Short-term Counselling in Higher Education

Context,Theory and Practice

David Mair

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317614050
• Topic: Psicología
• Subtopic: Salud mental en psicología

As demand for counselling from students across Higher Education (HE) increases year on year, counselling services are continually seeking to explore creative ways of working under the pressure that results from this rise in client numbers. One of the most frequent responses to increased demand is limiting the number of sessions that individual students may have. Until Short-term Counselling in Higher Education, there has been no text which provides a contextual, theoretical and practical input to this evolving way of working.

This book explores constructive ways of providing very short-term counselling within a Higher Education context. Using case-studies, and employing up-to-date statistics from the sector, the book gives readers a clear understanding of the nature of the professional challenges, and offers ways of addressing these, including managing waiting lists, developing policies to facilitate timely intervention, and understanding the limitations of what short-term therapy can offer.

Short-term Counselling in Higher Education explores the implications of working in Higher Education counselling services in this very short-term way, and as such it will be an essential resource for counsellors, heads of counselling services and student services managers in Higher Education, helping to find ways of delivering effective short-term interventions within existing counselling services.

Practice

4 Assessment

Laying the foundation for brief therapeutic work in HE

Géraldine Dufour

DOI: 10.4324/9781315751078-5

In this chapter, I look at the complex role of the counselling assessment in higher education (HE). Since most readers will be familiar with the theory and practice of assessment as it is generally covered on professional counselling training courses, I explore here what is specific to assessment in a university context. In therapeutic settings, counselling assessments are used to identify and explore the presenting issue of clients as well as to consider suitability for different forms of psychological support. We will see that in HE there are a number of further requirements such as detecting risk and sign-posting students to additional sources of help. While exploring the multi-faceted role of assessment, I focus on issues of practice as they occur in the context of counselling services in British universities. I illustrate these with examples of clinical work and relevant research findings. Though we will see that there are many benefits to a good assessment, we will see that there are also some potential downsides. One area of difficulty is that by offering assessments, a counselling service might uncover needs that cannot be met and raise unrealistic expectations of the level of service it provides.

What is assessment?

Defining assessment is complex, particularly so because practice differs so much between counsellors¹ and counselling services. Despite this variety it is helpful to think of it as a process rather than a single intervention, a series of steps that help to define the problem from the perspective of both the client and the counsellor. As McLeod (2003) comments,

The nature of assessment depends a great deal on the theoretical model being used by the counsellor or counselling agency, and a wide spectrum of assessment practices can be found.

(p. 330)

Reeves (2012) further shows that it is not just practice that varies, but even views around assessment itself. There are therapists for whom assessing is anathema, believing it imposes a premature focus onto therapeutic work, whereas working in a non-directive way is seen as less “controlling”. Though differing views may have validity according to the setting in which the work occurs, I believe that failing to assess student-clients risks is missing both their needs and those of a counselling service in the HE context.

Why assess for brief work?

In a setting where most therapeutic work is brief in nature, a good assessment of the student and of their needs is worthwhile at many levels. In brief work there is less time for issues to emerge and therefore a thorough assessment assists in finding a focus for counselling. Because of the short-term nature of the intervention it is imperative that as well as being able to assess suitability for counselling, practitioners are able to assess suitability for brief work. A good assessment should help to identify a goal for the work. The inability to find such a focus could be a counter-indication for brief work. Once a focus is established, the counsellor needs to concentrate on the agreed issue(s) and steer the work back if it begins to drift. This will require a careful decision not to address other issues that, potentially, a client may wish to raise after the focus has been agreed –this is known as applying “selective”, or “benign neglect” (Levenson, 1995). However, it is worth noting that certain issues, due to their severity, or the risk that they pose, cannot safely be neglected. Consequently for a skilled and competent assessment, the ability to select suitable goals and to be appropriately flexible is central to the practice of brief work.

Assessment is key to the practice of counselling, brief or otherwise, because it helps to clarify the nature of a problem and the severity of symptoms. It also helps with triage, distinguishing between those students who can be helped within the context of a university counselling service (UCS) and those who need to be seen by specialist mental health services outside the university, their GP, or other colleagues within the institution. Assessing a student also helps to identify those whose needs are most urgent. Students approach services for many reasons: assessment helps to clarify the problem they are facing, and the sort of help they require –are their needs psychological, academic, or both? While some students attend counselling with an insight into what might be causing their difficulties, many are simply aware that there is a problem. For instance, many students complain of feeling “stressed”. At assessment the role of the counsellor is to establish why they are feeling stressed:

• Is it because they are unable to concentrate on their studies?
• What is happening to them when they are unable to concentrate?
• Is their inability to concentrate caused by their emotional state?
• Or is it because studying is too difficult?

If they have identified academic difficulty as an issue, the counsellor needs to explore further what the difficulty is about:

• Does the student lack study skills?
• Is the issue the academic level of their course?
• Do they need more academic support?
• Do they need a screening for Specific Learning Difficulties?

