Counselling: Outcome, Issues, Trends, and Ethics

1. Counselling Outcome, Issues, Trends and Professional Ethics Dr. Geoffrey Wango Counselling Psychology University of Nairobi

2. Counselling Counselling is a process in which the counsellor (therapist) attempts to understand and helps to clarify those issues and feelings in a client that impede growth, maturation and general well-being. The specific goals of counselling are: • To help the client access a greater part of their personal resources. (This is the means of enabling them regain their [lost] energy and get back on track); • To enable or help the individual to live more competently and/or with contentment; and, • To improve mental health and reduce psychological disturbance. In effect, counselling enables or helps the individual to live a fuller, satisfying life. Counselling, therefore, should lead to a meaningful positive change and to a better life. Counselling Outcome, Issues, Trends and Professional Ethics

3. Expected Learning Outcomes Therapy has an expected, appropriate outcome. Therefore, practitioners must possess professional competence, adhere to counselling ethics and be reflective in practice. This requires proficiency in therapeutic approaches, skills and techniques. By the end of the counselling course, you should be able to: Define and explain the various terms and concepts that are used in counselling. Explain the counselling process. Adopt use of professional principles in counselling. Assist a client in therapy. Monitor and evaluate the outcome of counselling. Interpret professional standards in the practice of counselling psychology by adhering to a code of ethics. Counselling Outcome, Issues, Trends and Professional Ethics

4. Rationale Counselling and psychotherapy are widely practiced in the world and it is hoped that they are effective in assisting people resolve life crises. Various populations, including children, adolescents, adults, and elders seek counselling as individuals, couples, groups or families. Persons who receive counselling and psychotherapy are expected to achieve much better outcomes than they would have had had they not received therapy. Clinical trials reveal that therapy is effective in assisting clients with several life challenges, including in treating various destabilizing conditions such as stress, fear and anxiety, depression, as well as other crises such as marital issues (marital dissatisfaction, effects of divorce/separation), drug and substance abuse, etc. In addition, various health issues can be resolved through therapy. They include eating disorders, releaving pain, sexual dysfunction and depression. Counselling Outcome, Issues, Trends and Professional Ethics

5. Conceptualization of Counselling • Research spanning over the tears has seen an evolution in the conceptualisation of counselling psychological services, from Philosophy to Psychology involving knowledge and research in behaviour and mental processes to a conceptualisation that acknowledges the complexity of the human experience and behaviour as a process that encompasses developmental, personality and social determinants in individual and social (community) decisions and conduct. • Counselling and psychotherapy as helping processes captures the complexity of the human experience as involving thinking, emotion, attention, and concentration. Therapy as a process seeks various processes that can help an individual maintain and effectively perform with relative moderation in various conditions; a systematic process involving the individual’s ability to moderate self and personality in line with his/her reference values, goals and community behavioural standards. Counselling Outcome, Issues, Trends and Professional Ethics

6. The Cultural Context of Counselling • Counsellor competence includes improved knowledge and awareness of social cultural background of the client. This is not entirely new as practitioners often find it useful to validate the world of the client through an exploration and understanding of the context of the problem. However, the major theoretical frameworks developed largely in Western (European) culture tend to have more focus on the individual rather than family and community. Yet, in the more traditional societies person may not achieve such independence. • Practitioners have to apply counselling in the cultural context of the individual and community. This requires sensitivity in the application of counselling psychology as well as cultural perspective in understanding the client. The cultural characteristics are pivotal in building alliance with the client. In the end, it also influences the counselling outcome. Counselling Outcome, Issues, Trends and Professional Ethics

7. Management of Mental Health and Psychological Disturbance in the more Traditional-cum-Contemporary Societies • Mental health and psychological disturbance are debilitating illnesses that affect a large part of the population including in the developing countries. Thus, the more traditional societies cannot claim to be advantaged over the more developed countries. Additionally, it must be acceptable that a greater part of the population suffering from mental illness and psychological disturbance (distress leading to depression and anxiety) are at the peak of their career; they are at the height of their social, economic, political and intellectual productivity. The functional loss affects activities of daily living leading to problems in individual, family, social and career functioning. • In the more traditional societies, there is a lot of misunderstandings of psychological well-being due to a strong inclination on traditional culture and religion. Counselling Outcome, Issues, Trends and Professional Ethics

