To have concerns about counselling

[navymack]

This isn’t about individuals who I am sure mean well and genuinely want to help. But AIBU to worry that some of the treatments offered, at great personal expenditure, are ineffective or even counter productive in some cases?

The costs are really concerning to me - it seems that a lot of money goes into this with universities offering degrees in counselling and individuals charging anything between £30 and £70 per hour.

I have seen over the years people raise concerns about inappropriate things counsellors say to them, and the fact that it isn’t recommended for those in abusive relationships makes me wonder if in fact it is the solve-all it is often presented as being?

I know that individuals will state counselling was helpful to them, but what specifically is so helpful? Is it just having time and impartiality?

I do think there needs to be more honesty about it, even if that is just ‘I can refer you to counselling, give it a try, it may not work.’ Not ‘get counselling’ with the inference that it will work

There’s evidence to suggest that when a doctor prescribes a medicine or gives advice in a confident ‘this will work’ tone, the medication is actually more likely to work for the patient! Even if it’s not 100% effective every time (nothing is). So it makes sense not to already dissuade someone who might be wary of the stigma of mental health treatment from the start by saying ‘i’ll refer you to this but it might not work’

But I would expect a counsellor to be honest about the potential efficacy of treatment.

I would expect honesty, full stop.

Sonota,is the inference that a counsellor’s effectiveness just can’t be measured in any way?

No, I am asking you how you would suggest it's done?

Side stepping the question isn't helping your point.

I have never heard a counsellor/ go or anyone say counselling is 100% effective or works for everything.

If someone comes onto MN with deep issues, of course counselling is going to be suggested.

In all honesty, I have had it. I didn't find it helpful. But I can see why some would. I may try again and find someone else. See if I can find a better fit. I don't think the counsellor was bad, nor did she promise to fix all my problems. It's just want for me. I am glad I tried.

The thing is that gps are not experts, they refer people to counselling because that's the protocol for depression but they won't know which type of therapy will be most helpful to that person. For a long time cbt was the "cure all" - some people found it amazing but for others it was useless or even made them feel worse. Counselling is all about the relationship between the client and therapist, in life you don't click with everyone you meet so for some people one particular counsellor will be no help at all while another will be amazing.

It is true that there is no legal requirement for regulation but there are 2 regulatory bodies - bacp and ukcp and it is very easy to check if a counsellor is accredited by one or both of those. If you go to see someone and they are acting unprofessionally you can report them to their regulatory body and they will fully investigate and take action. I do agree that there are times when counselling is not appropriate and antidepressants are what you need instead but please don't write off the entire concept of counselling because of it!

pinkunicorn20 I’m not a counsellor :)

Clients are only recorded with their permission, given a consent form to sign and can retract their consent at any time.

I’m not sure what you mean re what’s taken into supervision being confidential? Counsellors take details of their clients issues to supervision. Some counsellors for accreditation need to take a certain number of recordings each year, or if they’re training in a new modality. Usually for the supervisor to watch and give guidance and then the tape is destroyed.

I believe BABCP are a body that accredits counsellors, though like I say it’s not a requirement legally, anyone can say they’re a counsellor, it’s just good sense if going private to choose someone who is professionally accredited.

A counsellor will never record you without your explicit consent though, and it’s quite rare cos they see so many people annually and only have to submit a small number of recordings.

I’ve consented in the past, it’s in my interests as having close supervision (recordings or a supervisor sitting in) really helps their development.

My last counsellor was undertaking additional training in counselling for depression so had to take a set number of recordings to her supervisor. They were just audio but sometimes it’ll be a video recording instead. Supervisor is for the benefit of the counsellor and the client, to get a second pair of eyes and thoughts on how things are going and can be done better, ultimately to benefit the patient.

Nota

A start would be ‘are you feeling better’, surely?

What does concern me is that if someone is in a state of distress or confusion counselling is recommended

So what would you do with someone who is in a state of distress or confusion? Go straight to filling them full of medications which can damage them for life? (And before I get told off for hyperbole my son HAS been permanently damaged by psychiatric medications).

In my world medication should be a last resort and talking therapy (or in my son’s case PBS & excellent social care) should be used first.

Thanks lollypops, helpful to know that.

