Recently Amanda Williamson, a respected colleague tweeted this;
— Amanda Williamson (@Amanda_Exeter) February 27, 2015
I cannot agree more, 1 in 20 feeling therapy had severe negative effects should be something everyone involved in the area is excised about. We should be looking at why, what we can do to change this. Some will no doubt argue that upon occasion therapy will leave you feeling worse. I warn clients the process can be like picking at a scab, it will hurt even while it is leading to healing and wholeness. However I think it would be irresponsible to dismiss all those who have negative experiences of counselling as belonging to this group.
So I considered what I could do, for it is no good to believe a situation is wrong, and then do nothing about it. One thing I think could help is if people felt more equipped when embarking on counselling. With that in mind these are some questions for a potential counsellor I would consider useful, based on my experience as both a service user and trainee therapist.
What qualifications do you have?
This may seem like a basic question but in the UK anyone can call themselves a therapist, counselor, life coach, or whatever permutation is fashionable this week. There are a number of different awarding bodies and ways to qualify. I do not want to say one is better than another, and indeed it would be wrong of me to do so, but does your therapist have a qualification from a reputable source? Furthermore what level of qualification do they have? Since writing this I have sadly observed in a number of online groups people setting up in private practice with the bare minimum. A good general rule of thumb is to ask if their course included a placement – somewhere they had the opportunity to develop their skills actually working with clients under close supervision.
Its probably worth saying something about online qualifications here. They are a valuable resource, a way for many of us to add tools to our therapeutic toolbox. However there is a distinct lack of oversight of online and distance learning. I would see someone who only had online qualifications, without the bedrock of a recognized counselling qualification, to be a red flag.
Are you registered with a governing body?
As I have mentioned anyone can call themselves a counsellor in the UK. However not anyone can join the organisations which regulate counselling and therapy on a voluntary basis. There is an explanation here of what this means by Phil Dore. The three main bodies for the regulation of counselling and psychotherapy in the UK are the BACP, NCS and UKCP. Reputable counselors will be governed by their ethical frameworks, and complaints procedures. This provides some protection to clients should they wish to make a formal complaint.
Why are you a counsellor?
This is something I would have never dreamed about asking before I embarked on training. Now I think it would be the very first thing I would ask. At the first whiff of “to help poor unfortunates like you” I would be putting on my coat and making a swift exit. Of course counselling is what we would term a “helping profession” but the idea of being a saviour merges all to often with that of being a guru. My response to this question would be along the lines of;
I find counselling incredibly rewarding.The privilege of being allowed into someones inner world, of walking alongside them whilst they work on issues which are often very intimate and challenging, being able to create the safe space where that work happens, its an incredible experience.
Hopefully in a first session a counsellor would have discussed what counselling is, in their view, with you. This might make this question redundant as their credo would make the answer clear. Red flags here would be people who put themselves at the center of the work and who emphasized help or advice.
Have you ever worked with X?
If you belong to a minority group it is OK to ask the counsellor if they have any experience of working with that group. Every counselor will say they are non judgmental and open minded, what that means will vary with usage. It is important to point out here though that previous experience is not necessarily a guide to good practice. Let me demonstrate with 2, hypothetical, conversations.
Client: Have you ever worked with non binary clients?
Counsellor; I am afraid not, could you explain what non binary means to you?
Client; Short explanation of their non binary gender identity.
Counsellor; OK, this is new to me, and I am going to have to go away and educate myself a bit. I hope we can still work together, and you will let me know if I am misunderstanding, or misinterpreting things. My first thought is that when I write up my clinical notes I usually only refer to clients by a pronoun. How would you like me to refer to you?
Client; Have you ever worked with non binary clients
Counsellor; Oh yes, I have worked with clients of all sorts of sexual preferences, I make no judgement on them, I think this can be a very good space to explore the issues around sexual orientation and of course it is a safe, confidential space.
These may seem like extreme examples, and some clients may feel that despite the congruence of the first example they prefer to find another counsellor who does have experience. The second example highlights that training in working with gender and sexuality divergent clients is limited. There is also widespread anecdotal evidence of therapists pathologizing certain sexualities and genders, seeing them as issues to be solved rather than facts about the client. For all we know our hypothetical client may be attending because their mother died, for job related reasons, because they suffer from OCD or a whole host of other reasons.
By asking this question, and observing the response, you are gaining an insight into how a particular counsellor will view certain things, the lens with which they look at the world. The decision of whether you wish to work with them can then be taken from a position of information and power. The example I have given is around gender, but people with disabilities, people of colour, sex workers, kinksters, and others report being seen as a label rather than a person by their therapist.
Do you attend supervision?
Again when I originally wrote this piece this is a question I did not even imagine needed to be asked. However there are people in private practice, and even working for large organisations who do not have a supervisor. In therapy the supervisor role is vital, since a third person cannot be physically in the room it is a way of ensuring our work is ethical, in the client’s best interest and our own.
So, five questions that I hope might give potential clients an insight into whether someone is the therapist for them, and might lead to fewer people believing the therapeutic process has led to harm.