(c) Koshyk, Flickr

Depression is not always – and not just – about feeling sad. Depression can appear in many different forms.

For example, depression can leave you noticing that your behaviour has changed from how you usually lead your life. Perhaps just as surprising might be when when friends and family tell you that you are depressed, and yet you feel that you didn’t notice this yourself.

And there is the more recognisable forms of depression – feeling melancholy, sad, down, tearful, unable to get out of bed, feeling low and not being able to get on with your day.

Counselling may be helpful toward forms depression that are mental roots (eg through the loss of a love done and other life events) as opposed to more physical roots of depression that are managed and treated by your GP doctor.

Effecting one in three people at some time in their lives, depression is nothing to be ashamed or annoyed about.  Many sufferers feel that they are in a dark pit, become estranged from their family and friends, and some see no way forward or out of their state.  An experienced counsellor, such as Dean, will listen to your story, will listen to what’s going on in your depression and can assist you in in making helpful connections as to what’s going on.

Psychodynamic counselling helps to develop insight into your depression, and can reveal unconscious factors and conflicts that contribute to depressive symptoms.  The therapist can help gently reveal a client’s denial and oblivion toward their causes of depression.   Sometimes, it’s just the relationship between the depression suffer and counsellor that makes a world of difference in just a few sessions.

When depression lifts – it can feel like the sun just came out after a raining day.

Dean offers counselling in both Portsmouth and Chichester locations – make an appointment today.

(c) banoootah_qtr, Flickr

Couples Counselling.

Couples counselling can help with:-

• Sexual difficulties,
• Communication / misunderstandings / assumptions / accusations,
• Affairs,
• Heading towards a relationship breakup,
• Present life events (eg children – including first babies & teenagers, retirement, job loss/change),
• Medical diagnoses (eg HIV+, sexually transmitted infections, cancer etc).
• Impact of employment/unemployment,
• Ageing parents,
• Domestic abuse / violence,
• Separation/divorce,
• Step families & step children,
• Impact of childhood events,
• Illness,
• Bereavement

What’s on offer from the couples counsellor?

Considering couples counsellors who are systemically & psychodynamically trained, the couples counsellor does not attempt to “fix” the relationship for you nor offer instructions, that if the couple follow, will find that their problems go away.  This realisation can (initially) be a big disappointment for a couple who feel that they have exhausted all possibilities themselves and who are seeking professional help to “cure” them.

However, the couples counsellor does take on a role of being curious towards the relationship, learning about how the relationship came together, each partner’s individual history, the history of the relationship, asking about how things work in the relationship, challenging assumptions made by partners about the other partner, asking questions that address the functioning of the relationship and making (and encouraging from the couple) tentative hypotheses about how the relationship has come to function in the way that it does (the relationship’s “system”).

The intention of learning about the relationship system is to be able to challenge some of the couple’s perspective about their relationship, affording the couple newer opportunities to make alterations for themselves and helping them to communicate more successfully than previously.  By peturbing the relationship system, the couple are afforded newer ways of looking at things and can help them to choose what they would like to change having gained such new knowledge.

All of this counselling work takes place in a safe(r) environment (the counselling room) away from your home (although you can set yourself homework too, with the counsellor’s help, if you wish).  The counsellor is always present during the session.  Sessions are weekly and last for 50 minutes.

Checking if the couples counsellor is right for you (both).

It is good practice to check a couple’s counsellor’s professional qualifications and what professional body(ies) the therapist is a member of (see “Finding and Evaluating a Counsellor”).  You may also want to experience the counsellor’s style for a session or two, because all counsellors who are trained in a particular model of counselling do not all implement their practice in quite the same way.  A good counsellor will meet with the couple for an assessment – to discover the presenting issues, to discuss what the focus of the counselling work should be, and for everyone to determine if entering into couples counselling is right for everyone at this time.

Coming to counselling together … or …

Couples counselling works by offering counselling towards the couple’s relationship, as opposed to offering counselling to two individuals. Therefore, it’s advisable to come to counselling together.  If that is not possible, you might still seek a counsellor who would work with you both separately, or consider individual counselling to help you personally with your relationship problems.

