Counselling outcome, issues, trends and professional ethics dr geoffrey wango

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Dr. Geoffrey Wango
Counselling Psychology
University of Nairobi

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Counselling
Counselling is a process in which the counsellor (therapist)
attempts to understand and helps to clarify those issues and
feelings in a client that impede growth, maturation and
general well-being.
The specific goals of counselling are:
1.To help the client access a greater part of their personal
resources. (This is the means of enabling them regain their
[lost] energy and get back on track);
2.To enable or help the individual to live more competently
and/or with contentment; and,
3.To improve mental health and reduce psychological
disturbance.
In effect, counselling enables or helps the individual to live a
fuller, satisfying life. Counselling, therefore, should lead to a
meaningful positive change and to a better life.
Counselling Outcome, Issues, Trends and Professional Ethics

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Expected Learning Outcomes
Therapy has an expected, appropriate outcome. Therefore,
practitioners must possess professional competence,
adhere to counselling ethics and be reflective in practice.
This requires proficiency in therapeutic approaches, skills
and techniques.
By the end of the counselling course, you should be able to:
1)Define and explain the various terms and concepts that are
used in counselling.
2)Explain the counselling process.
3)Adopt use of professional principles in counselling.
4)Assist a client in therapy.
5)Monitor and evaluate the outcome of counselling.
6)Interpret professional standards in the practice of
counselling psychology by adhering to a code of ethics.

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Rationale
Counselling and psychotherapy are widely practiced in the
world and it is hoped that they are effective in assisting people
resolve life crises. Various populations, including children,
adolescents, adults, and elders seek counselling as individuals,
couples, groups or families. Persons who receive counselling
and psychotherapy are expected to achieve much better
outcomes than they would have had had they not received
therapy. Clinical trials reveal that therapy is effective in
assisting clients with several life challenges, including in
treating various destabilizing conditions such as stress, fear
and anxiety, depression, as well as other crises such as marital
issues (marital dissatisfaction, effects of divorce/separation),
drug and substance abuse, etc. In addition, various health
issues can be resolved through therapy. They include eating
disorders, releaving pain, sexual dysfunction and depression.

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Conceptualization of Counselling
- Research spanning over the tears has seen an evolution in the
conceptualisation of counselling psychological services, from
Philosophy to Psychology involving knowledge and research in
behaviour and mental processes to a conceptualisation that
acknowledges the complexity of the human experience and
behaviour as a process that encompasses developmental,
personality and social determinants in individual and social
(community) decisions and conduct.
- Counselling and psychotherapy as helping processes captures
the complexity of the human experience as involving thinking,
emotion, attention, and concentration. Therapy as a process
seeks various processes that can help an individual maintain
and effectively perform with relative moderation in various
conditions; a systematic process involving the individual’s ability
to moderate self and personality in line with his/her reference
values, goals and community behavioural standards.

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The Cultural Context of Counselling
Counsellor competence includes improved knowledge and
awareness of social cultural background of the client. This is
not entirely new as practitioners often find it useful to validate
the world of the client through an exploration and
understanding of the context of the problem. However, the
major theoretical frameworks developed largely in Western
(European) culture tend to have more focus on the individual
rather than family and community. Yet, in the more traditional
societies person may not achieve such independence.
Practitioners have to apply counselling in the cultural context
of the individual and community. This requires sensitivity in
the application of counselling psychology as well as cultural
perspective in understanding the client. The cultural
characteristics are pivotal in building alliance with the client.
In the end, it also influences the counselling outcome.

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Management of Mental Health and Psychological Disturbance
in the more Traditional-cum-Contemporary Societies
 Mental health and psychological disturbance are debilitating
illnesses that affect a large part of the population including in
the developing countries. Thus, the more traditional societies
cannot claim to be advantaged over the more developed
countries. Additionally, it must be acceptable that a greater
part of the population suffering from mental illness and
psychological disturbance (distress leading to depression
and anxiety) are at the peak of their career; they are at the
height of their social, economic, political and intellectual
productivity. The functional loss affects activities of daily
living leading to problems in individual, family, social and
career functioning.
 In the more traditional societies, there is a lot of
misunderstandings of psychological well-being due to a
strong inclination on traditional culture and religion.