I think there is a difference between seeing counselling offered or suggested and seeing counselling being pushed as the ‘solve all’ solution. I have seems lots of the first, none of the second.
I agree that there needs to be more regulation and transparency so that people are aware of who they are seeing, what qualifications they have and how (whether!) the professional is regulated.
There is lots of literature of the effectiveness of various types of therapy for various ‘problems’, however this is tricky for lots of reasons. Transparency would at least help people to make an informed choice about whether the costs of therapy are worth a try for them.

Ok, so my experience...

I’ve just finished about a year of weekly counselling sessions which I paid £25 a week for with a wonderful counsellor. I can’t speak highly enough of her and I will go into more details in a minute.

Many years ago, I had a relative die...she was effectively euthanised against her and the family’s will and it was something she was never asked consent for. She was basically put into a coma and pumped full of morphine and other drugs that were dangerous in high doses because she was old and costing the NHS a lot of money. She wasn’t dying but she was dead in a few days after she was starved of food and water and pumped full of drugs she didn’t need. We believed she was being treated for a mild chest infection by community nurses who came into our home and set up a syringe driver telling us “these drugs will help her breathing”. I was very young at the time and was left feeling like I stood by and watched whilst she was killed. It was also the first significant death in my life and I’d been there with the body and at the moment of death etc. I was offered counselling for complex grief at my local hospice and attended two sessions.

The first counsellor I saw was a supervisor, very experienced and great. I felt listened too and like she understood. She explained she just assessed clients and then passed me on to another person for my second session. This person was a student and came across as being very self obsessed. Looks shouldn’t matter but her image was quite overpowering, she was very Katie Price with lots of jewellery that jangled loudly, fake tan and lashes and very overdressed and a loud, in your face personality to match. I was sat there broken, very depressed, in my twenties but feeling ancient and so far away from this person. She was an awful listener and came across as so fake! When I was speaking she was just waiting her turn to talk and saying things in a fake, sing song voice, full of her own self importance,

“OH MY GAWWWWWD SHAAAAAADDDYYYY. You. Must. Feel. Like a MURDERER. I’m hearing that...like YOU murdered your RELATIVE. And you are coming across as absolutely DISTRAUGHT and HYSTERICAL!”

I was quiet, barely speaking and basically just very sad, not hysterical or distraught. I also hadn’t felt like a murderer until she said that and it took me a long time afterwards to understand that I had put my trust in the NHS and it was the GP and Nurses that had failed my relative and our family. I felt she was putting all the blame on me and like she wasn’t hearing me at all. I never went back.

I also had another therapist at the hospice who was supposed to be helping me using homeopathy with not sleeping and feeling anxious following my relative’s death. I saw her once for about 20 minutes. Bearing in mind this was before the funeral, about a week after the death, she told me “You are very physically attractive but you send out such a negative vibe through constantly feeling sorry for yourself, I could understand that no one would want to be around you and you won’t have any friends. You’ve got a very negative personality. You should smile. It’s physically impossible to smile and feel negative emotions. Smile now and show me. Walk around with a smile on your face and you’ll feel better and you won’t be so offputting to people.”

I had friends but she made me feel like I was an awful person who didn’t deserve friendships. It was just terrible but I was in such a rotten place and she was a professional so I just accepted what she said as the truth. Looking back now, I wished I’d made a formal complaint but I thought that would have just been proof that I was a negative person!

With the situation with my counsellor that was wonderful, my experiences with these two women at the hospice and free counselling/therapy, I decided even though I couldn’t afford it easily to pay for counselling and choose the person I really wanted.

I’d done many years of work on myself but was stuck. I’d experienced a lot of abuse and neglect as a child and was stuck in life and unable to look after my needs properly. Self hatred was holding me back in every area of my life and I wasnt able to express or even feel certain emotions. I felt dead inside and like I had no future.

Far from her website offering solutions to every problem, she was very specific about what she could help with. I saw she had LOADS of experience, didn’t just use one approach and seemed to have a lot of tools to use. She was BACP registered and registered with a religious body of counsellors and as I was raised in that religion, I knew she would understand my mindset.
Another relative had seen an atheist counsellor who encouraged her to do things that were against her religion and to ditch her religion, which was one of the only positive things she had in her life. It had been really traumatising for her and when she eventually went back to her religion (because she needed it to make sense of her life) she felt so much internalised guilt and shame. I didn’t want to go down that route!