Make an Appointment for Couples Counselling.

Send me a message to make an appointment or an enquiry for Couples Counselling.

A Role-played counselling session.

As part of a university project for Pete Allen-Worth, I was invited to be filmed performing some role-played counselling sessions.

We planned and recorded three demonstration sessions: (1) a display of integrated basic counselling skills, (2) asking only open-ended questions, (3) performing only reflective statements. The second & third videos are more geered towards counselling students, whereas the first is an appropriate “gives you a gist” of how counselling takes place. The part of the client is role-played by Liam Devaney.

Video: Integrated Basic Skills.

This is the first of the videos mentioned.

The part of the client (left hand side) is being role-played but I (right hand side) am working with real counselling techniques. This session is an example early session with a client – assuming that we have completed an assessment and have made a decision to continue into regular weekly counselling.  You may assume that both the client and counsellor have met at least once before.

The sessions lasts for just four minutes – a real session would last for fifty minutes and, for example, would likely contain more spaces for silences and thought than this role-play demonstrates.

(c) antwerpenR, Flickr

Introduction.

This is not meant to be a detailed formula regarding couple therapy, and no couple’s relationship – or problem – is quite the same as another, but as a very brief overview this post describes an overview of systemic- and psychodynamic-based counselling for couples.

Major aims.

Major aims for couple counselling would include:-

• Identify what we all agree the focus of the counselling should be.
• With the focus agreed, we begin looking at the couple’s relationship “system” … in other words, what’s happening in the way that the couple relates to each other that the couple believe is going wrong (or that one partner might think is going wrong, but the other partner disagrees).
• Encourage hypotheses – what do the couple think is make the relating “system” go astray and become unsatisfactory (initially the couple is helped by the therapist’s curiosity towards learning how the “system” works and how the problems arise – but the couple would be encourage to hypothesise for themselves).  Hypotheses can change quickly as more information about the system is learned.  Hypotheses do not need to remain static.
• Be curious with each individual’s past history … what might there be in each person’s history that might be getting replayed in this relationship.
• State the obvious – the therapist helps the couple to see how they behave with each other and react to each other.  Whilst this might be obvious to an onlooker, the behaviour may not be so obvious to the couple themselves.  This helps to provide more information towards the hypothesising activity.
• With working hypotheses, theorise on what triggers the system into becoming unsatisfactory, and theorise on how the triggers can be changed / shifted / perturbed.
• Continue the process of hypothesising, theorising and perturbing until sufficient change comes into effect that counselling can conclude.

If, during the therapy, a couple decides that they do not wish to stay together, then the therapy can move into preparing separation:-

• What needs to happen for the couple to separate?
• Who will be affected (children, family etc)?
• Does the law need to be involved (ie formal divorce or civil-partnership dissolution)?

Moving into a separation process does not necessarily guarantee that the couple will separate.  Separation can always be reversed if the couple wishes … even after divorce.  Couples counselling can (and does) continue during the separation process in order to help both partners separate satisfactorily from their relationship.

Domestic Violence.

If domestic violence is revealed in the assessment – or in the counselling work – then we will talk about stopping the violence immediately.

We will discuss the “Safety Plan”.  In summary: during a situation between the couple that may be leading to violence, one partner will take responsibility for leaving the room/leaving the situation.  The other partner will take responsibility for not following the leaving partner (the partners don’t need to decide beforehand which role they are going to take).  The partners will stay separated until such a time when both partners feel that it is safe to come back together.  Then can then have a conversation about what lead up to the safety plan being executed.  They will also discuss with the counsellor what happened when they next meet with the counsellor.  Whilst this sounds like a simple plan – and in essence it is simple – it can be very difficult for a couple to execute the plan.  In counselling we will discuss the plan in detail and discuss things every time the plan is put into action.

Relationship counselling can helpful but it can initially make things worse because we are perturbing with a relationship system in order to help re-build it more safely and successfully.  Disturbing a disturbed relationship can be very difficult for both partners.  Both of you must convince me that it is safe for you both to work with me in counselling – and discussing the safety plan is the main way we will achieve this.

Conclusion.

This has been a brief overview of the aims of systemic- and psychodynamic-based couple counselling.