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Management of Mental Health and Psychological Disturbance
in the more Traditional-cum-Contemporary Societies
 Deviations in what is regarded as general or appropriate
conduct (disorderliness in behaviour, psychopathology) and
psychological illness often leads to apathy, isolation and
withdrawal. This is because in a majority of instances, most of
the indigenous communities do not have the more
philosophical or scientific explanation of mental illness and
psychological disturbance that would lead to a more logical
explanation leading to more rational and timely interventions
such as therapy and medicine.
 Instead, the more traditional societies rely on changes in
functional status to signify psychological disturbance and
attribute the irregular phenomenon to certain causes (curse,
religion, unexplained phenomenon). This in turn leads to a
large gap between psychological needs and therapy
(counselling and psychotherapy as well as
psychopharmacological interferences).

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Rationale
Counselling competence includes four
basic aspects as follows:
(1)Knowledge of Counselling and
Awareness of its application
(Counselling Issues, Counselling
Process and Trends in Counselling
and Psychotherapy).
(2)Theoretical Approaches.
(3)Skills and Techniques.
(4)Professional Ethics.
All these are
designed to
ensure a
positive/
desirable
Counselling
Outcome

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Counselling
Outcome
Rationale

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Rationale
Counselling is a helping process that involves a
relationship between the client (counsellee) and the
counsellor. The client seeks counselling when in need:
Client
Counselling
(assistance
on issue)
Counselling
Process
(Resolution)
Counselling
Outcome
(end result)
Counselling outcome refers to the end result of the
therapeutic process. An effective counsellor provides
care and support to the client.

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Rationale
The counsellor is proficient in their conduct and this is
achieved through effective training; she or he is a
facilitator and assists the client to achieve healing
through the therapeutic process.
Counsellor
Counselling
Competence
(training)
Counselling
Process
(facilitator)
Counselling
Outcome
(healing)
The counselling process is a planned structured dialogue between
a client and a counsellor. The counsellor uses skills and
techniques developed through professional competences.
Together, the client and counsellor develop ways of dealing with,
and resolving the issue that brought the client to therapy.

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Counselling
Outcome
Rationale
Counselling is a
healing process
Product – End
Result

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Rationale
- Counselling or therapy would be expected to have an
outcome or effect. The concept of an ‘effect’ is
unclear since in many ways, effect implies result and
therefore has the denotation of ‘healing.’
- The outcome of counselling implies several things
such as the following: overcoming life challenges;
resolving life issue/s; intensified mobility; improved
global social functioning; and, general life satisfaction.
All these conditions imply improvement in the client.
- It is the anticipated improvement in the client that
envisages the concept of ‘positive’, ‘effective’ or
‘progressive effect’ of psychotherapy (counselling /
therapy) results.

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Counselling
Outcome
Rationale
Counselling is a
healing process
Product – End
Result
Counsellor Client+

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Counselling
Outcome
Rationale – Counselling Outcome
Counselling is a
healing process
Product – End
Result
Counsellor Client+
Healing as
end result

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Understanding the Client
Interaction between Client and Environment
Assessment for coping competence

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- Counsellors need to understand the needs of special
populations. These include: children; girls and women; persons
with disability; gays, lesbians and persons in same sex
relationship; transgender and gender nonconforming people;
the rich and famous; alcoholics and persons involved in drug
abuse; victims of abuse; and, the elderly and terminally ill
clients (such as those with cancer and HIV/AIDS).
- Counselling practitioners and practice often tend to leave these
populations out and misunderstand them. In the more
traditional societies, these persons are negatively perceived
(patriarchal societies have the power and authority in males,
while some of the conditions in others may be perceived as
something undesired, although this is not necessarily the
correct experience or belief).
- Negative attitudes, beliefs, and associations extend beyond the
general public, and counselling practitioners also take them in.

