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About this book

Whilst assessment has long been central to the counselling process, with the recent moves towards evidence-based practice and increased regulation it is taking an increasingly pivotal role in service provision. This important new text helps clarify the nature and purpose of assessment in counselling. It explores the theoretical underpinnings of assessment across the core therapeutic schools and addresses critical differences in the meanings and importance deferred to it. It will be invaluable reading for all trainees as well as for practitioners wishing to gain a broad insight into therapeutic practice across the boundaries of the many therapeutic models.

Table of Contents

1. Introduction: Assessment Complexities

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

2. The Climate of Counselling

Abstract
In this chapter we attempt to lift counselling practice from its general context in order to examine the political aspects that affect the specific contexts in which the therapeutic relationship takes place; in particular, various aspects of power and the potential abuses of power, and the implication of these for assessment. Generally, abuses of power are assumed to be avoidable if the counsellor holds the ‘right’ values and adheres to a desirable set of ethical principles. Although aspects of counsellor values and principles will be discussed at various points in this chapter, we do not intend to promote a particular code of practice, largely on the grounds that ‘… the client is typically less concerned with these personal abstractions [values and principles] than with the personal and moral qualities of the practitioner offering the service’ (Ashcroft, 2001, p. 11, our emphasis).
Judith Milner, Patrick O’Byrne, Jo Campling

3. Assessment: What, When and How?

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

4. Psychodynamic Approaches: A Map of the Ocean

Abstract
In this and the following five chapters we will present a selection of established theoretical ‘maps’ or models commonly taught to and used by counsellors. These maps sum up the philosophy, beliefs about people and about problem causation as well as the approach to and method of helping. We set them out in a logical order that is based on their underlying view of problems and, along with O’Hanlon (1993), suggest that they have come in ‘waves’. As we said earlier, the first wave saw difficulties as pathology; the second was problem-focused, seeking to understand problems and their maintenance before attempting to solve them; the third was solution-focused, seeking to understand solutions, with little need to analyse problems.
Judith Milner, Patrick O’Byrne, Jo Campling

5. Transactional Analysis: A ‘Games’ Map

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

6. Cognitive Approaches: Handy Road Maps

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

7. The Person-Centred Approach: A Growth Map

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

8. The Narrative Approach: A Forecast Map

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

9. The Solution-Focused Approach: A Navigator’s Map

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

10. Integrative Models. Mixed Metaphors

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

11. Assessment Decisions

Abstract
Assessment is a crucial element in the power relations between counsellor and client. Whether or not a counsellor makes a formal assessment, he or she makes an important decision — to proceed or not. If the decision is to proceed with counselling, an assessment has been made that the counsellor understands the client well enough to calculate the likelihood of therapeutic success. If not, the counsellor decides either that the client will not benefit from counselling or refers the client to another counsellor or agency — most usually for specialist help. Thus the counsellor controls who has access to counselling, who will undertake it, what form it will take, and how long it is likely to last. Clients have no power over these issues, other than the power to vote with their feet. There is considerable evidence that clients do vote with their feet: drop-out rates from counselling have been estimated at approximately one-third (McLeod, 1998).This gives the client some say over how long counselling will last, but it does not give the client any power over access. As we saw in Chapter 2, clients with longstanding, intractable problems and those with multiple socio-economic difficulties are the least likely to be accepted for counselling; it is therefore possible that assessment as unsuitable for counselling may further oppress the most needy clients.
Judith Milner, Patrick O’Byrne, Jo Campling

Concluding Remarks

Abstract
Counselling is a process of constructing meaning within the ‘real world’ conditions in which we live, a reinterpreting of how things are for each and every client. In an increasingly available world of great diversity, we can hardly expect any one map to fit every client; we need many metaphors and vocabularies, perhaps many theories.There is a growing awareness that there has, perhaps, been too much focus on pathology: ‘Psychology is also about strength and potential’ (Seligman and Csikszentmihalyi, 2000), and how to understand and mobilise these qualities in clients. Those authors say that counselling is not just about fixing what is broken; it is about nurturing what is best: opportunity development. Assessment is therefore, at least in part, working out with the client what needs to be made better and how best that can be done, but also looking at what is going well and at how the client does that. But as no theory is a transcript of reality, even though it has something useful to say, no assessment can write the ‘truth’ about another person’s problems; only, at best, a storied version of things that may be useful in making progress. It may summarise old ‘facts’ or lead to new ones. We need, therefore, to focus on what will work for the client, not on explaining the world — however interesting that might for the counsellor, it is an unnecessary intellectual excursion.
Judith Milner, Patrick O’Byrne, Jo Campling
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