(c) Lif..., Flickr

Cost of Private Counselling.

Counselling can be an incredibly liberating and helpful experience and when working with a qualified and experienced counsellor both together can make the client’s counselling journey worthwhile & therapeutic beneficial.

Private counselling is not free of charge.  My investment in your therapy is appropriately matched by my professional fees. I have set my fees according to my qualifications, experience & normalised within the areas that I cover: Portsmouth & Chichester.

• I am accredited by the British Association for Counselling and Psychotherapy (BACP) which confirms my ten+ years of substantial training, practical experience and adherence to the BACP’s code of ethics.
• I have qualifications in both individual psychodynamic counselling and couples systemic & psychodynamic counselling.
• I attend continued professional development workshops and training, which keeps my practice informed and up to date.
• I work with individuals and couples in both long-term and short-term psychotherapy.
• I operate a sliding scale on a limited number of places for those who choose private counselling with me over, say, going through their GP six-session counselling, NHS counselling waiting lists or waiting to go to a charitable counselling service.

Standard Fees.

My standard counselling fees are:

• Individual counselling: £45.00 / session*¹
• Couples counselling: £50.00 / session*¹

Notes:

• Fees are charged one session at a time, after each session, one session a week. This may help you budget toward the costs of your private counselling.
• The number of sessions may be an agreed fixed number of sessions with a particular focus (six or twelve sessions is common, for example), or an open-ended number (working until matters have been worked through), either of which will be discussed at the assessment.

Sliding Scale.

*¹ Sliding scale: For those whose income might make the full cost of private counselling fees a struggle to pay, I have a number of slots available to offer where I can discuss with you a reduction in fees (eg concessions and a ’sliding scale’). To discuss this with me, please first consider carefully what you could responsibly afford to pay weekly for your counselling and we will take up this discussion from there.

Compare the costs.

Taking a sample of professional fees for some random services available in the area may help you compare my fees with the costs of other services that you may be more used to paying:-

Cost Savings.

• The initial assessment session(s) are charged at the regular sessions rate. I do not add the additional costs incurred by post-assessment administration,
• No VAT is added to my fees … saving you 17.5% (equivalent to a £47.25 fee reduction on a course of six individual’s sessions and a £52.50 fee reduction on a course of six couples’ sessions).

How many sessions?

The number of sessions can be brief/time-limited (a set number of sessions discussed at assessment) or open-ended work (working on a personal focus as agreed at the assessment, rather than specific number of sessions).  Ethically, we will discuss either counselling method at the assessment and open-ended work does not tie you into counselling on an unlimited number of sessions – we will keep an eye on the progress of the counselling work & the effectiveness of our working relationship.

Cancellation Policy.

Because I offer regular weekly counselling and reserve your appointment for you each week I cannot make the session available for anyone else without sufficient notice.

Therefore, I operate a two-working-day cancellation policy.  If you cancel your appointment within two working days of the appointment (ie Saturday & Sunday not included) the session fee is payable.

How to pay.

Fees are payable weekly and can be paid using these methods:-

(in Portsmouth) by cash, cheque, debit card or credit card (a £1 credit-card processing fee is added to credit card payments. Debit card payments are free of this fee),

(in Chichester) by cash or cheque.

All sessions (including assessment sessions) are fifty minutes in length.

Make an Appointment

See my Contact Me page or click here to send me a secure message to make an initial no-obligation appointment for an assessment for counselling.

(c) Daquella manera - Flickr

Couples Counselling can help a couple to separate -  if this is what they wish to do – whether this is decided at the start of therapy or if such a decision is made during couple counselling.

It can be a common misunderstanding when couple counselling is considered simply as “a therapy to prevent a couple separating“.  This single point of view is not entirely true, of course, because some of the aims of couple therapy are much more complicated than a simple situation of staying-together-or-not.  Outcomes of couples therapy are at the (informed) decision of the couple themselves and not the therapist nor the intention of couples therapy in general.

Couple counselling is a therapy targeted toward the couple’s relationship, rather than therapy for two individuals in a relationship.  The focus of a couple’s therapy will be what the couple want to change about the relationship, their behaviour within the relationship and as a qualified couples counsellor and BACP accredited therapist, I have training, experience and supervision in working with couples whose chosen outcome for therapy is not staying together.

