Medical and Psychiatric Issues for Counsellors


Brian Daines, Linda Gask & Amanda Howe

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  • About the Series

    The Professional Skills for Counsellors series, edited by Colin Feltham, covers the practical, technical and professional skills and knowledge which trainee and practising counsellors need to improve their competence in key areas of therapeutic practice.

    Titles in the series include:

    Counselling by Telephone

    Maxine Rosenfield

    Time-Limited Counselling

    Colin Feltham

    Personal and Professional Development for Counsellors

    Paul Wilkins

    Client Assessment

    Edited by Stephen Palmer and Gladeana McMahon

    Counselling Difficult Clients

    Kingsley Norton and Gill McGauley

    Learning and Writing in Counselling

    Mhairi MacMillan and Dot Clark

    Long-Term Counselling

    Geraldine Shipton and Eileen Smith

    Referral and Termination Issues for Counsellors

    Anne Leigh

    Counselling and Psychotherapy in Private Practice

    Roger Thistle

    The Management of Counselling and Psychotherapy Agencies

    Colin Lago and Duncan Kitchin

    Group Counselling

    Keith Tudor

    Understanding the Counselling Relationship

    Edited by Colin Feltham

    Practitioner Research in Counselling

    John McLeod

    Anti-Discriminatory Counselling Practice

    Edited by Colin Lago and Barbara Smith

    Counselling Through the Life-Course

    Léonie Sugarman

    Contracts in Counselling & Psychotherapy second edition

    Edited by Charlotte Sills

    Counselling, Psychotherapy and the Law, second edition

    Peter Jenkins


    View Copyright Page


    For Joan, John and Barry

    List of Figure and Tables

    Figure 6.1:Stepped care for depression87
    Table 2.1:Models of mental illness and mental health care08
    Table 2.2:Relationships between mental and physical illness10
    Table 2.3:Measurement tools11
    Table 3.1:Sample information sheet for referrers19
    Table 3.2:Sample liaison letter to GP23
    Table 3.3:Sample letter to client refusing counselling24
    Table 3.4:Referral checklist, particularly for referrals from other professionals27
    Table 3.5:Referral checklist particularly for self-referrals27
    Table 3.6:Possible assessment questions, existing recognised conditions28
    Table 3.7:Sample letter to GP31
    Table 4.1:Client concerns about counsellor illness45
    Table 4.2:Possible issues arising for clients with pregnant counsellors50
    Table 4.3:Possible issues arising for pregnant counsellors in relation to clients50
    Table 5.1:Clues to likely psychosocial factors being a major cause of presenting symptoms55
    Table 6.1:Important etiological factors in sexual dysfunction77
    Table 6.2:Main medical treatments of erectile dysfunction77
    Table 6.3:Features which should raise suspicion of an alcohol problem78
    Table 6.4:Features which should raise suspicion of a drug problem79
    Table 6.5:Effects of commonly used drugs80
    Table 6.6:Schneider's First Rank Symptoms of schizophrenia82
    Table 6.7:Pharmacological and physical causes of depression85
    Table 6.8:Major depression86
    Table 6.9:Symptoms of anxiety88
    Table 6.10:Post-traumatic stress disorder90
    Table 6.11:Mania90
    Table 6.12:The ‘Reattribution’ model for managing people who have medically unexplained symptoms92
    Table 6.13:A typology of personality disorders95
    Table 6.14:Criteria for Borderline Personality Disorder96
    Table 6.15:Antidepressants (commonly used types)100
    Table 6.16:Antipsychotic drugs (commonly used types)101
    Table 6.17:Drugs used in anxiety and as sleeping tablets (commonly used types)102
    Table 6.18:Drugs used to stabilise mood103

    Notes on Authors

    Brian Daines works primarily in independent practice. He is also Clinical Tutor in Psychosexual Medicine at the University of Sheffield and a college counsellor.

    Linda Gask is Professor of Primary Care Psychiatry at the University of Manchester and an honorary Consultant Psychiatrist in Salford.

    Amanda Howe is Professor of Primary Care at the Institute of Health, University of East Anglia.


    There are many to whom we owe thanks for help in the writing of this book. In particular we would like to thank Tim Usherwood for his work as one of the co-authors for the first edition. We would also like specifically to mention Judith Globe from St Luke's Hospice Library in Sheffield and Ainslie Green from the University of Sheffield Counselling Service.

  • Appendix 1 Suggested Reading

    Chapter 4 Issues in Established Counselling and in Supervision

    Abel Smith, A., Irving, J. and Brown, P. (1989) Counselling in the medical context, in Dryden, W., Charles-Edwards, D. and Woolfe, R., Handbook of Counselling in Britain. London: Tavistock/Routledge, pp. 122–33.

    Counselman, E.F. and Alonso, A. (1993) The ill therapist; therapists’ reactions to personal illness and its impact on psychotherapy, American Journal of Psychotherapy 47(4): 591–602.

    Chapter 6 Taking Account of Psychiatric Conditions and Their Treatment

    Gelder, M., Gath, D. and Mayou, R. (1989) Oxford Textbook of Psychiatry (2nd edition). Oxford: Oxford University Press.

    Chapter 7 Safety and Safeguards

    BAC Code of Ethics and Practice for Counsellors.

    BAC Code of Ethics and Practice for the Supervision of Counsellors.

    BACP Information Sheet

    P4: Guidance for ethical decision making: a suggested model for practitioners. Lynne Gabriel and Roger Casemore.

    Bond, T. (2000) Standards and Ethics for Counselling in Action. London: Sage.

    Bond, T. (1993) When to protect a client from self-destruction, in Dryden W. (ed) Questions and Answers on Counselling in Action. London: Sage, pp. 118–23.

