Summary of Key Considerations for Counselling and Psychotherapy

Presenting Issues
Considerations for Counselling and Psychotherapy
An Introduction to Counselling and Psychotherapy: From Theory to Practice
Anxiety and Panic Attacks
• Support can including specific techniques to help manage anxiety
and panic, but also space to explore underlying issues
• Strategies can include:
• Relaxation techniques (e.g., relaxation CD, or meditation)
• Guided imagery (e.g., talking the client through an imagined place
they associate with calmness)
• Use of self-help books and online resources
• Breathing exercises (e.g., encouraging calm, steady breathing)
• Physical exercise
• Avoiding stimulants (e.g., caffeine, alcohol)
• Ensuring good sleep routines
• Positive ‘self-talk’ (e.g., I am going to be okay)
• Meditation techniques, such as mindfulness
• Medication (if agreed between client and GP as a short-term
• Important the client understands the nature of therapy being
offered and how it might help
• Undertaking a careful assessment
• Where depression is suspected but not yet diagnosed, exploring
with the client possible benefit of a GP referral
• Taking an holistic approach: social and physical factors are as
important as psychological ones in a move to health
• Timing sessions when the client is best able to make use of them
(e.g., early morning sessions might not work)
• Understanding the impact on the client of any existing prescribed
• Ensuring regular reviews
• Helping the client to understand the nature of their fluctuating
mood (to help build resilience to ‘down’ times)
• Paying careful attention to the risk of suicide or self-harm.
Post-Traumatic Stress Disorder (PTSD)
• Specific approaches have been identified as particularly useful
for PTSD:
Exposure therapy
Cognitive therapy
Anxiety management (see previous slide)
Eye movement desensitisation and reprocessing (EMDR)
• Always work within own competence and make careful use of
• Ensure the client has sufficient support in place (e.g., selfsupport and social support), prior to beginning therapy.
Eating Disorders
• Assessment might include:
Current and past physical health treatment
Cognitive abilities
Any present physical disabilities
Family and interpersonal relationships
Social circumstances and support
Occupational and social functioning
• Therapy should also consider:
Client’s understanding of therapy and willingness to engage
Agreement to liaison with other professionals, where appropriate
A recent health check by GP
Clearly defined agreements of confidentiality should physical or
mental health deteriorate
• An agreement about the focus of therapy (which might not
necessarily always include food).
Loss and Bereavement
• Important to acknowledge how hard it is for people to talk
about dying and death
• Importance of listening and providing a forum for the client to
• Important to ‘normalise’ the grief process (e.g., not
pathological), and to help the client locate their own
experience within that context
• Where appropriate, gently challenge any internalised ‘scripts’
(e.g., I should be over it by now)
• Psycho-educational intervention can be helpful (providing
• Keep in mind the potential for other mental health distress
• Be aware of current research and thinking (e.g., continuing
Suicide and Self-Injury (SI)
• Be aware of personally held views about suicide/SI and how they
can influence your approach
• Working with risk can provoke anxiety in practitioners. Anxiety is
not a ‘bad’ thing if self-support is in place, but is problematic when it
prevents us from engaging with our clients
• Be aware of context of working situation and any policies or
procedures in place for working with clients at risk
• Be aware of the contract of confidentiality and how limitations to
confidentiality would be managed in practice
• Be aware of local agencies and mental health support options in the
event of crisis – know of these before you need to
• Understand relevant social policy and be aware of research
• Know the legal and ethical parameters in which you work
• Reflect on how risk is recorded in case notes
• Always be prepared to ask the ‘suicide question’.
Sexual Problems
• Consider referring to a specialist service, if appropriate
• Always remember there may be a physiological cause for
problems and a GP referral is advised prior to therapy
• Be comfortable in talking about sex and sexual problems
• Ensure there is careful discussion in supervision about any
work to be undertaken
• Asking about sex in assessment can help flag problems early
• Make use of self-help and online resources for the client to
work on between sessions
• Help explore the link between the client’s perceptions of their
sexual self and their sexual relationships (including their
relationship with themselves).
Psychosis requires careful and specialist assessment
If in doubt, agree with the client a referral for such an assessment
Consult carefully with your supervisor
Psychosis can be treated with a number of interventions, including:
Family support
Rehabilitation programmes
Self-help groups
Nutrition, rest and exercise
Talking therapies
• The provision of talking therapies needs to be in the context of a
well-planned and supported network of care.
Borderline Personality Disorder (BPD)
• Help the client to explore what a diagnosis of BPD means for
• During assessment, explore the factors that led to a diagnosis,
when it was made, and by whom
• As with all therapy, offer clearly articulated boundaries,
empathy, respect and honesty
• Work within agreed boundaries and do not allow these to be
• Make careful use of supervision
• Be clear with the client what they hope for from therapy and
what their goals might be
• Be aware of current research, and also some of the writing
that critically reflects on the nature of BPD as a diagnosis.

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