Therefore, in the assessment, a couple and I will discuss what the couple wants from counselling … and separation is a legitimate option for couples counselling.  Sometimes this decision is made at the beginning of counselling, sometimes it’s made during counselling.  Either is a legitimate option for couples therapy.

Separating / Staying together / Unsure?

I have worked with couples who wish to work to stay together, and with couples of wish to separate.  I have also worked with couples who, at the time of the assessment … and for several months after, did not know what they wanted to do with their relationship – and so part of the counselling was to discover what our focus for the therapy should be.

Also, the focus we agree upon in the assessment is not set in stone.  Sometimes, during the course of counselling, one (or both) partner(s) may change their mind … or find their voice … and begin talking about wishing to separate.  Vice versa, a couple wishing to separate can change their minds during the therapy.  All of these situations are legitimate and as a couples counsellor I can help facilitate a couple in discovering what they want to do with their relationship. And when mixed-agendas appear (partner “A” wishes to stay together, partner “B” wishes to separate) I can assist the couple in working with those differing agendas too.  When a couple change their mind and wish to change their focus of their work (ie separating instead of staying together, and vice versa) I can help a couple work with that change too.

Couple Counselling & Divorce.

Couples who have engaged in marriage or a civil-partnership may decide that they wish to formally separate.  Of course, solicitors will be involved for the legal matters but the couple can still meet weekly with me to discuss matters about their separation.

It is often the case that an individual wishes to leave a relationship by “saving face” … and there can be pressure to denigrate their partner (because doing so helps the individual to appear or feel better than the partner).  Couples counselling can assist with the separation processes so that both partners leave the relationship in a neutral (perhaps even friendly – though not essential) position.

Advice on Separating.

Couple counselling can be helpful when a couple decide to end their relationship and need help in separating out the emotions and building blocks that originally joined them together. My qualification is in systemic and psychodynamic couples counselling (similar to the training that Relate (ex “Marriage Guidance Council”) counsellors receive.

Therefore, I do not give directive advice on how to separate, but instead I help facilitate the couple in finding their own solutions to how they wish to separate. I do this by remaining neutral in the relationship and being curious about many things. This can help the couple in discovering new information about their relationship, how they operate, and how things go wrong.  With such discoveries, the couple can put into place difference behaviours that can be helpful in relieving some of the distresses of separating.

Are you thinking about Couples Counselling?

See my Contact Me page or click here to send me a secure message to make an initial no-obligation appointment for an assessment for counselling.

(c) Flickr / Wallyg

If you are a gay or lesbian couple in a relationship, you are having relationship problems, and you wish to work with a counsellor who identifies himself as similarly sexually orientated, then contact me, Dean Richardson, today to arranging a no-obligation initial session to see if gay couples counselling could be suitable for both of you. My contact details are here, or you can click here to send me a secure email .

Why a Gay Couples Counselling Service?

When I began setting up my private practice in Portsmouth/Southsea (and later expanding to include Chichester, West Sussex), I was aware that the last thing the areas I practised within really needed … was just another generic counsellor offering just another generic counselling service.

Notwithstanding that my qualifications and experience in individuals- and couples work allow me to work generically with all sorts of people and presenting problems, as a gay man, and beyond my general counselling service for gay and non-gay individuals, I have chosen to offer a counselling service specialising in working with gay couples whose relationship is in difficulty and who wish to work with a gay counsellor who is trained, qualified and experienced in helping couples resolve their relationship problems.

Why consider Couples Counselling?

Do any of these phrases sound familiar to you?

Gay Couple Relationships.

It is true that gay couple relationships have as many problems and issues to negotiate as any other couple relationship, regardless of sexual orientation.  So a systemic & psychodynamic approach to the couple therapy is useful no matter what the sexual orientation of the couple.  However, gay couples have a number of issues that other couples tend not to have:-

• Their relationship roles are not defined purely by their gender or their gender-stereotyping.
• Their relationship may require extra negotiation skills – requiring more openness in their communication skills.
• Family may not be able to help with gay relationship problems.
• Gay couples cannot marry – and some gay couples do not find the Civil Partnership to be a satisfactory equivalent.  Without formal commitment, gay couples can experience an extra burden when struggling to commit to one another.
• There can still be prejudice toward gay people – and gay couples – and living together as a couple may attract unpleasant attention.
• A gay couple may find entering therapy with a heterosexual therapist to feel problematic (whether real or not) & may prefer to work with someone of their own community.

