The Collison Newsletter August 2006

                   SUPPORTIVE COUNSELLING*

Definition: ‘Supportive Counselling’ is a therapeutic approach aimed at facilitating optimal adjustment, in particular to situations of ongoing stress such as chronic physical illness. 

Counselling / Psychotherapy 

 

‘Counselling’ or ‘Psychotherapy’ can be used to refer to all forms of psychological intervention.

 

The term counselling is often used interchangeably with psychotherapy.

 

‘Psychotherapy’ tends to lie in the province of Psychiatrists, who deal exclusively with mental illness and disease. Their work is frequently combined with prescribed medication, and is linked to different schools (eg Freud, Jung, Wolpe, Glasser) and is of different types (eg cognitive, humanistic, existential, behavioural). Outside of this speciality, psychological intervention is most commonly referred to as ‘Counselling’.

 

Mental health problems can have psychological, social and/or somatic dimensions. These issues often make if hard for people to manage their lives and achieve their goals.

 

Psychotherapy is directed at these problems. It attempts to solve them, or help people themselves to solve them, via a number of different approaches and techniques. The purpose and goal of these techniques is to improve mental health, and resolve emotional or behavioural issues of individuals, family members or a whole family’s interactional climate.

 

Counselling, likewise, aims to achieve the same end results.

Supportive Counselling / Supportive Psychotherapy

‘Supportive’ counselling/psychotherapy is a widely used approach employed by many different health professionals in both mental and physical health settings.

Supportive counselling/psychotherapy is used to facilitate optimal adjustment, either to situations of ongoing stress, such as chronic mental or physical illness, or in acutely stressful situations as, for example, following bereavement.

Such supportive therapy may consist of a large number of regular (for example weekly) contacts. These sessions may be brief, or more structured up to an hour, over a long period of time. Or supportive counselling/psychotherapy may consist of a few extended consultations (several hours) over a relatively brief period.

Supportive counselling/psychotherapy involves the use of many and varied psychological techniques.

In brief, and perhaps over-simplified, ‘Counselling’ refers to a specific form of client-centred treatment, originally devised and adopted by Carl Rodgers. ‘Psychotherapy’, in contrast, is often taken to be synonymous with forms of treatment derived from psychoanalytic models of understanding of human behaviour.

The word ‘counselling’, today, tends to imply a less interventionist approach based on listening skills which draw out the subject, rather than confronting or challenging them, although this is done when and if necessary – but not as the primary intervention.

‘Clients’ are counselled and receive supportive counselling. Psychotherapy, supportive or otherwise, as a method of treatment, involves ‘patients’.

Because of the sensitive topics often discussed in both supportive counselling and supportive psychotherapy, therapists are expected (and may be legally bound to do so) to respect client/patient privacy and client/patient confidentiality.

Supportive Counselling

Supportive counselling draws on the supportive aspects of the therapist-client relationship in order to maintain effective coping in clients whose level of psychological functioning is precarious. It is a palliative form of treatment where the therapist attempts to make the individual able to bear their problems better, especially if the underlying cause of the problem (for example, chronic back pain, due to injury or due to degenerative disease of the spine) is chronic and continuous. In this form of counselling, the client is encouraged to talk about the problems, for example guilt or anger, and is taught coping mechanisms and strategies to restore quality of life.

What are the Practical Components of Supportive Counselling?

Support is the central technique in this form of therapy. Many factors relate to this support and include:  

·       Empathy

Empathy is a vital component of therapy. If the therapist has the capacity to feel the client’s experiences, ie to perceive what is being experienced and communicate this sensitivity, then the client is more likely to feel and be relaxed, as well as feel accepted by the therapist. This includes sympathetic listening.

·       Sympathetic Listening

Sympathetic Listening, combined with empathy, leads to an intense confiding relationship.

·       An Intense Confiding Relationship

This relationship allows ventilation and expression to take place.

·       Ventilation and Expression of Emotional Material

·       Encouragement

Encouragement is given by stressing the client’s strengths and capabilities. This serves to increase self-esteem and helps to prevent demoralisation.

·       Explanation and Education

Explanation and Education are provided to increase understanding of the client’s situation. This is especially important if there is misunderstanding of certain issues relating to health or circumstances. To know and understand, for example, why pain occurs, how it comes about, and how it can be controlled, is an essential element in the coping process. This is coupled with appropriate reassurance.

·       Reassurance

Reassurance can boost self-confidence and hope. Also needed, and an integral part of supportive counselling, is guidance.

·       Guidance

Guidance may be covert or open and direct. It involves giving advice usually with reference to a specify problem, such as when to seek help, get a second specialist opinion concerning, eg a chronic physical problem. Especially is guidance important when particular obstacles have to be faced or decisions have to be made.

·       Practical Help

Practical Help is often required to assist in bringing about behaviour modification.

·       Behaviour Modification

Behaviour Modification – so-called Cognitive Behaviour Therapy. Change (in behaviour) requires identifying the ‘from what’ (ie what needs to be changed, that which is unacceptable) and the ‘to what’ (ie the desirable end result). Once the ‘from what’ and the ‘to what’ have been identified, supportive counselling helps to bring about the change.

Other Relevant Aspects of Supportive Counselling 

The Health Professional’s role in supportive counselling is to be a sympathetic and reliable listener, an encourager, educator, reassurer and guide.

 

In addition, there has to be the ability to deal with feelings of frustration or hostility in the client when directed towards to the therapist. Also the therapist is unlikely to be exhausted by the client, or provoked to anger, if he or she has a psychological understanding of the reasons for the client’s behaviour. A good therapeutic relationship always requires in the therapist an attitude of respect to the client as a person.

 

There is always a risk of dependency on the therapist. It is important for the client to have active participation in the decision making concerning the duration of treatment – supportive counselling – and this means that, knowing the length of treatment, the client is not shocked, or angry or upset when treatment comes to an end. In some situations, however, supportive counselling may, correctly and with continuing positive results, be ongoing, ie long-term into the future.

*Copyright 2006: The Huntly Centre.

Disclaimer: All material in this newsletter is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.    

   

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