Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma

Unit 1: Using Information, Communication and Technology ICT in Counselling Studies

Information, communication and technology (ICT) comprises core skills for learning. In this distance learning course utilisation of methods, tools and strategies of ICT is important in order to establish and maintain a sound working relationship with tutors and the college.

Students will need to develop ICT skills in order to communicate effectively and maximise their study progression.

The first unit in this Level 5 Diploma in Counselling Studies course explains how to set up an ePortfolio which students will use during the lifetime of the course for storage of all their files including coursework, self-assessment activities, independent research notes and reflective journals. The ePortfolio may be requested from time to time by tutors and moderators. Students will be asked at various points in the course to upload files for this purpose. The ePortfolio will not only provide students with a structured system of unique information but once completed can be used as a resource for continuing professional development (CPD), and a body of revision for future studies.

Independent research is fundamental to level H5 study and also equips students with confidence to source and evaluate information relevant to the core course topics.

In this first unit students are presented with tools and strategies with which to begin to undertake independent research and integrate this into coursework activities, for example suggesting ways to read research articles and assimilate types of information from these.

The development of knowledge and understanding through writing skills is important for communicating ideas and arguments to tutors and other readers of written work. Therefore this unit reviews writing skills, and incorporates reflective writing into both the course and coursework activities. Reflective writing is a way that individuals can review their own approaches to learning and communication; and it also promotes pro-active implementation of skills enhancement through tutor feedback and self-assessment

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 2: Introduction to Counselling Part 1

In this next unit on the Counselling course we will be looking at the general approaches and applications in counselling. In subsequent units we will be looking at specialised applications and areas, together with additional skills requirements for these fields.

The counsellor is neither a friend or parent substitute, therefore is not in a position to act as advisor or teacher. Counsellors should also avoid being seen as a healer or mentor. These guidelines are quite difficult to adhere to as it is easy to get drawn into an overly personal conversation or relationship, especially if the client visits regularly. However, this is not the role of the counsellor and will inevitably jeopardise the client-counsellor professional relationship.

Counselling developed from theories and practices of psychology and psychiatry. This unit looks at some of the more well known people and theories, and show how these developed into the counselling approaches used today.

Some of the key people responsible for the development of humanist psychology were Rogers, Maslow, Buhler and Jourard. They all shared the vision that within the field of psychology there was a place and role for human inspiration, growth and choice. The person-centred or humanist approach to counselling consists of many theories and working models integrated and entwined, but the main emphasis is always on experimental processes rather than focusing on regressive experiences. These experimental processes are very much grounded and centred within the present.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 3: Introduction to Counselling Part 2

The psychodynamic approach (or model) refers to the action, changes or what is going on in the mind, which influences everything we do in life.

The basis of the theory as previously discussed, is that an individual’s personality and consequent behaviour are based on, and influenced by the Id, Ego and Superego (first identified and theorized by feud).

The person-centred approach to counselling has evolved over a long period of time through the desire to adopt a non-directive way of working with clients. It is now established and accepted as mainstream therapy.

Counsellors are the observers of people’s innermost thoughts, feelings and experiences; in addition to which they are party to intimate details of their lives which no other person may know. Therefore as keepers of this information, counsellors are bound by ethical codes and it must be clear that information disclosed during therapy sessions is confidential.

It is usual for people to think of counselling as a face to face process but in today’s modern world and with the advent of complex communication systems there are other ways of participating in therapy. Distance counselling by telephone or email is growing in use and popularity as it gives the client more control with regards to the timing of sessions and the length. However, it must be said that there is difficulty with distance counselling of building and maintaining the interpersonal bonds discussed earlier; although by virtue of the client choosing this route, it may have positive outcome benefits as it is something that they are willing to do rather than being anxious about face to face meetings. Often the anonymity of email and internet interaction is less inhibiting for people.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 4: Child Counselling

Dealing with children and adolescents in the therapeutic environment requires special counselling skills and strategies. Children are often not prepared to communicate freely and this could be due to a number of factors such as shyness, fear of the unknown, loyalty, lack of confidence, lack of expressive vocabulary etc.

