Listening and learning

Counselling culture has taken root in British socirty in the past decade. Now it is taking hold in British universities. Olga Wojtas reports.

Thatcherism lies behind the emergence of counselling as a profession in Britain over the last ten to 15 years, according to John McLeod, the first professor of counselling at the University of Abertay Dundee.

"There was a huge squeeze on the other helping professions, notably nursing and social work," he says. "People within these professions who wanted to work therapeutically at the individual level found they could no longer do this. If nurses were having to account for every minute of the day, how could they spend 45 minutes with one patient?"

The wellspring of counselling has been the voluntary sector, which has tackled issues such as marriage guidance and bereavement. But the sector has become more professionalised in recent years, hiring trainers to raise standards. More and more organisations - from medical practices and businesses to local authorities - are employing counsellors and want them to deal with an ever wider range of issues, such as personal problems, life changes and workplace stress. Professor McLeod believes this makes a pressing need for university level courses and research. Universities have offered adult education courses in counselling for some time but masters degrees have proliferated in England since the mid-1980s. Scotland has lagged behind, which Professor McLeod explains by the greater importance of a genuinely voluntary sector. And while he believes counselling should be "properly professionalised", eradicating self-styled counsellors who have taken a short course in hypnosis, he does not want to see any further erosion of voluntary sector counselling.

"I think there's a link between notions of citizenship and volunteer counselling in that there are many areas in which people are able to offer their experience back to other people," he says. "A classic example is HIV Aids buddy schemes, where often the volunteers have lost somebody close to them. There tends to be a five to seven-year block of time in people's lives where they feel very able to volunteer as counsellors for things like ChildLine, Relate and the Samaritans," he says. "If I had first minister Donald Dewar's ear in the Scottish Parliament, I would say what Scotland needs is a proper counselling profession, but part of the package should be highly trained professionals linked to supporting volunteers.* Most of the time clients can be helped perfectly well by volunteer counsellors. But occasionally there is somebody who is beyond their competence, so you always need to have somebody highly trained."

Professor McLeod, who wrote the standard reference work An Introduction to Counselling, has spent his working life south of the border, most recently at Keele University which was in the academic counselling vanguard. He has returned to his home town to help boost counselling's academic status in Scotland. To do this, he plans to develop a range of postgraduate courses in theory and practice, and is forging links with Edinburgh and Strathclyde Universities on a joint taught doctoral programme.

"I think undergraduate courses are deeply problematic because a good counselling course is a combination of theory and practice," he says. "The British tradition in counselling has been people coming into postgraduate courses in mid-career, who have worked with clients and patients and know what they're on about."

It is difficult to select undergraduates as carefully as postgraduates, and the preponderance of young people makes placements difficult because clients generally want counsellors who are the same age or older than they are. Moreover, undergraduates are unlikely to have postgraduates' maturity, communication skills or ability to work in teams. But Professor McLeod strongly supports offering modules in some aspects of counselling at undergraduate level, enabling students to boost their self-awareness and develop skills in, for example, interviewing.

"I think it is actually very useful for a wide range of groups - psychiatric students, health students, management students, law students," he says. "For me, there are three strands of counselling: professionals, volunteers and people who use counselling skills within their work."

There are complex undercurrents surrounding the status and credibility of counselling, particularly compared with the elite-label, medically dominated discipline of psychotherapy. McLeod frequently uses counselling and psychotherapy as interchangeable terms. "The difference between counselling and psychotherapy is around Pounds 8,000 a year," he quips.

"Psychotherapists would deny this, of course, but what they do is similar."

But psychotherapy undoubtedly leaves counselling straggling in terms of solid research, generally carried out in departments of psychology or clinical psychiatry. Counselling's recent arrival as an academic discipline means refereed research is still scanty. An institution will have perhaps only three core staff, backed by a network of part-timers. "As of now, I would say there are at least a thousand separate pieces of research that show pyschotherapy is effective with a wide range of client groups," says McLeod. "The counselling research is somewhat sparser and while there's loads of evidence that it's very positive, it's very soft evidence."

Studies based on client questionnaires, for example, have shown that 90 per cent are very pleased with the counselling they received. But a counsellor who is any good at all will have paid serious attention to their clients and supported them in however they are trying to resolve their problems, says Prof McLeod. "They've probably never had that quality of attention in their life before, so obviously they're going to say it's great. But lots of studies show very satisfied clients who are not any less depressed or anxious." There have been mixed results from studies of counsellors in GP practices. Around a third of patients come with emotional problems - termed "heart sink" patients by some doctors, who are only too pleased to refer them to a counsellor. But rigorous research would demand a tightly defined group of patients with similar problems, who are given the same intervention.

"In GP practices you get people with multiple problems, and you're trying to deal with whatever comes through," says Prof McLeod. "The studies ended up with counsellors being evaluated on dealing with a very mixed bag of patients."

He is now working on methods of evaluating counselling, and is still running a study at Keele on the role of counselling and infertility treatment. Legislation states that patients undergoing treatment must be offered counselling, but does not specify what this should be. He is also keen to explore the counselling needs of students in new universities.

Surveys by the Association of Student Counsellors show increasing demand for counselling. But it is difficult to tease out student concerns since financial problems are overlaying everything else. "I think there are distinctive counselling issues around universities like Abertay that have driven the boundaries back in terms of access," he says. "There are perennial counselling issues of self-esteem and self-confidence. If undergraduates are coming here and possibly nobody in their families has gone to university before and they haven't done particularly well at school, their belief in their capacity to do well may be an issue."

Attracting counselling students is itself problematic, since no grants are available, even though part of the curriculum is similar to that for social workers or clinical psychologists. Concerns about cost means the counselling profession attracts very few black, working-class or disabled people - something to tackle over the post-Thatcher years.