Critical Thinking in Counselling and Psychotherapy

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Colin Feltham

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    Acknowledgements

    I would like to thank Alice Oven very warmly for her enthusiasm, guidance and hands-on help at critical stages in this book's progress.

  • Appendices

    Appendix 1: Sample of Critical Textual Analysis

    Below, you will find a passage on supervision. It is not an actual passage but one I have constructed (and the reference is fictitious) but in some respects it contains some typical claims and arguments. I have of course deliberately exaggerated and distorted in places for demonstration purposes. Read through it and – using what natural critical thinking skills you have – identify its errors and raise any questions that can be asked about it. My own suggested questions in relation to this passage are found below.

    All right-minded therapists are aware that counselling supervision is essential. The BACP has made it clear that it is unethical to practise without supervision. Supervision mirrors the intense relationship between client and counsellor and ensures that practice remains safe and excellent. McSmith and O'Dear's (1984) research showed conclusively not only that counsellors value supervision highly but also that without it clinical errors would multiply and clients would be abused. Supervision is the jewel in the crown of the counselling profession and it seems suspicious that anyone would oppose it, especially those in the profession who should know better. It is likely that critics of supervision fail to understand the power of parallel process. There is also a danger that they may undermine the profession. Supervision, as has been stated, is essential and should be fully funded. Also, more research is urgently needed into the processes underpinning supervision and in order to identify best methods, best timing and best training. Without this, the mental health of the nation is at risk.

    McSmith, A. & O'Dear, O. (1984) Counselling supervision: a qualitative study of supervisors' experiences and beliefs. Journal of Advanced Counselling, 3 (2), 101–103.

    Appendix 1: Analysis
    • A phrase like ‘right-minded’ is loaded and precludes further enquiry. ‘All’ also implies a consensus.
    • ‘Essential’ does not tell us what it is essential for, nor is there any discussion here about what supervision is or what its allegedly essential ingredients are.
    • Using ‘has made it clear’ and ‘unethical to practise’ shuts down enquiry. Citing a single professional body as a final authority may tend to shut down enquiry. Is it in fact strictly unethical or, rather, poor practice according to one view? How and by whom was that view and policy arrived at with no research to support it?
    • Is the client-counsellor relationship always intense and is supervision necessarily similarly intense? Might this hold some truth for certain theoretical approaches but not for others?
    • Can supervision really ensure safety (and what is safety)? ‘Excellence’ is a very vague term and cannot be ensured.
    • The research cited is quite dated and extremely unlikely to be conclusive, especially at three pages long (but if it were conclusive, why would further research be needed?) and presumably it cannot show that all counsellors value supervision unless all were consulted. ‘Value’ is a vague and loaded term. A piece of such research could not say what would happen without supervision (or with it) and ‘errors’ and ‘abused’ are speculative and scare-mongering, emotive terms. These also suggest that supervision prevents client abuse, a claim for which we have no evidence.
    • ‘Jewel in the crown’ is a somewhat romantic metaphor and it is possible that not everyone would agree with this uncritical assertion.
    • ‘Suspicious’ and ‘should know better’ emotively suggest that anyone who queries any aspect of supervision is perhaps deviant, naughty or immature. This is a sly, combined projection of an offence, and a telling off. ‘Oppose it’ implies that scrutiny is taboo, and any criticism is a kind of inadmissible disloyalty rather than a human right to freedom of thought and expression.
    • ‘It is likely’ really means here ‘in my opinion’, and ‘fail to understand’ appears in place of 'do not agree with the idea of. Parallel process is a psychodynamic concept and not everyone accepts it is a reality, or as powerful or important.
    • The danger of undermining the profession is an emotive point and a vague ‘hands off’ warning: the profession must be supported at all times and critics should be wary.
    • To repeat ‘supervision is essential’ does not make this claim any clearer or truer, and the link with funding (by whom and for what?) is tenuous and emotive.
    • Exactly what underpinning supervision processes are being alluded to here and what makes such research so urgent? By this point in the passage it has been assumed that supervision is essential and that it performs certain functions. This (and the BACP mandate) mean that certain aspects of supervision simply cannot be researched. You could not have a control group of unsupervised counsellors, for example.
    • The point about the mental health of the nation demonstrates an absurdity about the sense of proportion, of course. Few writers would make such a statement but some probably (in my opinion) exaggerate the importance of supervision in the scheme of things.
    • This passage combines an appeal to emotions and to the authority of a professional body. It doesn't allow for subtleties of enquiry and it makes the assumption that ‘research’ will provide the solution for any gap in knowledge. It is assumed that research will validate supervision: what would happen if it didn't? Is it conceivable that BACP would abandon its mandatory supervision policy if research failed to validate it?
    • Critiques of supervision are dismissed here as somewhat dangerous, disloyal and childish. While the familiar call for ‘more research’ is made, no allowance for philosophical analysis or critical thinking is made.
    • Critics of statutory regulation have pointed out that their well-articulated arguments have been dealt with by simply being ignored or marginalized. Might it be that vested interests in supervision operate similarly, that is by calling for (inconclusive and extremely slow) research, but tacitly ignoring inconvenient critical thinking? In other words, it may not matter what you have to say critically about supervision because we are going to continue to do what we've always done anyway.
    • How can we separate out writings about counselling that are purely subjective, emotive, openly persuasive, based on ‘practice wisdom’, logical, based on empirical research or leading to research, or of a purely public relations kind? Should writers always try to declare their otherwise covert interests (e.g. to maintain the supervision tradition, to protect my livelihood, to publicize myself, to get funding, to attack someone)? How can a fair balance and transparency be achieved?
    • In what ways in this slightly spoof passage might I (CF) have smuggled in my own agenda and views on supervision? In what ways might I be trying subtly to persuade you to think like me? And what is it in you that leans towards or against my perspective?
    • What would be the effect of reading all texts in this quite detailed critical way? (See as a guide Wodak, R. & Meyer, M. (2001) Methods of Critical Discourse Analysis. London: Sage.) Might it not lead to tedium and paralysis? Must some things be taken on trust?
    • Are there any justified limits to critical thinking? For example, would it be warranted in principle to critique all the claims regarding counselling supervision to the point of coming to reject it as spurious or unproven, or as part of an agenda of authoritarian professional control? What happens when critical thinking finds itself up against a brick wall? Also, since it's possible that a kind of defensive, untrusting, pathological character trait manifests itself in always opposing authority and asking endless questions, how can we distinguish this from legitimate and useful critical thinking?