Children need to have very clear goals and these should be integrated with expectations. Goals should be small and frequent so that interest and motivation is maintained.

As discussed previously, transference could be described as the process by which the relationship between client and counsellor develops to such a degree that the unknown world of the client is no longer a closed secret. The relationship changes to being one of two people in a world outside of the therapy environment. In child counselling, transference has occurred when the child behaves towards the counsellor as though they were their mother or father. This happens because the child is convinced that the counsellor has similar attributes to their parent/parents and therefore projects beliefs onto them. This transference can be either positive or negative depending on how the child views the counsellor and what characteristics appear similar.

The initial assessment prior to commencement of child counselling is quite complex. This will be discussed within the unit.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 5: Relationship Counselling

Clients may seek relationship counselling with varied knowledge and perceptions of what it exactly entails including format and expectations. There may also be disparity in the willingness of clients to participate.

Resolution strategies for couples that display splitting and projection tendencies are mainly focused around encouragement of the breakdown of ego-syntonic situations, in other words help the clients to view the extreme life patterns as a creation of the relationship problems; they need to recognize that it is acceptable to have mixed, different and even opposing feelings about things than their respective partners. This unit explores the related theories and models and explains strategy development in different relationship scenarios.

In a previous unit we met the attachment theory. Here we meet it again in the context of relationship attachments.

Bowlby’s original theory of attachment was designed to help understand the intense distress experienced by infants who were separated from their mothers or caregivers.

Human beings begin to experience loss from the moment they are born: leaving the comfort of the womb, going to school, leaving home for the first time. These losses or ‘leavings’ eventually culminate in the greatest loss a human being will experience, which is leaving life itself.

Loss therefore and not surprisingly results in powerful and emotional feelings which are expressed through behaviour. Some of these feelings are of loneliness, being experienced by all age groups, even babies who feel this keenly when they are left alone; hence they quickly learn that crying brings human attention and comfort. As humans grow, they become accustomed to periods of being alone but childhood experiences have a great influence on the way in which adults subsequently deal with loss situations. The unit explores these concepts.

Triangulation in relationships has its origins within the oedipal complex and has been recognised as part of developmental issues which affects emotions throughout every stage of life. The whole relationship needs to be normalized so that exclusion is no longer an issue and clients can understand the nature of triangulation.

The unit concludes by looking at models and approaches within relationship counselling and discusses the specialist skills that relationship counsellors need to develop.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 6: Family Counselling

Family systems are unique socially structured units which have numerous avenues of membership and combinations of components. Within families there are definitive roles to be fulfilled by each member

When individuals ‘differentiate’ from the family origins, problems associated with this new and independent life can cause problems such as various psychological disorders, addictive behaviour, poor career prospects and even crime.

These negative problems can happen if the leaver is not mature enough to be independent, has not achieved a reasonable level of education, or if there was bad feeling within the parental home at the time of leaving. During the pre marital stage of the lifecycle, individuals begin to subconsciously select a partner or ‘mate’, and this selection is normally based on physical attraction together with having interests in common etc. As relationships deepen and develop, bonds are forged and compatibility is established; if sufficiently strong powerful these bonds can result in long term commitment.

The fragmented family is a growing alternative to the traditional structure. Step families through second marriages are now commonplace, and single parenthood is accepted as part of modern society.

There are many concepts and working models related specifically to family therapy. Most are derived from traditional approaches and research outcomes. This unit will explore these in some detail

Interventions are specific to cases and clients. It is therefore imperative that the counsellor has correctly assessed the situation, and identified the main areas and people of concern before continuing with the programme. These interventions are described and explained.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 7: Bereavement Counselling Part 1

Bereavement brings unexpected inner feelings, and even if death of a loved one was expected or planned as in assisted suicide, these emotions will still be unpredictable. It is impossible to predict or anticipate individual response to loss, or the time it will take to go through the grieving process. In some cases it may never be complete.