    Appendix 2 Glossary

    Most of the specialist medical and psychiatric terms used in this book are defined and explained in the text. Those not so defined are included below, together with others added for convenience of reference.


    The use of books to treat mild mental health problems. These may be specifically on mental health or, for example, novels with appropriate themes.


    Relating to a physical understanding of a biological problem.

    Bipolar affective disorder

    A disorder of mood in which episodes of both mania and depression. It is also known as manic-depressive illness.

    Borderline personality

    A type of personality disorder difficult to describe precisely and concisely. Such people are impulsive, poor at personal relationships, unpredictable and sometimes can seem to be on the point of losing touch with reality.

    Care Plan

    A coherent approach to someone's mental health problems that co-ordinates the input of the professionals involved and ensures that they are appropriate and complement each other.


    The treatment of illness by medication, commonly used particularly in such treatment of cancer.

    Clinical governance

    A process which aims to assure and improve clinical standards in service delivery.

    Cognitive-Analytic Therapy (CAT)

    A structured short-term treatment that combines psychodynamic and cognitive features.

    Cognitive-behavioural therapy (CBT)

    A structured psychological treatment which seeks to change problem behaviours and dysfunctional patterns of thought and beliefs. See also systematic desensitisation.

    CORE (Clinical Outcomes in Routine Evaluation)

    A set of questionnaire forms used routinely and widely in NHS settings to evaluate risk and to provide evidence of service quality and effectiveness.


    An organic disorder of the brain involving loss of intellectual ability and memory and also changes of personality. It can be caused by a number of conditions, the most common of which is Alzheimer's disease.


    The label given to a set of symptoms and signs based on their co-existence and confirmed with observed pathological phenomena.

    Electro-convulsive therapy (ECT)

    The treatment of mental disorders, particularly depression, by passing an electric current through the brain with the use of anaesthesia and a muscle relaxant.


    E-mail correspondence with a counsellor or psychotherapist, which may be suitable for those who are reticent about face-to-face contact with a counsellor and those who do not live near a practice, or have restricted mobility.


    Sudden returns to earlier experiences. There can be a number of causes for this, including a history of traumatic experiences or of taking hallucinogenic drugs.

    Heart arrhythmias

    Variations from the normal heartbeat.

    Inter-Personal Therapy (IPT)

    A short-term psychological treatment focusing on social functioning and relationships.

    Magnetic Resonance Imaging (MRI) scanning

    A (non-invasive) investigative procedure for visualising the structure of the brain. It can also be used to reveal how the brain functions.


    A state of extreme euphoria and over-activity often involving socially unacceptable behaviour.

    Manic-depressive illness

    A disorder of mood in which episodes of both mania and depression. Also known as bipolar affective disorder.

    Motivational interviewing

    An approach to interviewing which aims to help a person to decide whether or not they wish to change their behaviour.


    Relating to the interaction between the brain, and thoughts and behaviour.


    A bone disease, especially found in women over fifty, involving loss of bone tissue.


    The movement of a human egg towards a woman's uterus, taking place approximately half-way through the menstrual cycle.

    Parkinson's disease

    A progressive disease of the nervous system, usually occurring in later life, and involving tremor and progressive disability.


    Symptoms similar to Parkinson's disease but following on from viral infections and some drugs.


    Change in the structure or function of the body caused by disease.

    Post-traumatic stress disorder

    A disorder caused by a traumatic event outside the range of usual experience, characterised by a cluster of symptoms including anxiety, flashbacks, nightmares and guilt.

    Pre-term delivery

    A delivery of a baby that occurs before the completion of the full term of pregnancy (37 weeks).


    An approach that uses a dynamic understanding of the mind derived from psychoanalytic concepts such as the unconscious and psychological defences. See also cognitive-analytic therapy.


    Involving both the mind and social factors.


    A group of disorders leading to mental deterioration such as distortion of thinking, delusions and a disturbed sense of self.

    Secondary gain

    This is where disability reaps benefits such as care and attention, a cessation of difficult responsibilities, or some resolution of personal conflicts or disappointments.


    Objective physical changes, usually detected by physical examination. See also symptoms and diagnosis.


    Relating to the body.


    The expression of psychological problems through apparently physical disease.


    Selective Serotonin Reuptake Inhibitor. Commonest type of antidepressant drug which works to increase the level of serotonin in the brain (known to be decreased in severe depression).

    Stepped care

    An approach to mental health problems whereby the treatment approach is adjusted according to the severity of the problem. See Figure 6.1 in Chapter 6.


    Those words used by people to express unusual or uncomfortable phenomena, such as pain, dizziness or diarrhoea. See also signs and diagnosis.


    A collection of symptoms that can be recognised as commonly occurring together in an identifiable pattern. See also diagnosis.

    Systematic desensitisation

    A behavioural treatment combining progressive exposure to a feared object or situation together with a method of controlling the person's anxiety arousal (see also Cognitive-Behavioural Therapy).


    A gland near the larynx which produces hormones vital in maintaining normal growth and body functioning.

    Appendix 3 Useful Organisations and Internet Addresses

    British Association for Counselling and Psychotherapy

    British National Formulary


    Depression Alliance

    Mental Health Foundation


    National Phobics Society

    NHS Direct

    Royal College of Psychiatrists


    UK Council for Psychotherapy


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    P4: Guidance for ethical decision making: a suggested model for practitioners. Lynne Gabriel and Roger Casemore.
    P7: Working with the suicidal client. Andrew Reeves and Pat Seber.
    P9: Am I fit to practise as a counsellor? Heather Dale.
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