8. Management of Mental Health and Psychological Disturbance in the more Traditional-cum-Contemporary Societies • Deviations in what is regarded as general or appropriate conduct (disorderliness in behaviour, psychopathology) and psychological illness often leads to apathy, isolation and withdrawal. This is because in a majority of instances, most of the indigenous communities do not have the more philosophical or scientific explanation of mental illness and psychological disturbance that would lead to a more logical explanation leading to more rational and timely interventions such as therapy and medicine. • Instead, the more traditional societies rely on changes in functional status to signify psychological disturbance and attribute the irregular phenomenon to certain causes (curse, religion, unexplained phenomenon). This in turn leads to a large gap between psychological needs and therapy (counselling and psychotherapy as well as psychopharmacological interferences). Counselling Outcome, Issues, Trends and Professional Ethics

9. Rationale • Counselling competence includes four basic aspects as follows: • Knowledge of Counselling and Awareness of its application (Counselling Issues, Counselling Process and Trends in Counselling and Psychotherapy). • Theoretical Approaches. • Skills and Techniques. • Professional Ethics. All these are designed to ensure a positive/ desirable Counselling Outcome Counselling Outcome, Issues, Trends and Professional Ethics

10. Rationale Counselling Outcome Counselling Outcome, Issues, Trends and Professional Ethics

11. Rationale Counselling is a helping process that involves a relationship between the client (counsellee) and the counsellor. The client seeks counselling when in need: Client Counselling (assistance on issue) Counselling Process (Resolution) Counselling Outcome (end result) Counselling outcome refers to the end result of the therapeutic process. An effective counsellor provides care and support to the client. Counselling Outcome, Issues, Trends and Professional Ethics

12. Rationale The counsellor is proficient in their conduct and this is achieved through effective training; she or he is a facilitator and assists the client to achieve healing through the therapeutic process. Counselling Outcome (healing) Counsellor Counselling Competence (training) Counselling Process (facilitator) The counselling process is a planned structured dialogue between a client and a counsellor. The counsellor uses skills and techniques developed through professional competences. Together, the client and counsellor develop ways of dealing with, and resolving the issue that brought the client to therapy. Counselling Outcome, Issues, Trends and Professional Ethics

13. Rationale Counselling is a healing process Counselling Outcome Product – End Result Counselling Outcome, Issues, Trends and Professional Ethics

14. Rationale • Counselling or therapy would be expected to have an outcome or effect. The concept of an ‘effect’ is unclear since in many ways, effect implies result and therefore has the denotation of ‘healing.’ • The outcome of counselling implies several things such as the following: overcoming life challenges; resolving life issue/s; intensified mobility; improved global social functioning; and, general life satisfaction. All these conditions imply improvement in the client. • It is the anticipated improvement in the client that envisages the concept of ‘positive’, ‘effective’ or ‘progressive effect’ of psychotherapy (counselling / therapy) results. Counselling Outcome, Issues, Trends and Professional Ethics

15. Rationale + Counsellor Client Counselling is a healing process Counselling Outcome Product – End Result Counselling Outcome, Issues, Trends and Professional Ethics

16. Rationale – Counselling Outcome + Counsellor Client Counselling is a healing process Counselling Outcome Product – End Result Healing as end result Counselling Outcome, Issues, Trends and Professional Ethics

17. Understanding the Client Interaction between Client and Environment Assessment for coping competence Counselling Outcome, Issues, Trends and Professional Ethics

18. Understanding the Client • Counsellors need to understand the needs of special populations. These include: children; girls and women; persons with disability; gays, lesbians and persons in same sex relationship; transgender and gender nonconforming people; the rich and famous; alcoholics and persons involved in drug abuse; victims of abuse; and, the elderly and terminally ill clients (such as those with cancer and HIV/AIDS). • Counselling practitioners and practice often tend to leave these populations out and misunderstand them. In the more traditional societies, these persons are negatively perceived (patriarchal societies have the power and authority in males, while some of the conditions in others may be perceived as something undesired, although this is not necessarily the correct experience or belief). • Negative attitudes, beliefs, and associations extend beyond the general public, and counselling practitioners also take them in. Counselling Outcome, Issues, Trends and Professional Ethics

