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Counselling outcome, issues, trends and professional ethics dr geoffrey wango

  1. 11/11/2017 1 Dr. Geoffrey Wango Counselling Psychology University of Nairobi
  2. 11/11/2017 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: 1.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); 2.To enable or help the individual to live more competently and/or with contentment; and, 3.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. 11/11/2017 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: 1)Define and explain the various terms and concepts that are used in counselling. 2)Explain the counselling process. 3)Adopt use of professional principles in counselling. 4)Assist a client in therapy. 5)Monitor and evaluate the outcome of counselling. 6)Interpret professional standards in the practice of counselling psychology by adhering to a code of ethics. Counselling Outcome, Issues, Trends and Professional Ethics
  4. 11/11/2017 4 Rationale Counselling Outcome, Issues, Trends and Professional Ethics 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.
  5. 11/11/2017 5 Conceptualization of Counselling Counselling Outcome, Issues, Trends and Professional Ethics - 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.
  6. 11/11/2017 6 The Cultural Context of Counselling Counselling Outcome, Issues, Trends and Professional Ethics 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.
  7. 11/11/2017 7 Management of Mental Health and Psychological Disturbance in the more Traditional-cum-Contemporary Societies Counselling Outcome, Issues, Trends and Professional Ethics  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.
  8. 11/11/2017 8 Management of Mental Health and Psychological Disturbance in the more Traditional-cum-Contemporary Societies Counselling Outcome, Issues, Trends and Professional Ethics  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).
  9. 11/11/2017 9 Rationale Counselling competence includes four basic aspects as follows: (1)Knowledge of Counselling and Awareness of its application (Counselling Issues, Counselling Process and Trends in Counselling and Psychotherapy). (2)Theoretical Approaches. (3)Skills and Techniques. (4)Professional Ethics. All these are designed to ensure a positive/ desirable Counselling Outcome Counselling Outcome, Issues, Trends and Professional Ethics
  10. 11/11/2017 10 Counselling Outcome Rationale Counselling Outcome, Issues, Trends and Professional Ethics
  11. 11/11/2017 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. 11/11/2017 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. Counsellor Counselling Competence (training) Counselling Process (facilitator) Counselling Outcome (healing) 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. 11/11/2017 13 Counselling Outcome Rationale Counselling is a healing process Product – End Result Counselling Outcome, Issues, Trends and Professional Ethics
  14. 11/11/2017 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. 11/11/2017 15 Counselling Outcome Rationale Counselling is a healing process Product – End Result Counsellor Client+ Counselling Outcome, Issues, Trends and Professional Ethics
  16. 11/11/2017 16 Counselling Outcome Rationale – Counselling Outcome Counselling is a healing process Product – End Result Counsellor Client+ Healing as end result Counselling Outcome, Issues, Trends and Professional Ethics
  17. 11/11/2017 17 Understanding the Client Interaction between Client and Environment Assessment for coping competence Counselling Outcome, Issues, Trends and Professional Ethics
  18. 11/11/2017 18 Understanding the Client Counselling Outcome, Issues, Trends and Professional Ethics - 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.
  19. 11/11/2017 19 Understanding the Client Counselling Outcome, Issues, Trends and Professional Ethics - 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.
  20. 11/11/2017 20 Counselling Orientation: Mediating Factors between Client and Counsellor Client Counsellor Issue/s (life challenges, coping) Skills and Techniques, Methods (theory) Values, Attitudes and Emotions Values, Ethics, and Feelings Insight / Solution Task / Goal (guided by professionalism) Counselling Outcome, Issues, Trends and Professional Ethics Outcome of therapy
  21. 11/11/2017 21 Steps in the Counselling Process 1. Receiving Client and Relationship Building. 4. Counselling Interventions: Action plan and way forward. 5. Assessment and evaluation, termination / referral. 3. Goal Setting: Understanding and outlining of goals. 2. Problem Assessment: History taking and exploration, Relationship building. Counselling Outcome, Issues, Trends and Professional Ethics
  22. 11/11/2017 22 Counselling and the Counselling Process Contracting (goal setting) History taking of the client Understanding Creating rapport Offering core conditions 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 Action Essential action points. Further exploration. Termination / Referral World of client (Client re-entry back into their world) Counselling Outcome, Issues, Trends and Professional Ethics Initiation Process Action
  23. 11/11/2017 23 Counsellor awareness Core conditions Counselling goals Therapeutic alliance (client- counsellor relationship) Counsellor performance Termination Referral Counsellor Competence Core conditions Counselling goals Competence (knowledge, skills and techniques) Counsellor Accreditation Counsellor Training (Counsellor, therapist, psychotherapist) Competencies (Knowledge, skills and techniques) Professional ethics Monitoring and Evaluation Coping strategies (adaptation, resilience and wellness) Professionalism Therapeutic Approaches. Skills and Techniques. Code of Conduct for counsellors. Counselling Outcome (end result) Counselling Process (resolution) Counselling (issue, situational difficulty) Client The Counselling Process: Conceptualization Counselling Outcome, Issues, Trends and Professional Ethics
  24. 11/11/2017 24 Counselling Skills   Category  Skills  and Techniques 1. Core conditions - Empathy / Accurate Emphatic Understanding - Congruence / Genuineness - Unconditional Positive Regard (UPR) 2. Attending skills - Structuring - Active Listening - Silence - Observation 3. Facilitating or responding skills - Minimal prompts - Paraphrasing - Reflection of feeling - Questioning 4.  Challenging (confrontation) skills - Summarising - Focusing - Clarification - Concreteness - Confrontation - Self-disclosure - Disengagement / Termination Counselling Outcome, Issues, Trends and Professional Ethics
  25. 11/11/2017 25 Therapeutic Approaches Counselling Outcome, Issues, Trends and Professional Ethics
  26. 11/11/2017 26Counselling Outcome, Issues, Trends and Professional Ethics Psychotherapeutic Orientations - Adlerian Therapy - Art Therapy (Includes Bibliotherapy) - Behavioural Therapy - Body Psychotherapy - Brief Therapy - Cognitive Behaviour Therapy - Cognitive Therapy - Dance Therapy - Drama Therapy - Existential Therapy - Family Therapy - Feminist Therapy - Gestalt Therapy - Group Psychotherapy - Humanistic Therapy - Hypno-Psychotherapy - Jungian Analysis - Logotherapy - Narrative Therapy - Neuro–Linguistic Psychotherapy - Object Relations Therapy - Pastoral / Spiritually- Oriented Therapy - Person - Centred Therapy - Psychoanalysis - Psychodynamic Therapy - Rational Emotive Behaviour Therapy - Systemic Therapy - Solution Focused Therapy - Transactional Therapy - Transpersonal Therapy
  27. 11/11/2017 27 Counselling Outcome: Evidence Based Practices Counselling Outcome, Issues, Trends and Professional Ethics 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.
