Defining and Driving the Counselling Profession: Part 1
Defining Counselling: Part 1 of 3, as featured in Vol 23 No 1 Autumn 2022 of the Counselling Australia Journal.
By Larissa Dubecki
When Dr Sophie Lea arrived for her first session as a school counsellor 20 years ago, she found she had been given the cleaner’s storage room as her clinical space.
“I remember it like yesterday. It really does show how they just weren’t understanding the requirements that we need as therapists in the school space,” she says. “I tried to liven it up by putting a pot plant in there and an Eminem poster to appeal to the kids. Not coincidentally, my PhD ended up being on therapeutic space design.”
A Monash University lecturer in Counselling, as well as an adolescent and family counsellor, teacher, education wellness consultant and clinical supervisor, Sophie has witnessed significant changes in the counselling space over the past two decades.
“It was very unusual back then for school systems to even have counsellors, and I could see it was all about having psychologists and being able to do diagnostics and funding applications,” she explains. She has encountered all the myths about counselling over her career – including the view that the counsellor’s job is to ‘fix’ the client – but has cause for optimism after witnessing the profession assert its place in the allied health services while maintaining its own important identity.
“For me the core driver is around the gift and responsibility and privilege of being able to support others in their mental wellness journeys,” she says. “Counselling is a dynamic and courageous exchange with people who are sometimes at their most vulnerable. In my opinion, counselling explores the ‘how’ and ‘why’ of human existence in a safe, accepting and supportive environment. As I say to my students, counselling is all about heads and hearts.”
When differentiating counselling from other mental health professions to her students, Sophie asks them to envisage a triangle model.
“I place counsellors at the base of that triangle: we support clients with a wide variety of client issues such as relationships, aspirations of self-actualisation and, of course, mental health and wellbeing. Moving up the triangle, the client intervention becomes more specialised, with social workers and psychologists providing more targeted interventions, assessment and, when required, diagnosis. Finally, at the top of the triangle, we sit in the medical model, with psychiatrists and doctors able to assess and prescribe medication or referral to specialist in-patient settings for clients who require it. But there’s fluidity in that too; health care professionals may have training and experience on more than one level.”
She also draws a distinction between counselling and psychotherapy. “In my experience, the clear definition of counselling and psychotherapy has at times seemed murky – partly because some therapists, such as myself, would view them as interchangeable. The simple distinction I make is that counselling is usually more short-term in its intervention, it supports clients with conscious events and emotions and has a present-day orientation and impact; I see it as more pragmatic in its design. Whereas psychotherapy is a deeper exploration of a client’s life experience, it encourages further self-awareness and understanding of more entrenched patterns of behaviour and delves into uncovering unconscious understanding that empowers the client to facilitate lasting change.”
The road to accreditation
For Sophie and many of her students, counselling is a deliberate choice over psychology. “There is not just depth but also breadth to the work we do, which is one of the reasons I love the work so much,” she says.
A growing awareness and appreciation of counselling as an important part of allied health services is a heartening development for Sophie, but she finds all too often her Master of Counselling students are surprised that anyone in Australia can call themselves a counsellor.
“The lack of regulation in the counselling profession has created such a disservice to our profession over many years. It is something many counsellors have grappled with and been frustrated by. I am very grateful to have a membership to a counselling registration body, ACA, which sets required standards and champions our profession.”
The mental health burden of the pandemic on top of the complexity of the modern era – the corrosive effects of social media, for instance – has added weight to ACA’s call for qualified counsellors and psychotherapists to be included in the nation’s Medicare Benefits Schedule.
“The short-sightedness is what gets me,” says Sophie. “We have people who need support, who are suffering, and who don’t have the means to go private. The bottom line is it’s about humanistic intervention and support. It’s about the responsibility of putting our profession in a space where it’s recognised. There’s also the critical responsibility of doing no harm to our clients … how can we guarantee that without adequate training and being able to adhere to ethical and professional guidelines? It’s a no-brainer for me and it’s completely antiquated.”
Jim Schirmer (pictured), an associate lecturer with the University of Queensland whose research specialises in the professional identity of counsellors and counselling, argues that an advanced mental health system would recognise the complementary strengths of the range of professions involved. “In such a system, I think counselling would bring some distinctive theoretical, philosophical and practical strengths,” he says. “Practically, counsellors not only deal with mental illness, but also are particularly well-trained in non-pathological areas of human difficulty. When I compare counselling training programs to other mental health and human service professions, counselling training includes not only mental health, but also common areas such as grief and loss, relationships and families, crisis counselling, domestic violence and health. In this way, counsellors have the capacity to see clients across a very broad range of human needs.”
This raises the question: should counsellors play a role in hospital and emergency department settings – and conduct diagnostic tests if they are appropriately trained?
For Sophie, the integration of counselling services in healthcare settings makes perfect sense in light of the current mental health crisis. “I think counsellors could play a vital role in this area, triaging clients and working alongside healthcare professionals to reduce the current demand for mental health services and implement much-needed mental health support in a timely manner,” she says. “With the current pandemic, I remain concerned about the wait times clients are experiencing to be able to see allied health professionals. It’s unacceptable, particularly when there are thousands of qualified and experienced counsellors willing and able to play a part in supporting our community.”
Jim, however, cautions that formal diagnostic measures and tests might be at odds with the humanistic strengths of counselling.
“If the question is whether counsellors could conduct formal diagnostic tests, the answer would be a qualified yes. Currently, counsellors are rarely trained to conduct such assessments, but there would be no reason at all why they couldn’t be trained and assessed as competent in any formal diagnostic measure,” he says. “A diagnostic assessment can be valuable for its ability to provide a valid counterbalance to the counsellor’s subjective judgements, as a system-recognised means of accessing support, and as a validating experience for the client’s distress. That said, there are also several arguments for the limitation of diagnosis. Humanistic therapies would caution us from any reductionist account of our clients’ experiences and postmodern therapies would remind us that any discourse is only one socially constructed version of reality. More broadly, though, there would be forms of helping that would be beyond our definition. Something may be helpful or therapeutic but still not be practiced by counsellors. Psychiatric medication would be an obvious example of this. Similarly, a musician or a remedial masseuse may bring about therapeutic ends, but we would not call them counsellors. Therefore, counsellors should be proud of their broad and effective scope of practice, but also happy to know the limits of this and be willing to acknowledge the therapeutic work that others do.”
To the future
Ask Sophie where she would like to see the counselling profession in five years’ time and the answer is simple: “I’d love us to be regulated, number one. I’d love governmental systems to be able to recognise the important role we can play in supporting us through and around these trying times globally … that we have a really strong skillset to offer.”
So how is that achieved? Further resourcing in this space is crucial, enabling clients to access services in a variety of ways that might suit their individual requirements: “Not just in cities but in regional areas as well. Let’s think about the telehealth space and how we can appropriately facilitate that, let’s think about psychotherapists, let’s think about creative arts therapists and animal-assisted therapy as well as counsellors – those different delineations of therapeutic support and intervention.”
Overall, she hopes to see the counselling profession continue to commit to its professional standards and responsibilities, guided by a scope of practice and ethical guidelines, and not lose sight of the expert skill sets counsellors have in facilitating a safe and purposeful therapeutic relationship with a diverse range of clients.
“That’s where I’d love to see our profession heading and I think we have the training opportunities, experience and passion to do it.”