19. Understanding the Client • Counsellors that work with special populations and their families need to understand the unique experience and process of counselling them. Of particular importance is the awareness and consideration of terminology used to describe and refer to traditionally-marginalized groups, gender stereotypes and segregated persons such as persons with disabilities, drug addiction and sexual orientation issues. • Efforts aimed at creating understanding of unique clients and therapeutic circumstances have the potential to benefit special populations particularly children, girls and women, persons with disabilities, the counselling professional, the therapeutic relationship and the ultimate outcome of therapy. Counselling Outcome, Issues, Trends and Professional Ethics

20. Counselling Orientation: Mediating Factors between Client and Counsellor Counsellor Client Issue/s (life challenges, coping) Skills and Techniques, Methods (theory) Values, Ethics, and Feelings Values, Attitudes and Emotions Task / Goal (guided by professionalism) Insight / Solution Outcome of therapy Counselling Outcome, Issues, Trends and Professional Ethics

21. Steps in the Counselling Process 1. Receiving Client and Relationship Building. 2. Problem Assessment: History taking and exploration, Relationship building. 3. Goal Setting: Understanding and outlining of goals. 4. Counselling Interventions: Action plan and way forward. 5. Assessment and evaluation, termination / referral. Counselling Outcome, Issues, Trends and Professional Ethics

22. Counselling and the Counselling Process Action Process Initiation Contracting (goal setting) Action • Essential action points. • Further exploration. • Termination / Referral Exploration • Understanding the world of the client. • Exploring alternatives / intervention strategies. • Identifying persuasions / verifying accomplishments • Client understanding of issue / circumstances / problem situation • Effectively using counselling skills and techniques to assist client Understanding • Creating rapport • Offering core conditions World of client • (Client re-entry back into their world) History taking of the client Counselling Outcome, Issues, Trends and Professional Ethics

23. The Counselling Process: Conceptualization Client Counsellor Accreditation • Counsellor Training (Counsellor, therapist, psychotherapist) • Competencies (Knowledge, skills and techniques) • Professional ethics Counsellor awareness • Core conditions • Counselling goals • Therapeutic alliance (client- counsellor relationship) Counselling (issue, situational difficulty) Counsellor Competence • Core conditions • Counselling goals • Competence (knowledge, skills and techniques) Professionalism • Therapeutic Approaches. • Skills and Techniques. • Code of Conduct for counsellors. Counselling Process (resolution) Monitoring and Evaluation Coping strategies (adaptation, resilience and wellness) Counsellor performance • Termination • Referral Counselling Outcome (end result) Counselling Outcome, Issues, Trends and Professional Ethics

24. Counselling Skills Counselling Outcome, Issues, Trends and Professional Ethics

25. Therapeutic Approaches Counselling Outcome, Issues, Trends and Professional Ethics

26. Psychotherapeutic Orientations Counselling Outcome, Issues, Trends and Professional Ethics

27. Counselling Outcome: Evidence Based Practices Therapy and allied domains (clinical psychology, counselling, psychiatry, psychotherapy, pastoral counselling and social work) must be concerned about the outcome of treatment. This includes acceptance of the use of scientific evidence to inform clinical practice, including embracing evidence based practice (EBP). Only naïve realism can lead clinicians to conclude that client change is due to a helping intervention itself rather than to a host of competing explanations. These include: significant others; nature of the circumstances; and, the role of therapist as well as effectiveness of therapeutic approaches, skills and techniques. Psychological interventions take in the deep-seated misconceptions regarding human nature. But even then, there are misunderstandings regarding human nature and the application of various approaches to individuals and/or groups. Nonetheless, there must be evidence based practices to enable evaluate the increasingly technical nature of counselling and psychotherapy. Counselling Outcome, Issues, Trends and Professional Ethics

28. Counselling Outcome for Client • There is substantial variability in the extent to which clients benefit from psychological therapies. Typical outcome for clients receiving psychological treatment (therapy) varies systematically among practitioners and across therapeutic approaches. This is due to a variety of factors such as poverty and low income levels. • Differences exist between the more developed countries and the low income developing countries. Therapeutic approaches, training and expertise of practitioners may help to explain between-clinic differences in effectiveness. In the low income developing countries, it is important to consider the broader socioeconomic and geographic context in which therapy is offered. • All these factors will assist to improve the effectiveness of psychological interventions in various contexts. Counselling Outcome, Issues, Trends and Professional Ethics