  28. 11/11/2017 28 Counselling Outcome for Client Counselling Outcome, Issues, Trends and Professional Ethics - 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.
  29. 11/11/2017 29 Counselling Outcome for Counsellor Counselling Outcome, Issues, Trends and Professional Ethics 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.
  30. 11/11/2017 30 Counselling Outcome: Process – Effect and Network Approach Systems Counselling Outcome, Issues, Trends and Professional Ethics - 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.
  31. 11/11/2017 31 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. 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. Current Competencies Advancement in medicine and information technology (Globalisation). Modernization, Nationalization and Internalization. Adherence to Socio- Cultural (tradition and religion) norms and values. Behavioural Competencies in Effective Counselling Outcomes Past Competencies Coping Competencies Counselling Outcome, Issues, Trends and Professional Ethics
  32. 11/11/2017 32Counselling Outcome, Issues, Trends and Professional Ethics PROFESSIONAL ETHICS
  33. 11/11/2017 33Counselling Outcome, Issues, Trends and Professional Ethics Guidelines on consulting and adhering to Code of Conduct (1) Always get acquainted with the professional Code of Ethics of your profession. (2) Use the most recent (revised) version. (3) Get acquainted with all Sections of the Code (Avoid reading selected Sections). This allows you to contextualise the Code. (4) Distinguish between statements on obligatory practice and recommendations (suggestions in context). (5) Interpret any supplementary notes or guidance provided by the Code. (6) Always look at each situation in context. This requires that you review each case on its own (be specific).
  34. 11/11/2017 34 Quality of Standards in Counselling Practice Counselling Outcome, Issues, Trends and Professional Ethics Several factors have been identified that appear significant and contribute immensely to effective counselling. These are: (1)Level of skilfulness (defined as counsellor competence rather than experience). (2)Cognitive complexity (includes ability to comprehend a diversity of clients including the complexity of cases / issue/s and circumstances ). (3)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.
  35. 11/11/2017 35Counselling Outcome, Issues, Trends and Professional Ethics Quality of Standards in Counselling Practice Client + Counsellor Monitoring and Evaluation Continuous Evaluation Appraisal Therapy / Counselling Healing / Positive Change in Client Initiation Process End result
  36. 11/11/2017 36Counselling Outcome, Issues, Trends and Professional Ethics Quality of Standards in Counselling Practice: Counselling Outcome Representation Model Client + Counsellor Monitoring and Evaluation Continuous Evaluation Appraisal Therapy / Counselling Healing / Positive Change in Client Initiation Process End result Counsellor Competence Quality of Counselling Service Flourishing life - Counsellor training - Accreditation - Professional Ethics - Continuous Professional Development - Counsellor supervision - Professionalism - Client well-being - Coping competencies
  37. 11/11/2017 37Counselling Outcome, Issues, Trends and Professional Ethics 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.
  38. 11/11/2017 38 Conclusion Counselling Outcome, Issues, Trends and Professional Ethics 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.
  39. 11/11/2017 39 Conclusion Counselling Outcome, Issues, Trends and Professional Ethics 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.
  40. 11/11/2017 40 Module : Counselling Outcome, Issues, Trends and Ethics Counselling Outcome, Issues, Trends and Professional Ethics Wango, G. M. (2017). Counselling Outcome, Issues, Trends and Ethics. Nairobi: University of Nairobi.
  41. 11/11/2017 41 Selected References Counselling Outcome, Issues, Trends and Professional Ethics American Counselling Association (2014). ACA Code of Ethics. American Counselling Association. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders DSM - 5. Washington, D C: American Psychiatric Association. American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70 (9), 832- 864. doi: 10.1037/a0039906. American Psychiatric Association (2013). Qualities and Actions of Effective Therapists. Washington, D C: American Psychiatric Association. Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869 - 878. British Association of Counselling and Psychotherapy (2013). Ethical framework for good practice in Counselling. Bernes, K. B. (2005). The Elements of Effective Counselling. NATCON Papers. Bor, R., & Palmer, S. (2009). A Beginner’s Guide to Training in Counselling and Psychotherapy. Sage. Brown, S., & Lent, R. (2008). (Eds.). Handbook of Counselling Psychology. New York: Wiley. Chaturvedi, S. (2013). Mandatory Personal Therapy: Does the Evidence Justify the Practice? British Journal of Guidance & Counselling, 41 (4), 454 - 460. Collins, G. R. (2007). Christian Counselling: A Comprehensive Guide. Thomas Nelson. Conte, C. (2009). Advanced Techniques for Counselling and Psychotherapy. New York: Springer Publishing Company, LLC.