During this unit, the grieving process will be examined in some detail, and in addition to this, specific circumstances of loss will be covered. However, for the counsellor, skills, experience and theoretical knowledge can only be a small preparation for the enormity of sadness and emotional tragedy that may be expressed by bereaved clients during therapy sessions. Transference of the sense of loss and depth of emotion may occasionally occur, and even cause anxiety about personal mortality. This is something to be aware of when undertaking bereavement counselling.

Human beings begin to experience loss from the moment they are born: leaving the comfort of the womb, going to school, leaving home for the first time. These losses or ‘leavings’ eventually culminate in the greatest loss a human being will experience, which is leaving life itself. Loss therefore and not surprisingly results in powerful and emotional feelings which are expressed through behaviour. Some of these feelings are of loneliness, being experienced by all age groups, even babies who feel this keenly when they are left alone; hence they quickly learn that crying brings human attention and comfort. As humans grow, they become accustomed to periods of being alone but childhood experiences have a great influence on the way in which adults subsequently deal with loss situations.

It is necessary to look at all circumstantial losses as a possible precursor to grieving. Most losses will involve some form of grieving by people, depending upon their personality type, emotional stability and numerous other social and environmental influencing factors.

From as far back s ancient civilizations such as Greece and Egypt, through archaeological finds, tomb writings and research there is evidence that complex rituals and beliefs surrounded death. There is also strong evidence to suggest that people from such civilizations held beliefs of life after death in some form, and this expectation of further life must have affected how people dealt with death and bereavement. This positive view of death is obviously applicable to modern cultures where there is a similar belief.

When counselling the bereaved it is important to take into account the social and cultural aspects of their lives as this will have direct bearing on the individual’s grieving responses and process; this can make it extremely difficult for the counsellor to be empathetic and understand their needs

In order to understand what happens during the bereavement process, the theories and models must be understood in order to have some framework around which to base the counselling practice. This unit explores theories and models of bereavement.

It is accepted that counselling the bereaved helps to reduce anxiety levels and symptoms of post-bereavement illness. Bereavement counselling is often carried out using the person-centred approach, components of which are: empathy, unconditional positive regard and congruence. This unit describes the skills required to deliver effective bereavement counselling.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 8: Bereavement Counselling Part 2

Suicide

There are many additional problems that the bereaved of suicide victims experience.

They also experience acute feelings of vulnerability having faced what they perceive as the ultimate rejection. Factors such as the age of the deceased and the quality of the relationship between them and the bereaved are key factors in how the grieving stages progress and the outcomes. It is important to mention the risk of suicide after bereavement occurs as this scenario further complicates the subsequent grief process of the bereaved. There are various tables, charts and scoring systems to assess the suicidal intent of people. Within the field of counselling you may well come across clients who exhibit these intentions, or whom you suspect are contemplating the act of suicide.

Bereavement through war, terrorism or violence

Following a bereavement where the deceased was a victim of an horrific or violent death it is suggested that the grieving process can be particularly difficult. The following are some of the probable causes of this:

• The bereaved will be continually searching for reasons of the death and answers to questions.
• They will be desperate for every minute detail of the accident or attack, and may even appear to have an unnaturally macabre interest.
• They will want to establish the role the deceased played in the occurrence, for example if they were killed in war; were they involved in a particular attack or mission, if they were killed in a disaster were they involved in the rescue of others. This is particularly relevant to those in the emergency services. Relatives need to associate meaning to their loss.
• The absence of remains or body leaves an uncertainty of death.

The unit explores these contexts and presents description of counselling approaches and skills

A range of other bereavement contexts are explored such as disenfranchised grief, death of a parent etc.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 9: Addiction Counselling Part 1

The term ‘addiction’ is useful but needs clarification between what is positive or beneficial addiction and what is negative and harmful addiction. There are currently two definitions: the traditional which means being completely ‘given over’ to an activity and can refer to anything from love to gambling; the definition has never been solely associated with drug or alcohol abuse. The second definition of ‘restrictive’ addiction emerged during the 19 th century in response to the temperance movements. It has no scientific basis but describes those who are in the grips of harmful substances with associated levels of tolerance and withdrawal.

