselling agencies are funded by, or attached to, organizations that have a primary task of providing medical and health care. These range from mental health/psychiatric settings, which typically deal with highly disturbed or damaged clients, through to counselling available in primary care settings, such as GP surgeries, and from community nurses. There has also been a growth in specialist counselling directed towards people with particular medical conditions such as AIDS, cancer and various genetic disorders. Counselling has also played an important role in many centres and clinics offering alternative or complementary health approaches. One of the primary cultural locations for counselling and psychotherapy can therefore be seen to be alongside medicine. Even when counsellors and counselling agencies work independently of medical organizations, they will frequently establish some form of liaison with medical and psychiatric services, to enable referral of clients who may require medical or nursing care. These areas of counselling practice reflect the increasing medicalization of social life (Turner 1995), and the pressure to create a space for personal contact and relationship within technologically driven health care.

Counselling also has a place in the world of work. A variety of counselling agencies exist for the purpose of helping people through difficulties, dilemmas or anxieties concerning their work role. These agencies include vocational guidance, student counselling services and employee assistance programmes or workplace counselling provided by large organizations in industry and the public sector. Whether the work role is that of executive, postal worker or college student, counsellors are able to offer help with stress and anxiety arising from the work, coping with change and making career decisions.

A number of counselling agencies have evolved to meet the needs of people who experience traumatic or sudden interruptions to their life development and social roles.

Prominent among these are agencies and organizations offering counselling in such areas as marital breakdown, rape and bereavement. The work of the counsellor in these agencies can very clearly be seen as rising from social problems. For example, changing social perceptions of marriage, redefinitions of male and female roles, new patterns of marriage and family life, and legislation making divorce more available represent major social and cultural changes of the past century. Counselling provides a way of helping individuals to negotiate this changing social landscape.

A further field of counselling activity lies in the area of addictions. There exists a range of counselling approaches developed to help people with problems related to drug and alcohol abuse, food addiction and smoking cessation. The social role of the counsellor can be seen particularly clearly in this type of work. In some areas of addiction counselling, such as with hard drug users, counsellors operate alongside a set of powerful legal constraints and moral judgements. The possession and use of heroin, for example, is seen by most people as morally wrong, and has been made a criminal offence. The counsellor working with a heroin addict, therefore is not merely exploring ways of living more satisfyingly and resourcefully, but is mediating between competing social definitions of what an acceptable 'way of living' entails. In other fields of addiction counselling, such as food, alcohol and cigarette abuse, the behaviour in question is heavily reinforced by advertising paid for by the slimming, drink and tobacco industries. The incidence of alcohol-and-smoking-related diseases would be more effectively reduced by tax increases than by increases in the number of counsellors, an insight that raises questions about the role of counselling in relation to other means of control of behaviour.

The significance of paying attention to the context within which counselling takes place arises from an appreciation that counselling is not merely a process of individual learning. It is also a social activity that has a social meaning. Often, people turn to counselling at a point of transition, such as the transition from child to adult, married to divorced, addict to straight, or when they are struggling to adapt to social institutions. Within these contexts, counsellors are rarely managers or executives who hold power in colleges, businesses or communities. Counsellors, instead, have a more 'liminal' role, being employed at the edge of these institutions to deal with those in danger of falling off or falling out.

Conclusions

The aim of this chapter has been to provide an image of the complex mosaic of contemporary counselling practice. From the point of view of the user or client, counselling can be understood as a relationship and a conversational space that enables problems in living to be explored and resolved. Counselling is a flexible form of helping, that respects diversity and strives to understand problems from the point of view of the client, rather than trying to fit the client to a pre-existing diagnostic system. At its best, counselling is a frontline, community-based service that is readily accessible to people who need it. As a result, counselling is available in a wide range of community settings. The implications of this image of counselling, and the ways in which it has been interpreted and articulated by practitioners and organizations, are explored in the following chapters.