29. Counselling Outcome for Counsellor Therapists contribute to treatment and healing. Some practitioners (therapists) consistently deliver better outcomes, while others are not as effective in counselling. This is despite the fact that several variables can be considerably controlled for clients. Scholars identify the main characteristics associated with positive outcomes such as follows: empathy, expertise (appropriate choice of therapeutic approach), number of sessions, professional ethics, treatment effectiveness, therapeutic alliance with client and professional practice. Social support, religion and spiritualism and other factors are considerably convenient. In that case, we must continuously identify significant explanatory variables and their clinic effect in order to improve on practice. Practitioners must consistently identify important interactions between the client and therapists, therapeutic approaches, skills and techniques, the content and context of therapy as well as differences between therapists. All these will require to be consistently investigated. Counselling Outcome, Issues, Trends and Professional Ethics

30. Counselling Outcome: Process – Effect and Network Approach Systems • Research in counselling and psychotherapeutic processes must track changes in clients, including in on-going treatment and as an end result. This will aid in clinical decision-making. Additionally, the purpose of counselling and psychotherapy is to assist the client in everyday living, hence the effect of a session or sessions should extend beyond the duration of the session/s. • The importance of therapy is in the therapeutic change as a result of the meaningful interaction with the practitioner. This raises pertinent issues on the following: (1) Counsellor Competence (including training, qualifications and professional ethics); (2) Theoretical orientation / approach adopted by therapist; (3) Treatment goals; and, (4) Individual client, including their issue/s and circumstances. All these must be based on four facets, that is, theory, practice, professional ethics and research. Counselling Outcome, Issues, Trends and Professional Ethics

31. Behavioural Competencies in Effective Counselling Outcomes Adherence to Socio-Cultural (tradition and religion) norms and values. Positive Mental Health and Overall Wellbeing • Physiological and psychological competencies (including social, intellectual and spiritual wellbeing). • Modernity (new world order, including culture and religious interpretations). • Self- compassion and flourishment. • Adjustment behaviours, including self and community, as well as successful adjustment to life(individual, family, work, community) • Meaning in life, including post- traumatic growth and development. Psychological Variables • Personality (often self as part of society). • Community / Traditional values and norms, beliefs and customs (culture and religion). • Community understanding of life and living. • Past and Present behavioural competencies. • Socio-cultural (societal/ traditional) philosophy. Modernization, Nationalization and Internalization. Advancement in medicine and information technology (Globalisation). Past Competencies Current Competencies Coping Competencies Counselling Outcome, Issues, Trends and Professional Ethics

32. PROFESSIONAL ETHICS Counselling Outcome, Issues, Trends and Professional Ethics

33. Guidelines on consulting and adhering to Code of Conduct • Always get acquainted with the professional Code of Ethics of your profession. • Use the most recent (revised) version. • Get acquainted with all Sections of the Code (Avoid reading selected Sections). This allows you to contextualise the Code. • Distinguish between statements on obligatory practice and recommendations (suggestions in context). • Interpret any supplementary notes or guidance provided by the Code. • Always look at each situation in context. This requires that you review each case on its own (be specific). Counselling Outcome, Issues, Trends and Professional Ethics

34. Quality of Standards in Counselling Practice • Several factors have been identified that appear significant and contribute immensely to effective counselling. • These are: • Level of skilfulness (defined as counsellor competence rather than experience). • Cognitive complexity (includes ability to comprehend a diversity of clients including the complexity of cases / issue/s and circumstances ). • Ability to relate and match with the clients with whom they are working (the relationally matching of client and counsellor). • In addition, it is essential that counsellors have the knowledge and ability to assess the presenting issue/s so they can identify the appropriate therapeutic approach. It is the effective application of evidence-based approaches that determines the competent application leading to successful intervention. Counselling Outcome, Issues, Trends and Professional Ethics

35. Quality of Standards in Counselling Practice End result Initiation Process Healing / Positive Change in Client Therapy / Counselling Client + Counsellor Monitoring and Evaluation Continuous Evaluation Appraisal Counselling Outcome, Issues, Trends and Professional Ethics