My counsellor, I feel, was meant to be in my life. She modelled to me how I should have been raised, with self esteem, nurturing and love. She showed me how to care for myself and love myself properly. She was a good mother figure but very careful and respectful of boundaries and utterly, utterly professional. She made it safe for me to say, or not say, whatever I wanted. She really listened properly. She made it clear it was me that was putting the work in and doing the hard stuff, she was just encouraging it. She sought my consent over everything and asked often if there was anything I was unhappy with in her approach and if she could do anything differently.

My life has changed because of this counselling. My living circumstances, career and relationships have changed for the better. Things are possible now that never were because I have developed a healthier sense of self and of others, better listening and thinking skills and my core beliefs have changed for the better.

I’ve often heard people say counselling doesn’t work. I’d say counselling doesn’t always work for a variety of reasons but often, it can and does. It should be regulated better than it is for sure but counsellors, good counsellors, are desperately needed and counselling and therapy certainly have their place in society.

I actually agree with you OP in questioning it

I have extensively managed counsellors from an operational point of view and worked heavily with them and some of the work I have seen has at best been guessing and with an agenda

My experience is a truly good counsellor will be able to evidence and monitor outcomes. The ones who claim you can't do that are famously bad on most of the acute industries like mental health , ED and substance misuse

It's also very different in regards to specialities

I've run services that a generic mood related counsellor would not get hours because SM is very specific and needs extra training to do it properly. I cannot count the amount of counsellors that claim this is not the case but in fact they get quietly dropped by the ops managers.

I think human fallibility is part of any kind of work but I struggle with close minded counsellors because that is endemically at odds with what their job requires.

In terms of price point I tend to agree.

I know many who work out of home and charge extensively because it's industry standard and they would be viewed as inferior rather than feeling that it's a fair price. Which is fair enough but hard for the clients

I would also clarify a full counselling degree is the minimum required for any real statutory industry recognition ( and even then in a good delivery system you would be considered junior) so for me it's more about those who do one initial access course and then claim to others they are a trainee counsellor...no they aren't

I fully advise people to truly research and ask about their evidential basis for their choice of model. A good counsellor will absolutely be able to tell you....a bad one will claim they shouldn't have to justify it and mere mortals wouldn't understand.

I currently work with a degree and masters educated counsellor who is amazing and in a heartbeat can evidence her response at the drop of a hat.

It's not that counselling is not recommended in abusive relationships. Couples counselling isn't. Individual counselling would be.

I didn't read the thread with all of the responses.

However, I agree with a lot of the OP's posts. The money side concerns me only in terms of accessibility. The prices charged are reasonable for one-on-one time with a skilled as qualified professional. However this does good quality talking therapy out if the reach of some of the patient/client groups who could benefit.

The problems I understand include a lack of protected titles and lack of regulation. Anyone can call themselves a counsellor or psychotherapist regardless their training, qualifications or experience. Whilst there are many qualified people seeing clients, there are also self-trained unlicensed people advertising their services, as well as beginners who claim they are competent to treat a range of complex conditions when really they are too early in their careers to have much experience in all areas.

The professional bodies for councelling and psychotherapy are some markers of quality but are not statuatory bodies. If the client is harmed by the therapy process, unless the therapist has committed one of a fairly narrow range of offences (like having sex with a client, or taking advantage of them financially) there is no resource to complain that has much meaning in my opinion. There is no way to demand redress for hurt feelings, crap advice or wasted money for example.

Some therapists are worried about this and would prefer better oversight. Others feel that different types of therapy are so diverse and that regulation would stifle their freedom to work in their preferred style. It's really complicated.

I only know all this through having been a therapy client with many different practitioners and having had some therapy go well and others go astonishing badly. I also talk to my therapists about this specifically because it concerns me so much.

Choosing a therapist - "Therapist shopping" as I call it - is really really challenging and I hate the fact that in many situations the client has to do this when they are already feeling overwhelmed by their own emotions.

All of this is more to do with private practise, psychotherapy on the NHS brings with it a different set of challenges.

@navymack the aggression in the responses might be because this is AIBU? If you posted in Mental Health the responses might be different. Posters you have never had a harmful therapy experience and have only had straightforward interactions with professionals who helped them might find it hard to relate to your question.

The comparison to physiotherapy is not necessarily helpful. Physiotherapist is a protected title. Psychotherapist is not. In my opinion the evidence behind many physiotherapy interventions is questionable too but that would be to derail the thread a bit I feel.