  42. 11/11/2017 42 Selected References Counselling Outcome, Issues, Trends and Professional Ethics Cooper, M., & McLeod, J. (2011). Pluralistic Counselling and Psychotherapy. London: Sage. Corey, G. (2013). Theory and Practice of Counselling and Psychotherapy. Belmont, CA: Brooks / Cole, Cengage. Cottone, R. R., & Tarvydas, V. (2016). Ethics and Decision Making in Counselling and Psychotherapy. New York: Springer Publishing Company. Cromby, J., Harper, D., & Reavey, P. (2013). Psychology, mental health and distress. Palgrave MacMillan. Culley, S., & Bond, T. (2004). Integrative Counselling Skills in Action. Sage Publications. Duncan, B. L. (2014). On becoming a better therapist: Evidence-based practice one client at a time. Washington, DC: American Psychological Association. Duncan, B. L., & Reese, R. J. (2013). Clinical and scientific considerations in progress monitoring: When is a measure too long? Canadian Psychology, 54 (2), 135–137. Egan, E. (2002). The Skilled Helper: A Problem - Management and Opportunity – Development Approach to Helping. Chicago: Brook / Cole. Feltham, C. (2013). Counselling and Counselling Psychology: A Critical Examination. Monmouth, PCCS Books. Feltham, C., & Horton, I. (Ed.). (2010). The Sage Handbook of Counselling and Psychotherapy. London: Sage Publications. Geldard, K., & Geldard, D. (2012). Counselling Children: A Practical Introduction. Sage. Gibson, K., & Cartwright, C. (2014). Young clients' narratives of the purpose and outcome of Counselling. British Journal of Guidance & Counselling, 42 (5), 511-524.
  43. 11/11/2017 43 Selected References Counselling Outcome, Issues, Trends and Professional Ethics Green, D., & Latchford, G. (2012). Maximising the benefits of Psychotherapy: A practice- based approach. Chichester, UK: John Wiley & Sons. Hammersley, D. (2010). The Interface Between Psychopharmacological and Psychotherapeutic Approaches, In Woolfe, R., Strawbridge, S., Douglas, B. and Dryden, W. (Eds.). Handbook of Counselling Psychology. Sage Publications Ltd. Hazzaed, A. J (1995). Measuring outcome in Counselling: a brief exploration of the issues. British Journal of General Practice, March 1995. Jenkins, P. (2009). Counselling, Psychotherapy and the Law. London: Sage Publications. Lees, J., & Tovey, P. (2012). Counselling and Psychotherapy, Complementary and Alternative Medicine and the Future of Healthcare. British Journal of Guidance & Counselling, 40 (1), 67 - 81. Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33, 883 - 890. Lilienfeld, S.vO., Ritschel, L. A., Lynn, S. J. Cautin, R. L., & Latzman, R. D. (2014). Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness. Perspectives on Psychological Science, 9 (4) 355 – 387. Manthei, R. (2015). Evaluating Counselling Outcome: Why is it necessary? How can it be done? New Zealand Journal of Counselling, 35 (1), 60 - 85. McLeod, J. (2009). Qualitative Research in Counselling and Psychotherapy. Sage Publications.
  44. 11/11/2017 44 Selected References Counselling Outcome, Issues, Trends and Professional Ethics McLeod, J. (2012). What do Clients want from Therapy? A Practice - Friendly Review of Research into Client Preferences. European Journal of Psychotherapy and Counselling, 14 (1), 19 -32. McLeod, J. (2013). An introduction to Counselling. Maidenhead: Open University Press. McLeod, J., & McLeod, J. (2011). Counselling Skills: A Practical Guide for Counsellors and Helping Professionals. McGraw-Hill. Norcross, J. C., Beutler, L. E., & Levant, R. F. (2007). Evidence based practices in mental health. Washington, DC: American Psychological Association. Palmer, S. (Ed.). (2010). Introduction to Counselling and Psychotherapy: The Essential Guide. SAGE Publications Ltd. Pipes, R. B., & Davanport, D. S. (1999). Introduction to Psychotherapy: Common clinical wisdom. Boston, MA: Allyn & Bacon. Seligman, L. (2001). Systems Strategies and Skills of Counselling Psychotherapy. Merrill Prentice, Hall, New Jersey. Seligman, L. (2004). Diagnosis and treatment planning in Counselling. New York: Kluwer Academic/Plenum Press. Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004). Counselling and Psychotherapy Theories in Context and Practice: Skills, Strategies and Techniques. New Jersey: John Wiley & Sons. Sperry, L. (2010). Core competencies in Counselling and Psychotherapy. New York: Routledge Taylor & Francis Group.
  45. 11/11/2017 45 Selected References Counselling Outcome, Issues, Trends and Professional Ethics 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.