Clearly there is a path from dependence to addiction. During this stage the ‘user’ can stop but abstinence may result in relapse. The effects of drugs are either short term or long term and can result in neurological changes. Human addiction is a mixture of biological, social, political and cultural factors, not only emulating current trends but also being dependent on availability, legislative controls and public opinion. Further contributing factors are family history and predisposition via psychological factors.

This unit presents anatomy and physiology relevant to addiction and addictive processes and explores the counselling remits within this field of work.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 10: Addiction Counselling Part 2

This unit continues to look at addiction how to counsel those with alcohol addiction and discusses some of the traditional methods used such The Cycle of Change and The Twelve Step Approach

The unit draws further comparisons between approaches and outcomes, and looks at the tools available within the counselling skills remit to address possible problems. For example, if the client is having withdrawal symptoms they may already be on medication. If they are not then the counsellor should advise them to seek appropriate medical help or refer them directly.

Negotiation of realistic goals and drinking reduction programmes if essential. If they are not achievable the client will undoubtedly fail and this could be detrimental to the whole counselling programme.

Clients need to have their self-belief encouraged and nurtured. There are positives in everyone’s lives and this may be a starting point in order to focus them on areas of positivity.

The unit culminates with discussion of a range of other addictions such as smoking, gambling and shopping and identifies key strategies for each one in order to meet the client needs within counselling contexts.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 11: Addiction Counselling Part 3

Nicotine has been ranked alongside heroin and cocaine with regards to addictive properties (Royal College of Surgeons, 2000). Nicotine has effects on the neuro-transmitter levels in the brain similar to the aforementioned drugs, and it is therefore the nicotine in cigarettes which is addictive. However, there is some controversy over the apportionment of psychological addiction there is attached to smoking, for example as a habit, something to do with your hands, social connections etc. The therapy of choice is dependent on client personality and preference. If there are underlying problems which are causing increased smoking for example, then an integrated approach may be indicated.

About six percent of the population will have a gambling problem at sometime during their lives. The incidence of gambling is rising which is probably a result of increasing opportunities to participate in it.Uncontrolled gambling can result in financial and relationship problems, and even attempted suicide in some extreme cases. According to research, pathological gambling is more prevalent among men, ethnic groups and lower socioeconomic groups. Treatment involves individual counselling, and group therapy in order to facilitate client control over their habitual behaviour, and also to address the consequential or underlying issues.

Obesity is a growing problem in the developed world and one of the major contributing factors to this problem is diet. Some researchers are convinced that addiction to sugar and fat acts on the brain in much the same fashion as opioids

Like an alcoholic unable to stop drinking, sexual addicts are unable to stop their self-destructive sexual behaviour. Family break- ups, financial disaster, loss of jobs, and risk to life are the painful themes of their stories.

The unit explores these kinds of diverse addiction as well as other less known ones and presents suggestions for counselling approaches and strategy development

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 12: Debt Counselling

People can get themselves into debt for a multitude of reasons: overspending, loss of employment, divorce or bereavement, change in personal circumstances etc. In many instances the debt is unforeseen and to a certain degree, out of the individual’s control. Of course, overspending can be described as free will or personal choice; spending money that you don’t have, or cannot easily pay back is a conscious decision. However, sometimes these decisions are based upon sound economic assumptions and then something unavoidable occurs to negate them.

Some debt is very difficult to control, for example credit card balances where the interest repayments far outweigh the capital paid, and therefore balances continue to rise even when spending on the card has ceased. Further in the course we will be looking at the legal ways to control this, for example by IVAs and bankruptcy; however, these are last resorts and much can be done to help people change their behaviour and view money in a completely different way. Once a person is in control, their debt is often manageable.