Therapeutic interventions for LGBT relationships.

As part of my qualifications, I practice couples counselling using a combination of systemic and psychodynamic methodologies (plus some useful techniques borrowed from other therapies such as CBT and Gestalt counselling).  This allows me threefold:-

1. To therapeutically facilitate a couple in discovering behaviours and possible root causes of their chosen focus for therapy,
2. To assist the couple in hypothesising for themselves what could be done to creatively perturb the problems sufficiently to create a change,
3. To help the couple find lasting changes to the originally presenting relationship problems.

Working with one gay relationship – not two gay partners?

Therapeutically, when I work with a couple I work mostly with the one relationship as my client.  Thus, my contract is, in a way, with the couple’s relationship itself and less with each individual within that relationship.  I meet with the couple together (weekly) but when there is a difficulty in the couple meeting together we can discuss an alternative approach suitable and agreeable to everyone (for example meeting with the available partner and bringing the other partner up to date when they return).  Meeting with one partner, though, is not individual counselling and the therapy is still in the context of the relationship, not the individual’s personal problems in isolation.

Sometimes a couple come to therapy identifying that one partner “has the problem.”  Nevertheless, I will work with the both of you at the problem within your relationship – if you both agree – rather than to see the one partner in isolation in an attempt to “cure” them to the satisfaction of the other partner.

Problems in the relationship are within the relationship and needs the relationship available to therapeutically work the problems through to a resolution.

Domestic Violence.

If domestic violence is revealed in the assessment – or in the counselling work – then we will talk about stopping the violence immediately.

We will discuss the “Safety Plan”.  In summary: during a situation between the couple that may be leading to violence, one partner will take responsibility for leaving the room/leaving the situation.  The other partner will take responsibility for not following the leaving partner (the partners don’t need to decide beforehand which role they are going to take).  The partners will stay separated until such a time when both partners feel that it is safe to come back together.  Then can then have a conversation about what lead up to the safety plan being executed.  They will also discuss with the counsellor what happened when they next meet with the counsellor.  Whilst this sounds like a simple plan – and in essence it is simple – it can be very difficult for a couple to execute the plan.  In counselling we will discuss the plan in detail and discuss things every time the plan is put into action.

Relationship counselling can helpful but it can initially make things worse because we are perturbing with a relationship system in order to help re-build it more safely and successfully.  Disturbing a disturbed relationship can be very difficult for both partners.  Both of you must convince me that it is safe for you both to work with me in counselling – and discussing the safety plan is the main way we will achieve this.

The counsellor’s sexuality – does it matter?

Many therapists will agree that the counsellor does not have to have very much (if anything) in common with  a client in order to work successfully in therapy.  Although some clients may ask “have you been through this yourself” or “have you worked with other people with this problem” they are seeking assurances that their problem can be worked through – that is the important part.  For the most part I would agree that the counsellor does not have to identify with the client for helpful therapy to take place.  However, LGBT-identifying clients have also told me that when they have attempted to work with a non-LGBT counsellor they have found themselves reserved .. and sometimes unable to speak about matters that are strongly related to a LGBT lifestyle. I find that this concerns me for the clients.

Indeed, this particular issue may, or may not, be about the therapist themselves … but the fact is that the gay client needs to feel as though they can talk with the therapist.  Gay couples working with a gay couples therapist is part of the unique selling point of my practice.

Could your choice of counsellor, for example, appreciate the struggles and practicalities of an open-relationship?  Or discuss openly gay or lesbian sexual practices?  S&M?  Threesomes?  Keeping your relationship secret because one or both of you are not “Out”.  Or just the struggles of a plain vanilla relationship between a couple who happen to be homosexual?

See also “LGBT Counselling – Does the Counsellor’s Sexuality Matter?”

