Judith Milner

Brief Counselling: Narratives and Solutions

Solution Talk Practice Principles Practice Techniques The First Session Subsequent Sessions Thoughts on Personal Relationships School and Work Personal Safety and Wellbeing Happiness, Leisure and Recreation Conclusion Appendices Bibliography Index

How do counsellors make client assessments

This paper reports on a consultation exercise undertaken with 18 experienced counsellors on how they make client assessments. These practitioners expressed a high degree of consensus on the purposes of assessment making (to reach a shared understanding with the client about their willingness and ability to undertake a shared therapeutic journey) but the way in which they approached the task varied according to the theoretical orientation they acquired during training. Although most had developed their counselling skills and techniques considerably since initial training, not all had integrated the assessment implications of later experience into their formulation making. The implications of combining single model assessment with eclectic practice are discussed, particularly in relation to making a decision to continue working with a client or to refer a client to a colleague. The authors call for further debate on how counsellors find meaning in what their clients say, why they ask the questions they do a...

The Person-Centred Approach: A Growth Map

This chapter will discuss the other main second-wave approach, the person-centred approach to counselling and assessment, an approach that is basically problem-orientated but with a strong focus on the person. This is a humanistic approach with links to phenomenology and existentialism. The person-centred approach has its origins in the work of Carl Rogers, whose basic belief was that clients know best what is the problem and how to make progress in dealing with it, provided that they have a relationship that offers the climate in which they can grow towards fulfilment. The theory is therefore much taken up with the conditions for growth, first the conditions for getting the work started, and second the conditions for a successful process, for progressing towards a successful change outcome.

Cognitive Approaches: Handy Road Maps

This chapter will discuss some of the cognitive approaches to counselling and assessment, principally the cognitive behavioural therapy (CBT) of Beck (1967, 1989 and 1997), and the rational emotive therapy (RET) of Ellis (1962, 1998, 2001). The lifeskills approach of Nelson Jones (1993) will also be briefly discussed.We describe these approaches as handy road maps because they are interested in clear goals towards which the therapist hopes to travel with the client, and also because of their accessibility and transparency and their potential for use in self-help. The core theory is clear and capable of being understood and used by clients. Users of such approaches say they need to understand the problem; it can therefore be said to be problem-oriented, taking an information-processing approach to the client on the principle that the way in which people interpret their experiences determines how they feel and act, how they become disturbed. Although startling to the world of psychoanalysis in the 1950s, this is not a particularly new idea; Dryden (1990) quotes the Roman philosopher Epictetus as saying that men are disturbed not by things but by their views of things. The move away from emotion and into cognition places this approach in the second wave of theory.

The Solution-Focused Approach: A Navigator’s Map

This chapter presents the second of two theoretical maps that belong to the third wave of counselling theory. Like the narrative approach, it eschews pathology and problems. It shares some of the values of the humanist models of counselling and has some features in common with cognitive behavioural therapies in that it uses cognitive and behavioural questions and frequently leads to tasks to be carried out (although the range of questions used is much broader, encompassing narrative, experiential and systems dimensions of clients’ lives). However, the focus is quite different. As its name implies, this approach focuses on understanding solutions maintaining that it is not necessary to understand a problem in order to understand its solution. Any link between the problem and the solution may be nominal. This approach begins at the end (the solution) and works back from there, rather like a navigator plotting a sea journey, pinpointing the destination first and then drawing a line back to the present position.

The Narrative Approach: A Forecast Map

This chapter presents the first of the theoretical maps belonging to the third wave of counselling; unlike approaches described in previous chapters, it is more interested in clients’ futures than their pasts, in potential rather than pathology. The term narrative refers to the differences that can be made through particular tellings and retellings of clients’ stories of their lives (developing alternative stories), but the term has been developed further than the story-telling involved in psychodynamic or cognitive behavioural approaches. Narrative therapy shares the solution-focused notion (addressed fully in Chapter 9) that there are no fixed truths but, additionally, emphasises that some ‘truths’ are more powerful than others. Narrative therapy involves ways of understanding the stories of people’s lives, and ways of re-authoring these stories in collaboration between the counsellor and the clients whose lives are being discussed. It is a way of working that is interested in history, the broader context that is affecting people’s lives and the ethics or politics of therapy (Morgan, 2000).

Transactional Analysis: A ‘Games’ Map

This chapter forms the second of the theoretical maps belonging to the first wave of counselling practice in that its origins lie in the psychopathology-orientated theory of psychoanalysis. As the term Transactional Analysis (TA) indicates, it is primarily interested in the communication patterns both within and between people. The Freudian structures of id-ego-superego are replaced with the not quite analogous three ego states of parent-adult-child. Concepts of transference, counter-transference and resistance are retained. It provides a comprehensive theoretical framework for counselling that encompasses not only processes between two or more people, but also the relationship between an individual and society over the lifespan. The use of everyday language demystifies Freudian ideas, making TA particularly user-friendly. It is often combined with Gestalt therapy in longer-term counselling but can also be used briefly, Berne (see below) promoting the short-term ideal.The underlying philosophy of TA requires an equal relationship between therapist and client. As clients are considered to have the resources to think about change themselves, they are responsible for the way they live their lives. Thus the counsellor’s role is to educate the client to use the therapeutic process profitably and confront the client when their share of therapeutic responsibility is not taken up (Cox, 2000).

Introduction: Assessment Complexities

In this chapter we will begin by putting our interest in assessment into context and discussing briefly our research for the book. Then the influence of the process of assessment is discussed along with the interplay between this and counsellors’ theoretical homes and common techniques. The chapter will end with an explanation of what we see as ‘waves’ of theory, of what we call the theoretical ‘maps’ that appear in Chapters 4 to 9, and of our social-constructionist philosophy.

Assessment: What, When and How?

In this chapter we move on from the broad issues of the objectives and potentially oppressive aspects of assessment, to a more detailed consideration of purpose and process. This is not to say that it is solely the domain of the assessing counsellor or that it is a fixed entity; assessment is essentially two-way and ongoing. Assessments are made at intake or pre-assessment screening, at the start of counselling proper, throughout counselling, at the end and in evaluating the work. First, we examine the nature of assessment.

Integrative Models. Mixed Metaphors

In this chapter we examine how theory and practice intertwine and how this influences both the purpose and form of assessment. Although all counselling practice emphasises increasing clients’ responsibility for their lives by helping them make choices that will help them feel, think and act effectively, formulations that counsellors develop — their working hypotheses — are highly dependent on their theories about the nature of people and their problems. As we have seen in the preceding ‘maps’ chapters, the sorts of questions asked vary enormously, depending on the particular theoretical orientation of the counsellor.The qualities of the therapist will also be different, and thus the ‘coherent narratives’ offered to clients can be very different. Counsellors develop a sense of ‘fit’ with their own practice theory, probably based on their own learning style; that is, how comfortable they are with feelings, thought or actions.This may not match clients’ learning styles and, where the counsellor has adopted an eclectic approach, there are further possible tensions.