36. Quality of Standards in Counselling Practice: Counselling Outcome Representation Model End result Initiation Process Healing / Positive Change in Client Therapy / Counselling Client + Counsellor Monitoring and Evaluation Continuous Evaluation Appraisal Quality of Counselling Service Flourishing life Counsellor Competence • Counsellor training • Accreditation • Professional Ethics • Continuous Professional Development • Counsellor supervision • Professionalism • Client well-being • Coping competencies Counselling Outcome, Issues, Trends and Professional Ethics

37. Quality of Standards in Counselling Practice A prominent focus of concern among practicing therapists is assessment of therapy, especially taking into consideration the fact that quality of services has the notion of ‘positive’ or ‘effective’ results or product. Essentially, effective or positive results promulgate a rather polarizing positive-negative, effective-ineffective dichotomy. Certain results, therapists or therapeutic approaches may be labelled as positive (effective), and thus presented as inherently appropriate, desirable and/or successful. The necessary corollary, of course, is the contrasting phenomena in which certain therapists, approaches or end-results can be implicitly conceptualized as negative, ineffective and undesirable. This positioning is delicate as clients may intrinsically expect certain (desirable) results. Yet certain clients may be too highly optimistic while yet others may tend to be pessimistic. Both nuances may be a categorical impediment to wellbeing. Counselling Outcome, Issues, Trends and Professional Ethics

38. Conclusion The more traditional populations tend to use counselling, psychotherapy and mental health services only in the most extreme circumstances. In addition, medical and psychological services are lacking and/or limited. This greatly skews the statistics about persons using counselling, psychotherapy and other mental health services. Even when the helping services are (readily) available, numerous clients are either unaware of their significance or shy away altogether. In the end, a majority of clients tend to drop out of treatment within the first few sessions. Although the reason why clients do not persist with therapy may be unclear, it is possible that persons in the more traditional societies do not find reasons to persist seeking helping services. Clients may not be as motivated, perhaps because they may not comprehend therapy. Besides, they may not perceive the services as helping since they may have other sources of help such as family and religious faith. Counselling Outcome, Issues, Trends and Professional Ethics

39. Conclusion Counselling and psychotherapy is being associated with good health, and this inherently implies improved wellbeing. The quality of counselling and therapeutic services is exceedingly significant informed by the development of evidence-based clinical interventions.. Also, the importance of the quality of human interaction during therapeutic encounters has gradually become accepted A lot of therapy and care, especially in the more traditional societies, is provided informally, meaning that it may not be reflected in statistical terms. But still, helping (counselling process, use of skills and techniques and adherence to professional ethics) and the outcome of counselling (end product, including effectiveness and quality) must be beneficial to the client. The process must be monitored and evaluated and at the same time appraised. Evidence-based counselling practice is the future of both preparation of counselling and practice of professional counselling. Counselling Outcome, Issues, Trends and Professional Ethics

40. Module : Counselling Outcome, Issues, Trends and Ethics Wango, G. M.(2017). Counselling Outcome, Issues, Trends and Ethics. Nairobi: University of Nairobi. Counselling Outcome, Issues, Trends and Professional Ethics

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45. Selected References Wango, G. M. (2015). Counselling Psychology in Kenya: A Contemporary Review of the Developing World. Nairobi: Kenya Literature Bureau. Wango, G. M.(2017). Counselling Outcome, Issues, Trends and Ethics. Nairobi: University of Nairobi. Williams, D. C., & Levitt, H. M. (2007). A qualitative investigation of eminent therapist’s values within Psychotherapy: developing integrative principles for moment-to-moment psychotherapy practice. Journal of Psychotherapy Integration, 17, 159 -184. Wilson, T. D. (2011). Redirect: The surprising new science of psychological change. Boston, MA: Little, Brown. Woolfe, R., Strawbridge, S., Douglas, B., & Dryden, W. (Eds.). (2010). Handbook of Counselling Psychology. Sage Publications Ltd. World Health Organization. (‎2004)‎. ICD-10 : International statistical classification of diseases and related health problems. Geneva: World Health Organization. Counselling Outcome, Issues, Trends and Professional Ethics