Notas del editor

  1. Dr. Geoffrey Wango is a Senior Lecturer in Counselling Psychology at the University of Nairobi. Email. [email_address]. Dr. Wango has authored several publications on Counselling, Education and Gender including: Counselling in the School: A Handbook for Teachers (Wango & Mungai, 2007); School Administration and Management: Quality Assurance and Standards in Schools (Wango, 2009); School Finance Management: Fiscal Management to Enhance Governance and Accountability (Wango & Gatere, 2012); Early Childhood Development Education Guidance and Counselling (Wango, Kimani, Osaka, Githinji & Amayo, 2015); Counselling Psychology in Kenya: A Contemporary Review of the Developing World (Wango, 2015); Study Skills for Secondary School Learners (Wango & Gatere, 2016); and Parenting: Counselling in the Home (Wango & Gatere, In Press).
  2. Life experiences pose a number of challenges that in turn can affect our overall functioning including health and wellbeing. The effects on health and wellbeing are numerous and varied. For example, children and adolescents who are exposed to adversities such as maltreatment (including violence), as well as adults experiencing disquiet and distress, are usually at an increased risk of poor mental and physical health. This can lead to conditions such as anxiety and personality disorders, psychiatric disorders or just an inability to effectively handle activities of daily living (ADL). There are five major domains of the therapeutic practice: work and employment; career and career development; health, including mental health and psychological well-being; relationships; and, family. Psychological services such as counselling and psychotherapy, clinical and psychiatric services, pastoral counselling and care, as well as various social services, have been shown to have positive effects in alleviating psychosocial adversities.
  3. A client may experience a single problem or a range of psychosocial adversities in a variety of combinations. The clients’ thoughts, feelings and experiences are interrelated and a part of their lived experiences. When a client seeks therapy (counselling, psychotherapy) they expect assistance in resolving their issue/s. Consequently, the operationalization and quantification of the outcomes of counselling and psychotherapy have varied in available literature. This is because certain issues may not be resolved as immediately or amicably as would be expected. In other instances, certain issues are likely to recur and relapses in clinical diagnosis are common. Counselling and psychotherapy have developed a cumulative approach consisting of theoretical approaches, skills and techniques and professional ethics to deal with a greater breadth of life experiences. Additionally, practitioners have demonstrated an association between seeking help and greater psychosocial functioning.
  4. Psychotherapy is generally viewed as a legitimate and beneficial treatment for mental disorders. But perhaps the more complex question is what factors make counselling and psychotherapy effective, and with what clients. For many of us in low-and middle-income developing countries living in the more traditional-cum-contemporary societies, we need to incorporate the practice of counselling and psychotherapy and ensure that therapy is beneficial to the clients. This is because although certain scholars are convinced that counselling and psychotherapy have a Western or European orientation, the concepts are deeply embedded in the guidance and counselling, teaching, coaching and mentoring explicit in the more traditional societies. Subsequently, therapy is more about empowering the client by ‘giving voice’ and ‘making sense’ of their personal and social worlds. Nonetheless, counselling and psychotherapy is being associated with good health, and this inherently implies improved well-being. 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.
  5. Counselling is not an end in itself; it the client who seeks assistance in a bid to make the necessary adjustments and thus makes effort to maintain the agreement between individual and social values, between what he/she is doing and what he/she intends and would like to do. Practitioners in counselling psychology seek a description of the main clinical and associated features as provided in available literature. In that case, therapists conduct operationalized diagnosis using available guidelines in order to assist the variety of clients. Therapists will make use of the client material and often review it systematically when making an initial diagnosis, and hence the use of various therapeutic approaches in counselling and psychotherapy.
  6. Counselling psychological competence must include a background of the client population. This does not imply that the practitioner categorizes clients, neither is it an opportunity to label them. Instead, the cultural perspective bridges the gap between knowledge in counselling psychology and the world view of the client. A lot can be achieved through the established counselling process including history taking of the client, that will reveal their philosophy, belief systems as well as the cultural constructs. This enables therapy to focus on the health of the client as a whole, including how personal health is defined and interpreted in their world. It appears that counselling psychology after all is ingrained in the people’s philosophy with continuous reference to context and traditions. This encourages a more harmonious relation as clients become more assertive, while counsellors require to be more competent, logical and rational.
  7. The mental health needs and availability of resources including medical and therapy in low- and middle-income countries is highly wanting despite the fact that a large majority of the world’s population reside in these countries. The people live in the more traditional societies and tend to experience the largest majority of the burden of disease including mental illness. This is principally because of two major factors, that is, (1) lack of available medical and other health services; and, (2) lack of proper understanding of therapeutic services such as counselling, psychotherapy and psychiatry. In order to reduce the burden of ill health and promote health and wellness, developing countries must promote psychological studies including counselling, clinical psychology, psychiatry and psychotherapy. Self-care must be possible through therapy. The implementation of psychological services should be conducted through a task-shifting paradigm that aims at education on psychological services and in turn resulting in more proficient identification, diagnosis and treatment of psychosis. Promotion of health and wellness must propose to transcend traditional barriers and transform the societies to greater philosophical underpinning in a Global World.