Arriving together and leaving … together … or separately?

Sometimes couples come to therapy in order to learn how to stay together.  Sometimes they come to learn how to separate.  This is no different with gay and lesbian couples.  If part of the initial therapy is to help you two decide what you wish to do (stay together or separate) then this is perfectly fine with me.

Should the two of you decide that you wish to stay together then I will help you work on how this can be achieved.

Similarly, if the two of you decide that you wish to separate then I can help you work towards separation.

Perhaps the two of you disagree on if you shuld stay together or separate.  I can help you work towards making this decision too.

How to begin gay couples counselling?

Initially we would meet together for an assessment.

The assessment allows us time to discuss the relationship problems, discuss finding a focus for our couples work, and then setting a contract to work together.

Together – or individually.

If, during the assessment, it was felt by all parties that couples therapy could not proceed at this time … perhaps because one or both of the individuals wanted to seek individual therapy, or domestic violence could not be worked with sufficiently to proceed with counselling  … then I would suggest making a referral to one of my other experienced colleagues.  Ethically, it would not be appropriate for me to work with the one individual in the relationship, only to later invite the other partner to return later to begin couples therapy.

If individual therapy was appropriate before couples therapy began, then after one or both of you had completed individual therapy, we can arrange for you both to return to couples therapy with me later.  This is a perfectly legitimate situation, if not unusual, because working through individual problems within the couple-relationship is also a perfectly legitimate therapy too.

It is also perfectly OK for a couple to be in couples therapy at the same time as one or both are in individual therapy.  This is because I will be working with your relationship, not you as individuals.  Individual therapy works with you as an individual.

Appointments.

I offer a weekly counselling appointments (rather than several times a week, or ad-hoc ‘drop-in’ sessions) – and both partners are required to attend each session.  On the occasion where it’s not possible for one partner to attend, the other partner may attend on the understanding that (a) the session will continue to be about the relationship (not the individual, or the other partner) and (b) that the attending-partner and I will inform the other partner about what we discussed.

(c) armigeress, Flickr

This is not an exhaustive list, but this post lists some of the problems that clients have brought to my psychodynamic counselling/psychotherapy practice over the years:

See also What could Couples Counselling help with.

(c) treesftf, Flickr

Introduction to Short-term, “brief” Psychodynamic Counselling.

In addition to open-ended counselling, Dean Richardson can offer short-term psychodynamic psychotherapeutic counselling to individuals where an assessment & both client & counsellor deem it appropriate to do so.

Short-term psychodynamic psychotherapeutic counselling is where the client and counsellor meet weekly for an agreed set number of sessions.  Each session lasts for fifty minutes, occurs once a week, and the whole therapy is limited to an agreed number of sessions (which may be between four to twelve sessions, to give an example).  The actual number will be agreed by mutual consent between counsellor and client.  The brief-therapy work concentrates upon a specific (and agreed) matter in the life of the client(s) and the therapy aims not to expand into other subject matters.  Expanding into other matters is more in the realm of open-ended counselling.

A Summary of Brief Counselling.

• Short-term psychodynamic counselling takes place within an agreed fixed number of sessions.
• The client and counsellor must agree a focus for the counselling work at the beginning (ie during the assessment).
• Although other matters may come up during counselling, these matters may need to be put aside (at least for now).
• The client must be motivated and focussed to do this form of therapy.
• The relationship between counsellor and client must be good to achieve this focussed work.

Benefits of Brief Counselling.

Some benefits of short-term, brief psychodynamic counselling work can include:-

• …the therapy lasts for a certain “known” amount of time,
• …the end date of the therapy is known at the start (which can be helpful on the focus of the counselling),
• …the client is aware of how much money the counselling will cost,
• …only a specific matter is worked with,
• …it can be useful to be able to measure the outcome of the counselling, although this is in no way essential or compulsory,
• …the rapport between client and counsellor is good, and therapeutically reliable (the client having had at least one beneficial relationship in their life)
• …uses client’s own insight into their problem,
• …works if the area of conflict can be agreed upon.

