Medical and Psychiatric Issues for Counsellors
Publication Year: 2007
Counselors often encounter situations where clients' medical or psychiatric conditions—and their treatment—affect the assessment of, or work with, clients. This Second Edition of Medical and Psychiatric Issues for Counsellors offers a comprehensive overview highlighting key concerns and offering practical advice for judging when a situation may be beyond the counselor’s skills. The original text has been completely updated and restructured to ensure material is presented in the most user-friendly format, and three brand new chapters have been added: a new introductory chapter which provides a contextual framework for the reader; a chapter on the common principles of care and working with others; and a new concluding chapter
- Front Matter
- Back Matter
- Subject Index
About the Series[Page ii]
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
Personal and Professional Development for Counsellors
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
Geraldine Shipton and Eileen Smith
Referral and Termination Issues for Counsellors
Counselling and Psychotherapy in Private Practice
The Management of Counselling and Psychotherapy Agencies
Colin Lago and Duncan Kitchin
Understanding the Counselling Relationship
Edited by Colin Feltham
Practitioner Research in Counselling
Anti-Discriminatory Counselling Practice
Edited by Colin Lago and Barbara Smith
Counselling Through the Life-Course
Contracts in Counselling & Psychotherapy second edition
Edited by Charlotte Sills
Counselling, Psychotherapy and the Law, second edition
© Brian Daines, Linda Gask and Amanda Howe 1997, 2007
First published 1997
Reprinted 2002, 2003, 2004
This second edition published 2007
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
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Printed and bound in Great Britain by Athenaeum Press, Gateshead
Printed on paper from sustainable resources
For Joan, John and Barry[Page vi]
List of Figure and Tables[Page viii]
Figure 6.1: Stepped care for depression 87 Table 2.1: Models of mental illness and mental health care 08 Table 2.2: Relationships between mental and physical illness 10 Table 2.3: Measurement tools 11 Table 3.1: Sample information sheet for referrers 19 Table 3.2: Sample liaison letter to GP 23 Table 3.3: Sample letter to client refusing counselling 24 Table 3.4: Referral checklist, particularly for referrals from other professionals 27 Table 3.5: Referral checklist particularly for self-referrals 27 Table 3.6: Possible assessment questions, existing recognised conditions 28 Table 3.7: Sample letter to GP 31 Table 4.1: Client concerns about counsellor illness 45 Table 4.2: Possible issues arising for clients with pregnant counsellors 50 Table 4.3: Possible issues arising for pregnant counsellors in relation to clients 50 Table 5.1: Clues to likely psychosocial factors being a major cause of presenting symptoms 55 Table 6.1: Important etiological factors in sexual dysfunction 77 Table 6.2: Main medical treatments of erectile dysfunction 77 Table 6.3: Features which should raise suspicion of an alcohol problem 78 Table 6.4: Features which should raise suspicion of a drug problem 79 Table 6.5: Effects of commonly used drugs 80 Table 6.6: Schneider's First Rank Symptoms of schizophrenia 82 Table 6.7: Pharmacological and physical causes of depression 85 Table 6.8: Major depression 86 Table 6.9: Symptoms of anxiety 88 Table 6.10: Post-traumatic stress disorder 90 Table 6.11: Mania 90 Table 6.12: The ‘Reattribution’ model for managing people who have medically unexplained symptoms 92 Table 6.13: A typology of personality disorders 95 Table 6.14: Criteria for Borderline Personality Disorder 96 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 mood 103
Notes on Authors[Page ix]
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[Page 123]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[Page 124]
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.
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.
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.
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.
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.
A disorder of mood in which episodes of both mania and depression. Also known as bipolar affective disorder.
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.
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.
[Page 126]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.
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.
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).
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.
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
[Page 127]British Association for Counselling and Psychotherapy
British National Formulary
Mental Health Foundation
National Phobics Society
Royal College of Psychiatrists
UK Council for Psychotherapy
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