She was BACP registered and registered with a religious body of counsellors
Could I ask which religious body of counsellors it is? I'm guessing (possibly wrongly) that it's a less-mainstream religion but maybe not. (I may google religious bodies & counselling anyway)

I think it's absolutely right to question these things. People go to counsellors when they feel vulnerable and are struggling to cope with different issues in their life so it needs to be considered if counselling is right or not.

I think the issue with 'try harder' can be that in some circumstances some people expect a handful of 50-minute sessions to magically transform their problem(s) into 'solved.' But they aren't willing to make any changes to their lives. What's the point in forking out for therapy in that case?

In other cases, counselling might just make everything worse - especially if the counsellor is a bad one or not a good fit.

It's just such a wide variety of circumstances people and therapists and so complex that you can argue for all these points - for some it's a life saver and helps enormously. For others they don't go in good faith and aren't willing to actually address any issues in their lives and expect just sitting in a room with a counsellor to solve it all, then say it doesn't work when predictably nothing in their life changes.

For still more people they might get a shit therapist who turns a vulnerability back into an open wound with no actual healing happening.

It is hard to qualify because each person is unique, as are their situation. Two people might react very differently to the same kinds of therapy.

No, I would devilish

I’m not sure which of my posts lead you to think I am in favour of shoving medication down people. Sorry if I sound cross but it’s infuriating when you as a poster are talking about one thing and someone else makes a massive leap, infers things you did NOT say and then turns it around to make you sound unpleasant.

I am sorry about your DS. I am familiar with your ‘story’ as it were. And I have always been in full support of you but this is not what I’m talking about here.

I’m pleased the counselling worked for you shady and sorry about your bad experiences.

My point really isn’t the massively contentious one people believe it to be. It is simply that I think people struggling or suffering are not always best placed to be ‘cured’ with counselling.

i wouldn’t devilish*

Another thing which is problematic is that healing from terrible therapy takes yet more therapy. Is there a global psychotherapist conspiracy keeping us damaged individuals enslaved to it forever?

(I am being provocative on this point although it also comes up in I think it's Adam Philips' writing, that the goal of psychoanalysis is to cure the patient of psychoanalysis.)

It’s a mainstream religion Range.

Cheers Shady - I'll google then.

I don’t think there’s a conspiracy as such.

I mentioned pyramid schemes before and I do think that they are comparable. There are people who have had their lives changed by buying into Younique, Forever living and so on at the right time. I do honestly think some of them believe that anyone can do it. And the fact that it benefits them financially helps, too!

Counselling is a bit like this - only a bit. It presumably helped the counsellor so they are often eager to go into it and the desire to help is very genuine but of course it’s a job, people have to pay bills. So when they see posts on a forum like this questioning its worth its read as provocative, when it isn’t.

And that’s where the ‘it worked for me’ comes in - it did work for them, and if it isn’t working for somebody then the assumption is it is the ‘fault’ of the individual. I have seen

You didn’t work hard enough
You didn’t want to get well (sometimes phrased a little more gently - you weren’t ready, something was holding you back are variants of you didn’t want to get well.
The counsellor wasn’t the right one for you.

I think hearing these things when someone is already vulnerable can be distressing in the extreme. If it was me, I would feel very bewildered and confused - what was I doing ‘wrong’?

There are pretty complex MH conditions out there and some of them can’t be cured. Therapy might help people manage some of the conditions of course but it might not and it’s a bit shit to effectively hold counselling as such a gold plated ‘cure’ that if it doesn’t work it is never, ever, it’s fault.

I have a big issue with the concept that counselling ‘works’ or ‘doesn’t work’. It’s not measurable in the way that, say antibiotics for a tooth infection might be.

It’s work. It’s about the correct chemistry and of course it’s about the therapist themselves. However, nobody is ever going to be 100% fixed and perfect from any emotional trauma. It’s part of your history and fabric. For me though, with a real willingness to engage and a strong motivation to overcome PTSD I did make amazing progress.

EMDR really helped me turn a corner but it would never have done so without a strong therapeutic relationship in the first place and an open airing of my issues. I have now discharged myself but would be massively open to returning.

Counselling isn’t the panacea for all emotional ills, particularly if the client isn’t looking at doing the hard work. I’ve seen several and all have been excellent. Personally I got more from a highly trained counsellor than a doctor of phsychology but that may be down to me and the situation at that point.

Lastly I enjoyed the process and the ‘feeling heard’ aspect of it. If nothing else it’s a great way to explore oneself and reactions to other people.