  8. Psychological diagnosis and treatment (Counselling and Psychotherapy, Clinical Psychology and Psychiatry, Pastoral and Social Work as well as various psychopharmacological interferences) has improved outcomes on a range of clients. Two major classification systems have played a key role in informing modern psychiatric practice and research. They are the American Psychiatric Association Diagnostic and Statistical Manual (DSM) and the World Health Organization International Classification of Disease (ICD). The systems provide diagnostic criteria for mental disorders that are useful in clinical settings and hence are useful in therapeutic practice. But again, the health needs, particularly the mental health and psychological needs in the more traditional societies is a matter of urgent concern. My own experience demonstrates a need for a multi-disciplinary approach that takes in the role of the psychologies. This is only feasible if we build teams of health, psychological diagnosis and treatment social work. In the end, these teams can achieve much more through a conceptualization of psychological assistance. Again, in my view, it is such team work that can achieve immediate, lasting, and measurable impact.
  9. A notable limitation of counselling and psychotherapy is assessing potential moderators and mediators in the association between ‘successful’ (efficacious) therapeutic outcomes and ‘failure’ (inability) to achieve ‘positive results.’. This is because when a client seeks assistance there is need for the practitioner to link present adversity and later (improved) health and well being. Such an examination of wellness may not be possible at a single point in time; it may be as longitudinal just as it is vertical, a short term assessment as well as long term (continuous) assessment. The competence of the practitioner is therefore of significance as it determines the outcome of therapy, whether in a single session, subsequent sessions or as an end result of the overall therapeutic process. Practitioners too want to find out the extent to which various therapeutic approaches are successful: with what client, in which circumstances, and perhaps put a mark of evaluation of the overall effectiveness of therapeutic services.
  10. An important aspect of therapy (counselling and psychotherapy, clinical psychology and psychiatry) is the desire to promote positive mental health. Positive mental health involves theoretical constructs like psychological well-being, experiencing a sense of meaning in life (personal meaning), flourishing and post-traumatic growth. Counselling and psychotherapy may in many instances take on a phenomenological construct by seeking to understand the meanings individuals and community (society) attach to human experience, and thus a concerned with exploring experiences in their own terms. The constructs psychological well-being and personal meaning overlap to a large extent in that they contribute to client health and overall well-being. Also, there are disparities in counselling and psychotherapy outcomes based on race/ethnicity, gender, age, cultural and religious differences, and the issue/s as well as circumstance(s).
  11. Psychological well-being and personal meanings often overlap to a large extent in almost all clients. Still, counselling must have an outcome. This is because the client will have streams of consciousness – their thoughts, feelings, actions and memories are part of their experience. Consistent with the origins of psychology as an attempt to understand human experience, psychological services such as counselling and psychotherapy (therapy) must be dedicated to gleaning individuals’ in order to direct their individual and social experiences through an understanding of themselves (their thoughts, feelings, actions and memories – both conscious and unconscious). The therapists encourages respondents (clients) to tell their own story in their own words. In the end, the client is able to have an interpretative construction of their lives (end result). This is contingent upon the social, historical and cultural factors.
  12. It seems fair to say that counselling and psychotherapy continues to evolve, and this is exemplified by various efforts to identify and assess mechanisms of successful treatment outcomes within and across interventions. Also, there exists commonalities as well as differences in the experiences and challenges of clients. Therefore, it is possible to identify various competencies of would-be helpers (counsellors, psychotherapists). In the end, the professional competence of the practitioner should enable intensity in care-giving. Compared with not so effective helpers, effective counsellors are more likely to provide higher-intensity care. In addition, counselling practitioners may report having unmet needs with care provision, and at times to experience increased challenges with certain circumstances.
  13. There is ample data to demonstrate that scientifically supported psychotherapies can alleviate many mental health difficulties (Barlow, 2004). Help may be formal or informal. Clients may seek help from formal caregivers who may be said to offer increased effectiveness in helping. But the need for dependent care that is provided by family members including spouse, child/ren, relatives and friends is likely to increase as we deal with various challenges such as the aging population, terminal illnesses, dementia and other circumstances. Informal caregivers are often unpaid, yet they tend to bear the overwhelming responsibility for the provision of home and long-term care services.
  14. Although many similarities exist in the experiences and challenges of both formal and informal helpers, gaining insight from different clients in the population assists in designing effective counselling programmes. Admittedly, the helper is simply trying to assist the client to make sense of their personal and social world. Counsellors must develop and implement culturally-sensitive programmes and policies that take in the needs of the client. Practitioners too must evaluate the effectiveness of treatment for a given client and this in turn involves an assessment of the effectiveness of a specific therapeutic approach, practitioner competence, or both. Additionally, counselling programmes must be supportive of the needs of the clients and their life experiences.
  15. Future efforts in counselling and psychotherapy and other psychological services particularly in the more developing communities should focus on three major aspects, that is, (1) The neuropathological picture of psychosis including the factors leading to development and changes over time; (2) The effectiveness of therapy; and, (3) Exploring the potentially significant role of formal and informal helpers. This is because of two reasons: (1) There are early signs and symptoms of neuropathology characterized by subtle, self-experienced deficits. Because of lack of medical and mental services, most of the signs are termed as non-specific symptoms, especially in the cultural context. Yet these ‘basic symptoms’ are often accompanied by attenuated negative symptoms and could be identified and managed (treated) in the early stages. (2) Although counsellors and psychotherapists assist a variety of clients in the more formal settings, informal caregivers provide a lot of assistance to the members of the community. These include psychosocial and spiritual support. All these aspects affect the outcome of therapy.