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- Counsellors that work with special populations and their
families need to understand the unique experience and
process of counselling them. Of particular importance is
the awareness and consideration of terminology used to
describe and refer to traditionally-marginalized groups,
gender stereotypes and segregated persons such as
persons with disabilities, drug addiction and sexual
orientation issues.
- Efforts aimed at creating understanding of unique clients
and therapeutic circumstances have the potential to
benefit special populations particularly children, girls and
women, persons with disabilities, the counselling
professional, the therapeutic relationship and the ultimate
outcome of therapy.

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Counselling Orientation: Mediating Factors
between Client and Counsellor
Client Counsellor
Issue/s (life
challenges, coping)
Skills and Techniques,
Methods (theory)
Values, Attitudes and
Emotions
Values, Ethics, and
Feelings
Insight / Solution Task / Goal (guided by
professionalism)
Outcome of therapy

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Steps in the Counselling Process
1. Receiving Client and Relationship Building.
4. Counselling Interventions: Action plan and way forward.
5. Assessment and evaluation, termination / referral.
3. Goal Setting: Understanding and outlining of goals.
2. Problem Assessment: History taking and exploration,
Relationship building.

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Counselling and the Counselling Process
Contracting
(goal setting)
History taking
of the client
Understanding
Creating rapport
Offering core conditions
Exploration
Understanding the world
of the client.
Exploring alternatives /
intervention strategies.
Identifying
persuasions / verifying
accomplishments
Client understanding of
issue / circumstances /
problem situation
Effectively using
counselling skills and
techniques to assist client
Action
Essential action points.
Further exploration.
Termination / Referral
World of client
(Client re-entry back
into their world)
Initiation Process Action

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Counsellor awareness
Core conditions
Counselling goals
Therapeutic alliance (client-
counsellor relationship)
Counsellor performance
Termination
Referral
Counsellor Competence
Core conditions
Counselling goals
Competence (knowledge,
skills and techniques)
Counsellor Accreditation
Counsellor Training
(Counsellor, therapist,
psychotherapist)
Competencies (Knowledge,
skills and techniques)
Professional ethics
Monitoring and Evaluation
Coping strategies (adaptation,
resilience and wellness)
Professionalism
Therapeutic Approaches.
Skills and Techniques.
Code of Conduct for
counsellors.
Counselling Outcome
(end result)
Counselling Process
(resolution)
Counselling
(issue, situational difficulty)
Client
The Counselling Process: Conceptualization

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Counselling Skills
Category Skills and Techniques
1. Core conditions - Empathy / Accurate Emphatic Understanding
- Congruence / Genuineness
- Unconditional Positive Regard (UPR)
2.
Attending skills - Structuring
- Active Listening
- Silence
- Observation
3. Facilitating or responding
skills
- Minimal prompts
- Paraphrasing
- Reflection of feeling
- Questioning
4. Challenging
(confrontation) skills
- Summarising
- Focusing
- Clarification
- Concreteness
- Confrontation
- Self-disclosure
- Disengagement / Termination

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Therapeutic
Approaches

11/11/2017 26Counselling Outcome, Issues, Trends and Professional Ethics
Psychotherapeutic Orientations
- Adlerian Therapy
- Art Therapy (Includes
Bibliotherapy)
- Behavioural Therapy
- Body Psychotherapy
- Brief Therapy
- Cognitive Behaviour Therapy
- Cognitive Therapy
- Dance Therapy
- Drama Therapy
- Existential Therapy
- Family Therapy
- Feminist Therapy
- Gestalt Therapy
- Group Psychotherapy
- Humanistic Therapy
- Hypno-Psychotherapy
- Jungian Analysis
- Logotherapy
- Narrative Therapy
- Neuro–Linguistic
Psychotherapy
- Object Relations Therapy
- Pastoral / Spiritually-
Oriented Therapy
- Person - Centred Therapy
- Psychoanalysis
- Psychodynamic Therapy
- Rational Emotive Behaviour
Therapy
- Systemic Therapy
- Solution Focused Therapy
- Transactional Therapy
- Transpersonal Therapy

