This is a question therapists of all affiliations will have had to address multiple times: What even is counselling? Whilst our professional curiosity may invite reflections as to why this matters to one particular client and not to another, it seems to me a fair question and a valid part of helping to engage a client and agreeing the parameters of the work to be undertaken.
Considering the many different ways of practising psychotherapy, this is not always a straightforward question to answer. Metaphors often come to mind to help provide a sense of what this creative and collaborative process entails. A ‘journey of exploration’ is one such metaphor that one Cogwheel counsellor offered. One might wonder about the paths chosen so far, the views taken in and the angle from which these are taken in. One might wonder about the forks in the road that have been presented so far and will present after counselling ends and how to create a map for the future to aid choices from a place of awareness. One might even ponder as to the contents of the backpack carried on this journey: does everything that we carry along with us need to be retained? Are there things that clients may benefit from letting go of?
The relationship created between the counsellor and the client is known to be critical to effective therapy and achieving desirable and desired outcomes. The quality of the collaborative alliance that is formed with a client, the level of trust, empathy, sensitivity, challenge even, all contribute to an overall goal of a psychologically healthier life which one form of therapy describes as ‘a life worth living’. Counselling can be a difficult and uncomfortable process at times; clients do sometimes report feeling worse before they feel better. Bringing to mind past hurts and feeling painful feelings or examining difficult thoughts is not easy. When it can be done in a safe and boundaried space with a compassionate and well-trained fellow traveller attuned to how far out of a client’s comfort zone is manageable at a particular time in therapy, it can be life changing. Regular feedback on how the therapy is going is a crucial part of keeping on track.
There are many ways of practising therapy. There can be an educative element: how does our mind work, what is anxiety, how do we respond when under threat? Past experiences may be explored to understand repeating patterns. There may be a focus on skill building, for example, seeking to enhance emotion regulation or distress tolerance. Working with our beliefs (such as ‘I am bad’), thoughts (for instance ‘they don’t like me’) and the rules we put in place to avoid needling painful feelings (‘I must always put others first’ for instance) may help to understand the impact of our thinking on our perception of a situation. Thoughts can be challenged by looking at what may justify them and what disproves them to reframe them into thoughts that are fundamentally more helpful and accurate. This in turn tends to lower the intensity of unwanted emotions. Often, different ways of working are combined to respond to each individual client’s needs in a multi-dimensional and personalised manner. The guiding principles may vary and include elements such as compassion, working with values or acceptance of life as it is and yet commitment to make some life-enhancing changes.
In the room, some counsellors may take notes to hold on to the specifics of an image the client brought up, a phrase or the details of a pivotal event, others won’t. Some will provide handouts or resources to work on in session or in between sessions. You may be invited to make a small change, observe and report back on its impact (or lack of it) or even be invited to design an ‘experiment’ to try out outside of therapy and evaluate the following week.
Fundamentally, the therapeutic work is primarily based on conversation but is much more than a chat. It should be rooted in what is causing and maintaining distress from the client’s point of view. It should be focussed on working towards establishing what might help alleviate this distress in a way that aligns with what matters to each individual client and cultivating change so it can be firmly established and can perdure well beyond active therapy.