  16. Counselling practitioners must identify effective interventions and address public concerns on the effectiveness of counselling. As the counselling process is invariably influenced and complicated by both the client and counsellors’ own preconceptions (and inclinations), it is possible that mixed findings from practitioners may state that therapy was effective and that the client did receive help. It is impracticable to gain full (exact) access to the exact personal world of another, completely or directly. The objective of therapy is, therefore, to obtain a description which gets as close to the client’s worldview. But, analysis of the description always involves interpretation. Still, assessment tools need to provide definitive answers.
  17. Psychological services including counselling and psychotherapy conceptualise the positioning of the client in physiological, psychological and social spheres, and hence the need for optimal functioning. Therefore, therapists will tend to specify the type of care provided. This includes specifics, for example activities of daily living (ADLs) such as feeding, dressing, bathing, getting in or out of bed (transferring), and instrumental activities of daily living (IADLs) such as housework, preparing meals, transportation, use of medical or assisting equipment, administering prescription medications, shopping, making telephone calls, managing finances, and access to various programmes available such as medical (including emotional and psychological) care.
  18. Unfortunately, many counselling and psychology programmes especially in developing countries do not offer extensive knowledge and training for special populations. There are few and restricted studies on special groups such as lesbian, gay, bisexual, transgender and queer (LGBTQ) community and transgender and gender nonconforming people (TCGN). Unfortunately, the needs of these special groups may not often be met. This may in turn negatively impact the counselling relationship with special populations and their families. Effective training can enhance counsellors’ understanding and effectiveness when counselling special populations. Trainers can provide pertinent and relevant information to help practitioners respond successfully and creatively to the special populations. Additionally, counsellors may find it highly beneficial to examine their own beliefs and expectations about various people, including gender, disability, sexual orientation and other considerations, and the anticipated outcomes when working with these populations.
  19. Professionals who counsel and work with special populations should keep in mind and practice a lot of caution. This is to enable them increase their chances of developing an effective therapeutic relationship and understanding of these persons. These include being mindful that expressed negative beliefs and experiences related to aspects such as gender, disability and terminal illnesses such as cancer and HIV/AIDS are real. The practitioner should carefully consider the effects that labelling and categorization has on such clients, and in turn be careful in the choice of language (words and their implications). A major starting point is to build awareness of own beliefs, expectations, attitudes and biases that may adversely affect the client-counsellor relationship. Also, it is good to search our values on various aspects such as human dignity and human rights, and ultimately our own willingness to have an open mind to assist all persons within the counselling relationship.
  20. Counselling is an intimate relationship; it is a process that requires skills and techniques; it offers concepts (theory) and methods of working with others (counsellor or therapist) to enrich the individual (counsellee/client) to enable them address a range of experiences and in furthering personal and social development. There are numerous factors operating at each phase and as the two-way arrows imply, it is not a linear process but rather one in which events at one phase can feed back and alter decisions made in previous stages. There are also areas of conflict, for example in values, and the focus during the counselling relationship may be slightly different. Value convergence results in development of trust in the client. Counselling is therefore rooted firmly in a particular quality of relationship that also takes in the values of the client as well as principles of counselling. it has an expected (positive) outcome.
  21. The aim of the consultation in counselling is to help the consultee (client) improve their overall performance. The counselling process accommodates history taking, consultation (diagnosis and examination), health promotion, well-being, as well as monitoring and evaluation. Therapy hold that helping has the potential to be a powerful tool in assisting clients to understand their lived experiences. The counselling process is both stimulating and rewarding. Practitioners must hold a grasp of the philosophical underpinnings of counselling and psychotherapy. These include: therapeutic approaches (theories); skills and techniques; and, the methodology that incorporates strong interviewing skills and the ability to commit to a systemic and meticulous analysis of the client accounts. Whilst counselling does not intend to be prescriptive, there is need to understand a representation of a ‘how to’ in the helping process. In the end, it is hoped that the practitioner will develop their own reflective insights on the counselling process and that the steps in the counselling process are valuable for the diversity of clients.
  22. Counselling is a product. The quality of a product or service such as counselling must aim to objectively establish the extent to which the end-result of therapeutic services can be measured, weighed, and expressed in quantitative outputs. But we also aim to give an explanation, as well as reach an understanding, of the counselling process (product). This way, it is possible to identify a broader basis for human psychic interpretations so that the procedure (initiation, process and action stages) are described, monitored and appraised. Certainly, there is the central idea that a good counselling experience should produce a linear process of symptom improvement. This may be reflected in clients’ and counsellors’ accounts of the helping process. Overall, the quality of helping may greatly depend to a large extent on gains that clients make through counselling.
  23. Although the relationship between therapy (counselling, psychotherapy) and the greater outcome may not be well documented, investigations into various moderating or mediating factors in this relationship can be conducted in context. These include counsellor awareness and counsellor competence, the two leading to (effective) counsellor performance. Again these are linked to counsellor accreditation, which bears on professionalism and the quality of standards, ensured through effective monitoring and evaluation. Moderation studies must aim at identifying the extent to which various interactions between the counsellor and the client are associated with higher achievement, and which omissions or commissions along the causal pathway lead to disappointment. This conceptualization of the counselling process enables practitioners to identify aspects that are particularly pertinent in the client-counsellor relationship and lead to superior outcomes.
  24. Counselling end results raise crucial concerns, especially that of a possible (or absent) continuity between normal (regular) functioning and ordinary experiences and dysfunctional or irregular experiences. This is because in everyday experiences we are not just confronting one reality only, but several uncertainties (such as the reality of everyday life, imaginary life, relationship, family and work). Practitioners are professionally trained with several skills and techniques to focus upon emotional needs and distress, and in certain circumstances to address psychological disturbance in the hope of facilitating its alleviation. Notably significant is the fact that therapy does not lead to spontaneous improvement.