The history of psychotherapy has been much more fully documented than the history of counselling. Counselling, as a distinct profession came of age only in the 1940s. One of the public markers of the emergence of counselling at that time was that Carl Rogers, in the face of opposition from the medical profession to the idea that anyone without medical training could call himself a ‘psychotherapist’, began to use the term ‘counselling and psychotherapy’ to describe his approach (Rogers, 1942). Although in many respects counselling, both then and now, can be seen as an extension of psychotherapy, a parallel activity or even a means of ‘marketing’ psychotherapy to a new groups of consumers, there are also at least two important historical strands that differentiate counselling from psychotherapy: involvement in the educational system and the role of the voluntary sector. The American Personnel and Guidance Association, which was later to become the American Counselling Association was formed in 1952, through the merger of a number of vocational guidance professional groups that were already well established by that time. The membership of American Personnel and Guidance Association consisted of counsellors who worked in schools, colleges, and career advisory services. In Britain, the Standing Council for the Advancement of Counselling, which was later to become the British Association for Counselling was inaugurated in 1971, by a network of people who were primarily based in social services, social work and the voluntary sector.

The precursors to the formation of these organizations can be understood in terms of a sense of crisis within society, or ‘moral panic’, around various areas of social life. In effect, what happened was that there was a sense of unease around some aspect of the breakdown of social order, or the identification of groups of individuals who were being unfairly treated in some way. These crises were characterized by widespread publicity about the problem, debate in newspapers and magazines, and efforts to bring about political or legislative change. At some point in this process, someone would have the idea that the best means of helping was to treat each person needing assistance as an individual, and that the most effective way to proceed was to sit down with that individual, discuss the matter, and find the best way forward for that person in terms of his or her unique needs and circumstances. The idea of ‘counselling’ appears to have emerged more or less simultaneously, in many different fields of social action, in this manner.

Probably the first recorded example of this kind of ‘invention of counselling’ was in the work of American social reformer Frank Parsons (1854-1908). In his earlier years, Parsons had been employed as an engineer, lawyer and writer, before turning to lecturing at Boston University. He was well known, internationally, for his writing and lecturing that argued against the uncontrolled capitalism of the time, and proposed that it should be replaced by a philosophy of mutualism – ‘the replacement of competition by cooperation, and lust for money by concern for humanity’ (Gummere, 1988: 403). He campaigned for votes for women, and public ownership of key industries. In the final years of his life, Parsons came to be particularly interested in the issue of helping young people to be matched with jobs that were right for them. He established a ‘Vocation Bureau’ in an immigrant district of Boston, where young people were interviewed and assessed, provided with information about possible career choices, and provided with opportunities to explore their feelings around the work they would like to do. The philosophy of the Bureau was clearly grounded in what we now consider to be a counselling approach: ‘no person shall decide for another what occupation he should choose, but it is possible to help him to approach the problem that he shall come to a wise conclusion for himself’ (Parsons, 1909: 4). The Vocation Bureau operated as an example and catalyst for the expansion of counselling provision in schools and vocational guidance services, throughout the USA (O’Brien 2001). Counselling of various kinds came to be offered within the school and college systems in the 1920s and 1930s, as career guidance and also as a service for young people who were having difficulties adjusting to the demands of school or college life. Psychological testing and assessment was bound up with these activities, but there was always an element of discussion or interpretation of the student’s problems or test results (Whiteley 1984).

In Britain, counselling had strong roots in the voluntary sector. For example, the largest single counselling agency in Britain, the National Marriage Guidance Council (now RELATE), dates back to 1938, when a clergyman, Dr Herbert Gray, mobilized the efforts of people who were concerned about the threat to marriage caused by modern life (Tyndall 1985). The additional threat to married life introduced by World War II led to the formal establishment of the Marriage Guidance Council in 1942. A comprehensive historical analysis of the growth of the National Marriage Guidance Council, in response to societal and governmental alarm about divorce rates and marital breakdown, has been published by Lewis et al. (1992). Since that time, many other groups of volunteers have set up counselling services as a response to perceived social breakdown and crisis in areas such as rape, bereavement, gay and lesbian issues and child abuse. As with the National Marriage Guidance Council, many of these initiatives were led by Church groups. For example, in Scotland, many counselling agencies owe their existence to the pioneering work of the Board of Social Responsibility of the Church of Scotland.

