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BACP Senior Accredited Counsellor

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The importance of choice in therapy

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Choice has recently become a mantra which is loudly chanted in an increasing number of locations.  Whether we are considering hospitals, schools or energy companies, there is a loudly and now oft repeated suggestion that true satisfaction will only come about when the user is able to exercise choice.

Yet not everyone seems to buy into this idea.  On that unfortunate day when an arm is broken or when the electricity supply fails, it seems that many people are happy just to have things quickly fixed.  But what of the counselling world?  How important is choice when it comes to selection of therapy? There are some who will argue robustly for the importance of variety and choice in counselling and there are some very good reasons for that.

Counselling or therapy is for the most part a voluntary activity.  Clients usually walk into my counselling room in the outskirts of Basingstoke in Hampshire because of a sense that the time is now right to do something.  I often see a mix of bravery and desperation reflected in that initial walk.  Bravery because it is not always easy to talk to a stranger about personal and intimate aspects of life; and desperation because the counselling room can for some represent the place of last resort.

Yet despite the constancy of this mix of bravery and desperation, much else can be very different as far as each individual is concerned.  Clients come into counselling with diverse issues, and experiences. People will often want to work in very dissimilar ways.  A common tool in the counselling room may be language but how the words are presented and used can vary enormously. 

Some clients will want to talk in a structured, linear way and tell a story from start to finish.  Others will want to play with words, to toss them around and see what can emerge.  Some will simply want a place of safety which will allow for a gradual uncovering until they are ready to reveal some hidden part of themselves to another person.

The variation in those preferred approaches suggest that very different forms of counselling may be needed.  It suggests that for some the structured approach of Cognitive Behaviour Therapy (CBT) may be an ideal technique, whereas for others a more holding modality such as person centred work could provide a more appropriate fit. 

For clients who want to remain very much rooted in the here and now, and remain with the exercise of choice, gestalt or existential work may provide the key to emotional resolution. Others who want to move more quickly may prefer to work with a solution focussed technique.  Alternatively those who need to understand and wish to delve into the deeper recesses of their emotional being may want to work in a psychodynamic way.

The actual descriptors of the various techniques can be bewildering.  The terminology within the counselling world can be unnecessarily complex. Therapists sometime seem to compete with areas such as the computer industry or business consultancies in using terminology and initials which seem intended to confuse rather than clarify. Yet that terminology does albeit clumsily, reflect the very different schools of counselling and therapy which exist.

The choice of modality can remain key to a good outcome from the counselling experience.  The client who wants to take time to understand her or his inner being may be frustrated by the CBT specialist who wants to work in a more structured and focussed way. Equally the client who needs to urgently conquer an obsession in order to be able to once again travel in crowded trains or subways, is likely to be irritated by a slow psychoanalytical journey around the misty lanes of yesterday.

In addition to a choice of technique, the selection of the right counsellor is also seen by many as crucial to the success of the work. There is an often repeated suggestion that the relationship between therapist and client can be more important than the specific counselling technique adopted. This relationship is sometimes referred to as the therapeutic alliance and that concept of a good working alliance between therapist and client can be regarded as crucial to a satisfactory outcome.

Whichever technique and whichever counsellor is selected, the challenge for us as therapists is to treat all clients with the utmost respect. We need to ensure that we take time in the counselling room to allow for transparency and to explain the process.  Choice is only meaningful if it is informed choice and that means helping clients to understand what support is available. 

I am not certain that as therapists we are always as clear as we could be in explaining our particular modalities. Sometimes that may be a deliberate approach on behalf of the counsellor.  There will be some therapists who prefer to present as a blank canvas in the room and who fear that to respond to any technical questions around process will somehow jeopardise the eventual outcome of the work.  I do not share that view.

Clients should be given the information that they need to allow reasoned choice to be made. Counselling should not become education but the initial assessment can be informative for both client and counsellor. In walking into our consulting rooms for the first time, clients will be seeking as well as giving information and we should encourage that process of exploration. 

Perhaps with choice may come a greater degree of commitment. That could explain in part why this phenomena of choice is now seen as so important for consumers.  Whatever the benefits, we should always remember that within the counselling world, clients have the right to choose. As therapists we should do all we can to facilitate that expression of choice. 



Geoff Boutle

added on 29th April 2012

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