  25. Psychological theories have made great strides in an attempt to understand our behaviour and personality. Despite strong links between the two, the heterogeneity of human responses suggests additional research. Thus, different life issues require a variety of approaches, and it is not as possible to pinpoint with utmost accuracy any one approach as paramount in psychology. Instead, there are a heterogeneity of responses to understanding life challenges and resolving adversity. Some treatments are considerably more efficacious or effective than others within and across the psychological disorders and prevailing conditions. Admittedly, this could imply that certain approaches if not appropriately selected and/or applied could ameliorate negative outcomes. Nonetheless, therapeutic approaches have been shown to moderate the outcome of therapy resulting in higher-order functioning, positive psychological dispositions and promotion of coping strategies. Additionally, theoretical models of counselling have distinctive set of values.
  26. A theory of psychotherapy acts as a roadmap for psychologists. It guides the practitioner through the process of assisting the client and developing solutions. Choice of a theory for use in therapy depends largely on: (a) the practitioner; and, (b) issue presented by the client. There are many psychotherapeutic approaches based on the major framework such as: Psychodynamics (Psychoanalysis, Adlerian, Object Relations); Behavioural (Behavioural, Cognitive Behavioural); Humanistic (Person-Centred, Gestalt); Feminism, Narrative, Positive and Evolutionary Psychology; Brief and Solution Focused Therapy; Spiritually Oriented Therapy; and, integrative and eclectic approaches. In the more traditional societies, it is also prudent to consider the involvement of traditional health practitioners (THPs) as well as other approaches such as religion and spiritualism, culture and other traditional subtleties leading to improved wellbeing (complementary and alternative care) in order to bolster mental health care and therapeutic services.
  27. There must be clear emphasis among practitioners that the outcome of therapy must be evaluated and that this is evidence based. In that case, counselling training must outline the essential role of assessing therapy. Evidence based practice should be included in clinical education (use of various therapeutic approaches, skills and techniques), training (the counselling process, and practice (client-counsellor interaction). Practitioners must also guard against confirmation bias, a tendency to perceive events in our own way. It is highly acceptable that the practitioner want their clients to improve, and this may motivated us to perceive certain changes, or unwittingly pick out the expected outcomes on which the client is improving, while at the same time neglecting those on which the client is stagnating or becoming worse. In the end, we lead the client to focusing primarily on positive (appropriate) outcomes while altogether ignoring negative ones.
  28. In technical terms, it must be admitted that much of the variability in counselling outcome is understood and interpreted in client terms, that is, client factors such as issue/s presented in therapy, initial symptoms, severity and other factors such as socio-economic circumstances. Clients in low income and developing countries may be more severe or deprived of therapeutic services leading to poorer outcomes. This is compounded by therapeutic factors such as the process factors including the number of sessions attended by client, as well as client engagement. All these factors are related to clinical outcome.
  29. The primary aim of therapy is to assist the client. Client outcomes may be varied systematically across both therapists and therapeutic approaches. But the therapist is critical in this process. The purpose of counsellor training (and research investigations) is to emphasize client wellbeing and the severity of therapist as a significant being the variable most strongly associated with outcome variability. However, the overarching implication of this for therapy is that the effectiveness of therapy is not restricted to the therapist. Instead, there are the much broader aspects such as the social support and the context in which the client lives. Nevertheless, the therapist must provide all the necessary help to substantially contribute to client outcome. In the end, we cannot assume that therapy was effective, nor can we rely on informal clinical observations to infer whether (certain) treatments and/or therapists are effective.
  30. Scholars and practitioners in counselling and psychotherapy are in agreement that there is already heavy workloads of many clients and hence an addition of instruments (questionnaires, interview and observational schedules) to be imposed on practitioners to assists monitor and assess outcome may be unnecessary and would be an extra burden. There is also the interpretation of the data. In the first instance, the data must be standardized and primarily aimed to assess therapy. Secondly, the data must not be too complex making it impossible to be introduced in everyday clinical practice. Thirdly, the system must provide similar or comparable results for diverse clients, while at the same time taking into consideration clients have assorted issues and practitioners adopt a variety of therapeutic approaches. Therefore, the system must not be too complex to allow for immediate interpretation of results to enable direct implementation and thus assist the client/s. in the end, therapists require a combination of professional skills and interpersonal skills. The personal attributes in an effective counsellor is a major factor that supports and influences the outcome of therapy.
  31. The end result of counselling in terms of behavioural competencies implies an adaptation of enhanced coping competences. Coping competences include improved and overall mental health, as well as other skills such as social and emotional intelligence and resilience. Knowledge of the client’s perspective on helping (counselling and psychotherapy) would enable practitioners (counsellors, psychotherapists, clinical psychologists, social workers) to engage more effectively with the potential that therapy creates for positive (desirable) change. Admittedly, other aspects such as the role of social support have been demonstrated to have strong links with overall mental health. Therefore, counselling outcomes may be the result/s of various interventions, including the role of the counsellor/therapist in promoting greater health. Overall, the outcome of counselling must consciously or unconsciously be a means to effectively foster better mental health.