Although we are a society of debtors, we still stigmatize those who fall prey to the downward spiral of spending and debt. This is a strange phenomenon as one would assume that sympathy and empathy would be the appropriate stance to adopt. However, just like any other addiction, money becomes the enemy and attracts negative responses.

It would be fair to say that we all have some prejudices with regards to debt; this is quite normal. As long as the counsellor is aware of personal opinions and preconceptions they may have, then these issues should not hamper successful delivery of counselling to these clients.

The role of the counsellor, as always, is one of facilitator.

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 13: Introduction to Cognitive Behavioural Therapy (CBT)

CBT is specific to the problems within and concerning the individuals life therefore it should be stressed that other problems outside this context cannot be dealt with at the same time. Of course there should be flexibility and common sense applied to each individual case.

The therapist should make an assessment of the client situation prior to commencement of sessions. Their problems and requirements should be included within this assessment, and it may well be that this process takes the form of the first session depending upon individual working practices.

Establishing an agreed programme of therapy with clients and elicits commitment on both sides. It also protects the therapist from financial loss if there is a contracted agreement in place. This, of course depends on business practices etc.

The clients need to be aware that in order for the therapy to be successful they need to have input which is external from the sessions. This is usually in the form of homework or tasks which are designed to help them implement changes or new concepts between sessions.

Clients will be particularly concerned with regards to confidentiality and it is the therapist’s role to ensure that the absolute condition of confidentiality is conveyed to them and adhered to. The codes of ethics of associations, professional bodies etc. are there for the purpose of clarification.

When individuals present for CBT, they may have been referred from other professionals or services as well as self-referral. For example:

• Social services
• GP
• Hospital
• School

The unit also covers client assessment, case formulation and approaches within CBT

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 14: CBT: Interventions Allied to Techniques and Individual Problems

The relationship between beliefs, thoughts and behaviour is central to the accurate understanding of emotional problems within a CBT situation, not least because the way we behave is a product of our experiences. These behaviour patterns are then reinforced, especially is our experiences act as the reinforcer.

The unit specifically deals with:

• CBT and depression
• CBT and obsessive compulsive disorder
• CBT and PTSD
• CBT and panic disorders
• CBT and phobias and fears

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 15: CBT: Internal and External Contributing Factors

Researchers believe that personality may play a role in the development of an anxiety disorder, noting that people who have low self-esteem and poor coping skills may be more prone. Conversely, an anxiety disorder that begins in childhood may itself contribute to the development of low self-esteem. This could therefore be viewed as a cyclical process or mechanism. Those who live with high levels of anxiety will tend to focus solely on their symptoms of anxiety or negative stimulus, often looking for negative stimulus that is not there, or perceiving situations out of context.

Researchers believe that the relationship between anxiety disorders and long-term exposure to abuse, violence, or poverty is an important research area and these exposures may directly contribute to raised anxiety levels, and an individual’s susceptibility to these disorders

It has been suggested that there are particular experiences, including heredity that can result in developing a predisposition to developing high levels of anxiety or an anxiety disorder.  Once this predisposition has been established, there are definitive environmental situations and factors which precipitate or contribute to, precipitate high levels of anxiety

This unit explores these factors and presents approaches and strategies within CBT to address them

Level 4+5 Accredited Therapeutic Person-Centred Counselling Diploma Unit 16: CBT: The Intervention Approaches

If one accepts that maladaptive behaviour patterns (due to irrational thoughts or beliefs) are the result of previous reinforcement of some kind, then the behaviour is a conditioned one. Therefore these patterns should be able to be reversed by using the same processes, in other words by using reinforcers or conditioning. The following are some interventions which are used in the reversal process:

• Increased expectancies through observational learning.
• Self-instruction to alter expectancies and outcomes.
• Recognition of maladaptive thoughts and beliefs, and adjustments.
• Rejection of negativity.
• Confronting stressors.
• Relaxation and focusing exercises.

This unit explores these interventional approaches and discusses specialist professional skills requirements for effective delivery of the programme