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Counselling Outcome: Evidence Based Practices
Therapy and allied domains (clinical psychology, counselling,
psychiatry, psychotherapy, pastoral counselling and social work)
must be concerned about the outcome of treatment. This includes
acceptance of the use of scientific evidence to inform clinical
practice, including embracing evidence based practice (EBP).
Only naïve realism can lead clinicians to conclude that client
change is due to a helping intervention itself rather than to a host
of competing explanations. These include: significant others;
nature of the circumstances; and, the role of therapist as well as
effectiveness of therapeutic approaches, skills and techniques.
Psychological interventions take in the deep-seated
misconceptions regarding human nature. But even then, there are
misunderstandings regarding human nature and the application of
various approaches to individuals and/or groups. Nonetheless,
there must be evidence based practices to enable evaluate the
increasingly technical nature of counselling and psychotherapy.

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Counselling Outcome for Client
- There is substantial variability in the extent to which clients
benefit from psychological therapies. Typical outcome for clients
receiving psychological treatment (therapy) varies
systematically among practitioners and across therapeutic
approaches. This is due to a variety of factors such as poverty
and low income levels.
- Differences exist between the more developed countries and
the low income developing countries. Therapeutic approaches,
training and expertise of practitioners may help to explain
between-clinic differences in effectiveness. In the low income
developing countries, it is important to consider the broader
socioeconomic and geographic context in which therapy is
offered.
- All these factors will assist to improve the effectiveness of
psychological interventions in various contexts.

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Counselling Outcome for Counsellor
Therapists contribute to treatment and healing. Some practitioners
(therapists) consistently deliver better outcomes, while others are
not as effective in counselling. This is despite the fact that several
variables can be considerably controlled for clients. Scholars
identify the main characteristics associated with positive outcomes
such as follows: empathy, expertise (appropriate choice of
therapeutic approach), number of sessions, professional ethics,
treatment effectiveness, therapeutic alliance with client and
professional practice. Social support, religion and spiritualism and
other factors are considerably convenient. In that case, we must
continuously identify significant explanatory variables and their
clinic effect in order to improve on practice. Practitioners must
consistently identify important interactions between the client and
therapists, therapeutic approaches, skills and techniques, the
content and context of therapy as well as differences between
therapists. All these will require to be consistently investigated.

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Counselling Outcome: Process – Effect and
Network Approach Systems
- Research in counselling and psychotherapeutic processes must
track changes in clients, including in on-going treatment and as
an end result. This will aid in clinical decision-making.
Additionally, the purpose of counselling and psychotherapy is to
assist the client in everyday living, hence the effect of a session
or sessions should extend beyond the duration of the session/s.
- The importance of therapy is in the therapeutic change as a
result of the meaningful interaction with the practitioner. This
raises pertinent issues on the following: (1) Counsellor
Competence (including training, qualifications and professional
ethics); (2) Theoretical orientation / approach adopted by
therapist; (3) Treatment goals; and, (4) Individual client,
including their issue/s and circumstances. All these must be
based on four facets, that is, theory, practice, professional
ethics and research.

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Psychological Variables
Personality (often self
as part of society).
Community / Traditional
values and norms, beliefs
and customs (culture and
religion).
Community
understanding of life and
living.
Past and Present
behavioural
competencies.
Socio-cultural (societal/
traditional) philosophy.
Positive Mental Health and
Overall Wellbeing
Physiological and
psychological competencies
(including social, intellectual
and spiritual wellbeing).
Modernity (new world order,
including culture and religious
interpretations).
Self- compassion and
flourishment.
Adjustment behaviours,
including self and community,
as well as successful
adjustment to life (individual,
family, work, community)
Meaning in life, including
post- traumatic growth and
development.
Current Competencies
Advancement in medicine
and information
technology (Globalisation).
Modernization,
Nationalization and
Internalization.
Adherence to Socio-
Cultural (tradition and
religion) norms and
values.
Behavioural Competencies in Effective Counselling Outcomes
Past Competencies Coping Competencies

PROFESSIONAL ETHICS

Guidelines on consulting and adhering to Code of
Conduct
(1) Always get acquainted with the professional Code of
Ethics of your profession.
(2) Use the most recent (revised) version.
(3) Get acquainted with all Sections of the Code (Avoid
reading selected Sections). This allows you to
contextualise the Code.
(4) Distinguish between statements on obligatory practice
and recommendations (suggestions in context).
(5) Interpret any supplementary notes or guidance
provided by the Code.
(6) Always look at each situation in context. This requires
that you review each case on its own (be specific).