  32. Counselling is an important and sensitive process that touches on a person’s life. A counsellor performs a special function, especially when working with children. Counselling as a profession is guided by professional ethics, principles and standards. The counsellor will observe ethical guidelines to protect both the client and the counsellor. Additionally, practitioners require an up-to-date snapshot of psychotherapeutic approaches and thus training should pinpoint gaps in knowledge of the efficacy and effectiveness of diverse interventions.
  33. Ethics are a set of rules that influence a person’s behaviour. Counselling ethics refer to the moral standards that guide the process and practice of counselling. Ethical issues in counselling are derived from human values and moral philosophy, such as the need to be responsible. This is to give due respect to both the client and counsellor. Therapist awareness of persona and professional values issues, and their competence in negotiating values differences, comprises central aspects of therapeutic effectiveness (Williams & Levitt, 2007). The counsellor must find ways of carefully balancing situations based on ethical guidelines. The counsellor is encouraged to develop competence through professional knowledge and personal development activities, in order to be able to work effectively with the diversity of clients.
  34. Despite the range of emotional and mental needs in the general population little research is devoted to the outcome of the counselling process. Future efforts in counselling and psychotherapy should focus on exploring the potentially significant role of formal and informal helpers. This is because informal caregivers provide a lot of assistance to the members of the community. These include social and spiritual support. Notwithstanding, traditional-cum-contemporary societies in particular must ensure a more enhanced understanding of various disorders such as bipolar disorders (BD), major depressive disorders (MDD) and schizophrenia (SCR) in order to improve on both diagnosis and treatment. The implications of these trends is also significant in regard to counsellor education in that they suggest redirecting efforts to building practitioner competence including increased knowledge of therapeutic approaches, and in ability to apply skills and techniques in counselling practice.
  35. In 1998, Martin Seligman proposed the notion of ‘positive psychology’ in his American Psychological Association presidential address. Seligman contented that psychology had hitherto tended to focus majorly on three aspects; that is, dysfunction, disorder and distress. In the more traditional societies, psychological issues are perceived mainly in terms of mental health and psychological disturbance. The tendency to seek psychological services such as counselling is often equated to the medical inclination of illness and seeking healing. There are of course pockets of scholarly writing that have pursued aspects such as guidance and counselling, coaching and mentoring, career guidance and life skills as probable areas of achieving greater human potential and excellence, leading to superior achievement. Positive psychology is a significant paradigm and there is need to investigate processes of its credibility and possible enmeshment in traditional-cum-contemporary societies, particularly as an opportunity to monitor and evaluate the quality of counselling services.
  36. The concept of positive psychology may not have been new altogether, as humanistic psychology and others could have argued for conceptualization of higher achievements in human potential. These include: happiness, flourishing life and success (family, career achievement) and overall wellbeing. There emerges a need to encompass processes and qualities that evaluate the product of therapy in terms of overarching constructs, that is, the end result as positive (flourishing, happiness, success). The client is more hopeful and contented. However, the concept of psychology (and of course psychological services such as counselling and psychotherapy) pertaining to wellbeing (read client wellbeing) were collectively brought together and considered collectively in positive psychology. The quality of counselling services must therefore be monitored and evaluated, assessed and appraised.
  37. Although considerable attention is devoted to the counselling process predominantly theories, little empirical attention is devoted to assess the outcome of therapy. The rationale for counselling and psychotherapy is that they are useful to a range of clients. Nonetheless, counselling therapeutic services including the quality of services need to be assessed and continually appraised. The principle of appraisal points out the difficulty in the categorization of phenomena as either positive or negative. This is chiefly because such forms of assessment are in many ways contextualized. In that case, there are bound to be fundamental differences in clients, issue/s, therapeutic approach and circumstances. The number of interacting variables may be fundamentally dependent and hence the context so diverse, and thus imminently fail to promote prudence for effective comparisons. It is therefore often difficult to attribute the outcome of counselling or variation in performance to specific cognitive processes.
  38. The counselling practitioner must have a coherent psychological understanding of the therapeutic process. The therapist must manage to work through the tensions between the client and counsellor and create a healing process that takes into account both personal experience and socio-cultural processes. It is likely that clients’ constructions of counselling is influenced by specific priorities such as identity construction, career progression or a better relationship. The analysis of client and therapist reactions points to considerable diversity in the way clients and practitioners might make sense of the purpose and outcomes of counselling. Counselling and psychotherapy relieve mental distress and at the same time help shape knowledge and research towards more empowering, respectful and reflexive practices. Even in the more traditional societies, the use of guidance and counselling, psychotherapy and alternative methods must be promoted in order to alleviate distress and improve on access to clinical mental health care and realize positive treatment outcome.
  39. Accountability is now a primary principles in all professional practices. Practitioners must engage with clients’ about the purpose of helping and the intended outcome of counselling. It is important to recognise the active role that clients play in shaping the meaning of their counselling experience. This will allow counsellors to better match counselling and psychotherapy, as well as the expectations and approach to helping, in order to fit with their clients. Additionally, clients and counsellors can work together to identify the objectives of therapy and in turn support helpful outcomes. It is possible that clients will describe less nuanced and specific psychological impacts of counselling in contrast to therapists. But still, accountability includes quality of therapeutic services, concerns for service costs, intervention effectiveness, and research that supports effective interventions leading to best practice. Hence, counselling must have an outcome. Counselling outcome is therefore part of clinical and administrative decision making. Ultimately counselling and psychotherapy are committed to the systematic exploration of personal and lived experiences and to enable individuals make meaning of their personal and social worlds.