    Appendix 2: Some Critical Thinking Matters in Therapeutic Practice

    Critical Decisions and Questions in Professional Life and Training

    Shall I undertake counselling/therapy training? Am I suitable?

    Shall I re-mortgage my house in order to pay my considerable course fees?

    Have I chosen the right course for myself (e.g. the most compatible theoretical model)? Can I change if I want to?

    How will I accommodate, afford and react to my training therapy?

    How is this training going to impact on my family?

    If I don't agree with my tutor/s, is it OK to voice this?

    How do I decide on any specialisms, further training, employment or private practice?

    Which criteria should I use to choose a supervisor?

    Should I retain links with my existing profession in case I don't find sufficient work as a therapist?

    How will I deal with any conflicts between myself as a practitioner and my managers and organization?

    Critical Thinking at Assessment

    What processes are necessary as regards self-referral, telephone enquiries, screening and allocation to practitioners?

    To what extent do I use any notes provided about my new client?

    Do I have a good grasp of this client's concerns?

    Am I competent to work with her?

    If I have not worked with this kind of presenting concern before, are there any risks I should take into account?

    How transparent should I be with this potential client about my experience or relative lack of experience with her concerns?

    What critical issues exist regarding my theoretical orientation, this person's presenting concerns, NICE guidelines, etc.?

    Can this person's concerns be substantially resolved within my service's time limits, if they have these?

    Is this person ready, motivated and robust enough for counselling or psychotherapy?

    Am I aware of suitable referral links should they become necessary?

    Are there any particular ethical concerns that arise with this client?

    Critical In-Session and Between-Session Considerations

    Are there any early warning signs of unhelpful friction in our relationship?

    What transferential clues are apparent from the outset?

    Am I getting any feelings of fear, dread, boredom, attraction or unusual insightfulness with this client?

    In what ways is this client challenging my usual style of doing therapy?

    How confident or considered am I in varying my practice when it feels right, against principles I was taught?

    What uncomfortable moments have there been?

    What good moments and turning points have there been?

    At which points have I drifted off, failed to grasp the client's point or felt stuck?

    Am I feeling that I have to solve the client's problems?

    Is there any sense of not believing, or finding it hard to believe, the client?

    Are there any ways in which my client and I are at odds, e.g. regarding expectations of the length and depth of therapy?

    In what ways might I creatively and legitimately improvise interventions with this client?