This approach (and, possibly, these limitations) can be beneficial to some clients. It is important, however, to realise that this approach is not suitable for everyone, and an initial assessment will be helpful in evaluating if this form of therapy could be helpful and in the client’s best interests.

Counter-indications for Brief Counselling.

The counsellor is responsible for judging during the assessment if the client is suitable for brief therapy or if such therapy may cause harm to the client (eg based upon the client’s level of functioning) when, instead, the counsellor may offer other forms of therapy (such as open-ended counselling).

Other counter-indications for brief counselling may include:

• The client is unable to focus adequately on one matter, instead requiring the time and space to make use of free association.
• The client is unmotivated to focus on a particular matter within the limited amount of time.
• It is felt by the client and/or counsellor that the client’s needs would not be adequately met by focussing upon just one matter.
• When setting a deadline to a psychological or emotional matter would be inappropriate (eg the client is motivated to select short-term work only because of costs or due to an EAP offering only of a fixed number of sessions, when the client’s needs are greater than that offered & beyond the therapeutic interventions available).
• The client’s ability or potential for insight is limited (insight = a kind of self-realization or self-knowledge).
• The client may be dependant on the counsellor for providing solutions, rather than be motivated to be an active participant  in their own therapy.
• From a psychodynamic point of view, the client’s defense mechanisms and resistance are too high/too ingrained to invite self-change during brief therapy.

The  assessment session will allow client and counsellor to discuss what is and what is not possible, and to reach a decision together as to whether short-term, brief therapy would be suitable as opposed to open-ended therapy.

See also “How long can counselling take”.

Introduction.

This post discusses how the use of a survey containing 34 questions (called “CORE-OM”) allows me to demonstrate that counselling can improve your distress; specifically your well being, symptoms, functioning and risk states (eg self-harm). Further, that these changes can become more permanent than simply temporary relief due to, say, simply talking through matters as you might with a friend or family member.

What is CORE?

The CORE Outcome Measure (CORE-OM) is a client self-report questionnaire designed to be administered before and after therapy. The client is asked to respond to 34 questions about how they have been feeling over the last week, using a 5-point scale ranging from ‘not at all’ to ‘most or all of the time’. The 34 items of the measure cover four dimensions: subjective well-being; problems/symptoms; life functioning; and risk/harm. The responses are designed to be averaged by the practitioner to produce a mean score to indicate the level of current psychological global distress (from ‘healthy’ to ‘severe’). The questionnaire is repeated after the last session of treatment; comparison of the pre- and post-therapy scores offers a measure of ‘outcome’ (i.e. whether or not the client’s level of distress has changed, and by how much).

For further information on CORE, including downloadable CORE forms, see the CORE-OM website.

How you and I can use CORE together.

CORE is an optional part of my counselling procedures – you do not have to participate if you do not wish to.  We can use CORE as part of our “tool-kit” to complement not only my training and experience, but also your own opinion of yourself, your life and your experiences of the counselling process. CORE is not a tool for a complete diagnosis. Rather, you might think of it a little like a room-thermometer – which might indicate if the room could benefit from the central heating being turned on … but, in reality, it’s the people within the room who will decide if they require more warmth.

The CORE survey takes about five minutes to complete, and is done in the counselling room.  When completed, I summarise the most important details and discuss with you what the survey reveals to us.  This can often be a useful source of topics to discuss in counselling.

Near to the end of our counselling work, another survey allows us to compare how you were then … with how you are now, and what has changed for you.  Of course, simply feeling better, recognising that your problems are much better and being able to get on with life is sufficient evidence for counselling, but having the CORE data can be useful too to compare levels of distress.

What CORE demonstrates about Counselling.

By using CORE, a client and I are able to demonstrate statistically that the counselling process is able to improve a person’s psychological well-being, symptoms, life-functioning and states of harm or risk.

For practitioners to assess meaningful improvement over the course of therapy, two measures are essential: reliable change and clinically significant change.

• Reliable change is change that exceeds that which might be expected by chance alone or measurement error, it is represented by a change of 5 or more in the clinical score.
• Clinically significant change is indicated when a client’s CORE score moves from the clinical to the non-clinical population (eg a CORE score of around 10 or below).

This page will be updated periodically with further anonymised statistics as they become available.