It is important to ascertain if there is anything that can be put in place to help the student practically, sign-posting them to other support services, or perhaps working concurrently with other colleagues in the institution. When a student is struggling, this can be a complex issue requiring several different sources of help. A counsellor needs to be able to adopt many roles: detecting issues, identifying potential sources of help and support while also exploring and attending to the psychological issue that the student is bringing. In that moment they work as a counsellor but also potentially as an advisor, by providing appropriate information. This is why it is so important that counselling services are embedded in the academic institution that they serve. As Caleb (2010) shows, a generalist counsellor, insufficiently grounded within a university context, will struggle to support a student in their academic endeavour. There are many areas that are specific to the university setting, such as referral to disability services for students needing reasonable adjustments. Another complex area is legislation around international students, where attempting to provide advice without appropriate training can incur criminal and financial liability for an individual and an institution. Counsellors need to have a thorough knowledge of other student support services to where they can direct students, as well as awareness of legislation that directly impinges on the provision of support. For instance, the Equality Act 2010 places responsibility on universities to make reasonable adjustments for disabled students.

This dual counsellor/advisor role can be surprising to a counsellor new to HE. It adds an extra dimension to the work of the therapist and connects the student seeking counselling to their studies and the rest of the university.

Triage

As we have seen, “assessment” encompasses different aspects of supporting students. In some services, an effort is made to offer appointments to clients based on their presenting issues and the counsellor’s expertise in these areas. Students may also be prioritised because of the severity of their situation and any risk issues. This system of allocation is known as “triage”. Triage can be based on different sources of information: a detailed pre-counselling form filled in online by a student, information passed by a referrer or an email from a student. For other services, triage takes place after assessment, and before the client is allocated to an on-going counsellor.

Services vary in the way in which they collect data. Some have pre-counselling forms completed by students. Others rely purely on the information collected by the counsellor at the first appointment. There might also be some additional information sent by other parties such as academic, tutorial, advisory or medical staff. Many UCS also use CORE (see McCrea, Chapter 5) to screen clients, particularly for risk, before they attend counselling.

Mental health issues

Students presenting with potential or diagnosed mental health issues are not uncommon in UCS. If they are young, students attending university go through many changes: leaving home, developing a different sense of self and identity. Early adulthood (18–25) is also an age at which psychiatric illnesses often first emerge (Iarovici, 2014).

In recent years, disability service colleagues have reported increases in students disclosing mental health issues when they attend university, as evidenced in the Equality Challenge Unit (2014) report:

Since 2007/08 the proportion of disabled students disclosing a mental health condition has increased from 5.9% to 11.1% in 2012/13 (from 0.4% to 1.1% of the entire student population).

(p. 123)

At assessment stage, it is crucial that counsellors are able to identify potential mental health issues to offer students appropriate support. These students might need referring to disability services in case they need reasonable adjustments, or additional support put in place. This is important for a number of reasons: a student with mental health difficulties might not be suitable for a brief counselling model because of the severity of their issues. A disabled student might need specialist support from the university disability service. Failing to set up reasonable adjustments has legal implications under the Equality Act 2010, which can be costly for an institution: they can be fined, and reputation can suffer as a result of negative publicity. Therefore the ability to offer a skilled assessment, where all the needs of the student can be addressed (and when addressed, recorded and actioned appropriately) is key to the institution in protecting itself against litigation, and in retaining students.

Issues of risk

The ability to assess and contain risk is central to the provision of counselling in HE, so a student counsellor will explore issues of risk related to harm to self or others. As well as risk of suicide, a student might be at risk of violence from a partner, or if they are a parent, they might be putting their child at risk.

For students on clinical courses such as medicine, nursing or radiography, the counsellor has to be aware of the risk that a student may pose to others if they are unwell. Many universities now have Fitness to Practice policies and on the very rare occasions when a student might not want to take responsibility for the welfare of those for whom they have responsibility, counsellors need to be aware of the policy in the service and in the university regarding risks to others. For instance, if a very unwell student who is putting others’ safety at risk does not agree to leave their placement, a counsellor might have to contact their course director so they can protect those at risk by suspending the placement. (It is important to note that although this is a possibility, it is not one that is frequent. Having worked as a counsellor in HE for over 10 years, I have never had to express concern about a student in order that they be suspended from practice.)

An additional, and much more frequent, risk to which the counsellor must be attuned is academic risk, that could lead to the failure or withdrawal of a student. Therefore in many UCS, students can be prioritised not just on the basis of their psychological needs, but also in relation to their academic situation. Such students would typically include:

• “finalists” in the last few months of their degree
• “freshers” who have recently joined the university
• students at risk of failing where there is a sense that counselling can help
• those causing concern within the institution.

In cases where there is a waiting list, many UCS choose to prioritise students who show the greatest need. Therefore it is essential that assessments are rigorous in identifying risk and the needs of the students who approach the service, as failure to do so can put the student and the institution at risk.

Assessment –the downsides?

In this chapter, I show that there are many advantages linked to conducting good assessments. However, there are also some potential downsides to this process; for example, by identifying demand that is then difficult to meet. Having a counselling service available to students is one way in which a university can effectively demonstrate support for students. It can be difficult to think that such support is limited. Tutors want support for their students. Parents want reassurance that their children are cared for. Students want help when they are struggling. Counsellors want to be able to assist those who approach them seeking help. We can see that there are many expectations impacting on a counselling service. Unconsciously, all involved desire that the service contain and resolve all students’ pain and anguish. Zagier-Robert (1994) examines the unconscious wish for unlimited care that gets projected onto mental health services and how therapists use conscious and unconscious defenses to cope with the most difficult aspects of working in the caring professions. This wish for all encompassing support is, however, not one that can ever be perfectly fulfilled. Assessment uncovers need. It can be very challenging for therapists to identify needs that cannot then be addressed. Many counsellor...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• List of tables
• Notes on contributors
• Introduction
• Context
• Theory
• Practice
• Index