    Is it OK to practise eclectically based on strong hunches?

    Should I use a technique I haven't used before or wait until after I have discussed it in supervision?

    Are our personalities unhelpfully different in any ways?

    Do any awkward frictions or unspoken matters exist, e.g. differences in class, race, culture, sexuality?

    Is it difficult to tell my client that his problems seem too complex and/or non-psychological, for therapy to help as much as he hopes?

    How can I tell my client that he is wandering, using small talk or being defensive?

    If in private practice, will I honestly tell this client that I don't think he will benefit from further sessions?

    How long do I think it's normal or acceptable for therapy to continue?

    How do I feel if either I or the client mentions wanting to end and there being disagreement about this?

    How detailed are my notes and how would I feel if my client wanted to see them?

    Is it OK for my client to telephone me between sessions in some circumstances?

    Do I find myself not talking much about this client in supervision, or bringing them up much more than others?

    Critical Questions About Professional Development

    Should I retrain substantially in order to update myself or improve my employment options?

    How often should I change my supervisor or supervision arrangements?

    Should I cover my options by joining multiple professional bodies, or by leaving one to join another?

    Given my limited budget for CPD, which workshops or conferences are best for me to attend?

    To what extent will I read – and find useful – scholarly articles on empirical research?

    What would I do if I found my views on practice in conflict with NICE guidelines?

    What sense shall I make of discussions on statutory regulation?

    Should I re-enter my own therapy?

    How can I address my job stress?

    If I sensed that I might be past my professional best as I get older, what would I do?

    If I apply meta-critical thinking to my work (e.g. by reflecting on philosophical and sociological viewpoints on human distress) where might this take me?

    Appendix 3: Additional Questions

    Consider the following questions and what arguments you can think of to respond to them in positive and negative terms. Do you think any of these questions themselves are taboo or unhelpful? Consider also what additional questions you can think of – especially those which are important to you – and expand on these.

    • How useful or otherwise are questionnaires for clients?
    • Are there any circumstances at all in which friendly or sexual contact with a client might be permissible or even therapeutic?
    • Why are strong challenge and confrontation used relatively rarely in counselling and perhaps especially in statutory settings?
    • How can therapy lasting many years be justified?
    • Is there anything impractical or unethical about counselling that lasts for only six sessions?
    • Are certain aspects of human being or functioning neglected (e.g. the body)?
    • What is the ‘self’ and exactly what do we mean by ‘therapist use of self’?
    • How important is it to understand causative factors in clients' problems?
    • Can theories of evolutionary psychology and evolutionary psychiatry add to our understanding of clients?
    • Will persistent evidence-seeking eventually marginalize or discredit certain approaches?
    • Are some therapeutic approaches more dubious or dangerous than others?
    • Is counselling primarily a middle-class activity?
    • Why do some countries have little or no counselling tradition?
    • What reality do birth trauma, therapeutic rebirth and spiritual rebirth have?
    • Are there really master practitioners?
    • Is it conceivable that counselling and psychotherapy will one day merge under one title?
    • What place do the exploration of dreams, subpersonalities and transpersonal phenomena have in counselling in short-term contracts in statutory settings?
    • How can we square the belief in repressed memories with involuntary traumatic memories?
    • Should counselling training be audited and reduced commensurate with employment opportunities?
    • Is there any evidence that accredited counsellors are more effective than unaccredited counsellors?
    • Should counsellors be installed in all schools?
    • How realistic is it for counsellors in specialist counselling agencies (e.g. alcohol, eating disorders, bereavement) to confine clients to working on presenting concerns?
    • Should we consider limiting counselling practice to counsellors of a certain age (e.g. 25–65)?
    • Should it be compulsory for counselling trainers to remain in practice alongside their academic responsibilities?
    • Do counsellors tend to ‘over-psychologize’ clients' concerns?
    • To what extent is it practical for counselling to address needs for childcare, interpreters and other forms of assistance?
    • Would money spent on research and a professional infrastructure be better spent on providing counselling services?
    • If it were possible to arrange for highly intensive experiential research into profound personality transformation in the direction of reduced neuroticism and narcissism and enhanced pro-sociality and eco-consciousness, would this be desirable?
    • Given the profile of an ageing population, should the government fund research into counselling needs for older people?
    • If genetic, neurological, pharmacological and cybernetic advances were to promise more assured improvements than the talking therapies, would counselling disappear?

    Now add on any questions of your own.

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