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Quality of Standards in Counselling Practice
Several factors have been identified that appear significant and
contribute immensely to effective counselling.
These are:
(1)Level of skilfulness (defined as counsellor competence rather
than experience).
(2)Cognitive complexity (includes ability to comprehend a diversity
of clients including the complexity of cases / issue/s and
circumstances ).
(3)Ability to relate and match with the clients with whom they are
working (the relationally matching of client and counsellor).
In addition, it is essential that counsellors have the knowledge and
ability to assess the presenting issue/s so they can identify the
appropriate therapeutic approach. It is the effective application of
evidence-based approaches that determines the competent
application leading to successful intervention.

Client + Counsellor
Monitoring and Evaluation Continuous Evaluation Appraisal
Therapy /
Counselling
Healing / Positive
Change in Client
Initiation Process End result

Quality of Standards in Counselling Practice:
Counselling Outcome Representation Model
Client + Counsellor
Monitoring and Evaluation Continuous Evaluation Appraisal
Therapy /
Counselling
Healing / Positive
Change in Client
Initiation Process End result
Counsellor
Competence
Quality of
Counselling Service
Flourishing life
- Counsellor training
- Accreditation
- Professional Ethics
- Continuous Professional
Development
- Counsellor supervision
- Professionalism
- Client well-being
- Coping competencies

A prominent focus of concern among practicing therapists is
assessment of therapy, especially taking into consideration the
fact that quality of services has the notion of ‘positive’ or ‘effective’
results or product. Essentially, effective or positive results
promulgate a rather polarizing positive-negative, effective-
ineffective dichotomy. Certain results, therapists or therapeutic
approaches may be labelled as positive (effective), and thus
presented as inherently appropriate, desirable and/or successful.
The necessary corollary, of course, is the contrasting phenomena
in which certain therapists, approaches or end-results can be
implicitly conceptualized as negative, ineffective and undesirable.
This positioning is delicate as clients may intrinsically expect
certain (desirable) results. Yet certain clients may be too highly
optimistic while yet others may tend to be pessimistic. Both
nuances may be a categorical impediment to wellbeing.

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Conclusion
The more traditional populations tend to use counselling,
psychotherapy and mental health services only in the most
extreme circumstances. In addition, medical and psychological
services are lacking and/or limited. This greatly skews the
statistics about persons using counselling, psychotherapy and
other mental health services. Even when the helping services are
(readily) available, numerous clients are either unaware of their
significance or shy away altogether. In the end, a majority of
clients tend to drop out of treatment within the first few sessions.
Although the reason why clients do not persist with therapy may
be unclear, it is possible that persons in the more traditional
societies do not find reasons to persist seeking helping services.
Clients may not be as motivated, perhaps because they may not
comprehend therapy. Besides, they may not perceive the services
as helping since they may have other sources of help such as
family and religious faith.

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Conclusion
Counselling and psychotherapy is being associated with good
health, and this inherently implies improved wellbeing. The quality
of counselling and therapeutic services is exceedingly significant
informed by the development of evidence-based clinical
interventions.. Also, the importance of the quality of human
interaction during therapeutic encounters has gradually become
accepted A lot of therapy and care, especially in the more
traditional societies, is provided informally, meaning that it may
not be reflected in statistical terms. But still, helping (counselling
process, use of skills and techniques and adherence to
professional ethics) and the outcome of counselling (end product,
including effectiveness and quality) must be beneficial to the
client. The process must be monitored and evaluated and at the
same time appraised. Evidence-based counselling practice is the
future of both preparation of counselling and practice of
professional counselling.

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Module : Counselling Outcome, Issues, Trends and Ethics
Wango, G. M. (2017). Counselling Outcome,
Issues, Trends and Ethics. Nairobi: University
of Nairobi.

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