A further early example of the use of a counselling approach in response to a social problem can be found in the employee counselling scheme introduced in 1936 in the Hawthorne plant of the Western Electric manufacturing company (Dickson 1945; Dickson and Roethlisberger 1966; Levinson 1956; Wilensky and Wilensky 1951). In this project, counsellors were available to employees on the shop floor, to talk about any issues (both work based and personal) that might be affecting their capacity to do their job. The rationale for the provision of counselling was that the management of the company acknowledged the pressures of working on a production line, and sought to maintain workforce well-being both as a welfare response, and also as a means of maximizing productivity and reducing staff turnover. The acceptability and popularity of this service on the part of workers, was documented in an evaluation of the scheme by Dickson and Roethlisberger (1966), which found that over a three-month period, 36 per cent of the workforce made use of counselling, with 10 per cent of those who used it reporting that it had been very helpful.

These examples of critical moments in the emergence of counselling illustrate the existence of a distinct historical tradition, which has primarily arisen from a social action perspective rather than an individual pathology orientation. Although there has been much mutual interaction and influence across counselling-psychotherapy professional communities, from a historical vantage point it is possible to see that they are each culturally positioned in somewhat different territories.

From these beginnings, counselling expanded rapidly in the latter half of the twentieth century, in terms of the membership of counselling professional bodies, the range, scope and number of counselling agencies and the ease of public access to counselling. There would appear to be a number of factors responsible for this growth:

• The success of the earliest counselling services, in the areas of education, marital and bereavement work, inspired groups of people to develop counselling services for a wide array of other social issues, such as suicide prevention, domestic abuse, sexual violence, drug and alcohol abuse, disability and affirmation of sexual orientation.
• We live in a fragmented society, in which there are many people who lack emotional and social support systems that might assist them in coping with stressful problems in living – counselling fulfils a vital role in society, as a means of assisting individuals to effectively negotiate transition points in their lives.
• Counselling agencies are generally located within the communities of those whom they serve and are networked with other caring organizations – members of the public usually know about the counselling that is available in their community, and do not feel stigmatized in making use of it.
• Counselling regularly receives publicity in the media, most of which is positive. The media image of counselling is low-key and reassuring, in contrast to, for example, the cartoon representation of the psychoanalyst.
• The legitimacy of counselling has never relied on research evidence or government policy initiatives, but instead is based on word of mouth recommendation from users.
• Caring and ‘people’ professions, such as nursing, medicine, teaching and social work, which had previously performed a quasi-counselling role, were financially and managerially squeezed during the 1970s and 1980s. Members of these professions no longer have time to listen to their clients. Many of them have sought training as counsellors and have created specialist counselling roles within their organizations, as a way of preserving the quality of contact with clients.
• Many thousands of people who work in caring professions have received training in counselling skills, as part of their basic professional education, and use these skills within an ‘embedded counselling’ role. There are also a large number of part-time volunteer counsellors, who combine some counselling work alongside other occupational and family responsibilities. All this creates an enormous reservoir of awareness within society of counselling methods (such as empathic listening) and values (such as non-judgemental acceptance).
• There is an entrepreneurial spirit in many counsellors, who will actively sell their services to new groups of consumers. For example, any human resource or occupational health director of a large company will have a filing cabinet full of brochures from counsellors and counselling agencies eager to provide employee counselling services.
• Counselling is a highly diverse activity which is delivered in a broad range of contexts (voluntary / not-for-profit, statutory, private practice, social care, health, education); this diversity has allowed counselling to continue to expand at times when funding pressures might have resulted in cuts in provision to any one sector.

The emergence of counselling needs to be understood in relation to the parallel growth of psychotherapy. There have been many practitioners, from Carl Rogers onwards who have spanned the counselling-psychotherapy divide. The majority of counselling agencies drew heavily on ideas from psychotherapy, to shape their training, supervision and practice policies. In the UK, and other countries, there are organizations, such as the British Association for Counselling and Psychotherapy, that seek to emphasize the convergence of the two professional traditions and communities. Nevertheless, counselling has retained its own identity as a distinctive practice with its own history.