Clinical Counselling in Voluntary and Community Settings

Quentin Stimpson

• Publisher: Routledge
• Year: 2004
• Print ISBN: 9781583911563
• eBook ISBN: 9781135480639
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Clinical Counselling in Community and Voluntary Settings provides an overview of the development of counselling in a world of managed care, where resources are tight and professionals are stretched to their limits. Experienced contributors from a varied and diverse background cover issues including:
* the place of community and voluntary organisations in society at large
* the nature of counselling in voluntary and community settings
* containment and holding
* the nature of the client group and its affect on clinical work
This book will provide theoretical and practical advice of interest to both experienced practitioners and students considering a placement with a voluntary counselling organisation.

Chapter 1

The place of community and voluntary organisations in society at large

Christopher Robinson

Introduction

In this chapter I consider the role of community and voluntary organisations in society at large. I begin by defining what is a community or voluntary organisation. I then consider the historical perspective of such organisations— their relationship to the communities in which they develop as well as to the statutory sector or state-provided care services. I specifically consider here the growth of community-based counselling services and their value to society and local communities. I then discuss some of the particular qualities of community and voluntary organisations —their contribution to the development of services for local populations and their function in society at large in providing change and innovation. Finally, in balance to the qualities of such organisational activity, I look at some of the drawbacks and weaknesses of community and voluntary organisations, which may hinder their development and success.

I write this chapter from the perspective of someone who has worked in this sector for the majority of my working life and in doing so have come to value the particular atmosphere of innovation and hope that characterises community and voluntary organisation activity. At the same time I have a very practical awareness of the problems encountered by these organisations that weaken their potential contribution to society.

What is a community or voluntary organisation?

There are a number of ways of defining what a voluntary organisation is, or what differentiates it from other organisations. I shall consider a number of possible definitions below. (For the sake of ease and because my interest here is in smaller, community-based voluntary organisations, I use the term ‘voluntary organisation’ to refer to a community-based voluntary organisation rather than large national charities or pressure groups, which, although they may have similarities with community-based organisations, have a different, larger scale function in society.)

Community organisations: statutory and non-stotutory

There is a variety of community-based organisations that provide social or medical services to the population of that community. These organisations can be separated into statutory or non-statutory services. Statutory organisations form part of a statutory or government-provided system such as the National Health Service or local authority provision: they have certain defined statutory duties to perform for the local population, i.e. the provision of health or social care. The fundamental duties of such organisations are usually defined within a legal framework laid down by government. For example, a local, community-based social services team will be working within certain defined duties laid down within the most recent legislation adopted by government.

Non-statutory organisations, on the other hand, provide services that are not necessarily defined within a specific legal framework. These organisations are described as ‘voluntary’, ‘charitable’ or ‘independent’ sector organisations. A complication to this division into statutory and non-statutory organisations is that some statutory organisations may provide services that they are not necessarily legally obliged to do. For example, a local NHS clinic may provide a family therapy service, the provision of which is not within its statutory duties but is additional and complementary to them. Furthermore, a non-statutory or voluntary organisation does of course provide services within a legal framework (the Charities Act, etc.). However, the important point for the purposes of this chapter is that the service provision in this sector can be more freely defined and changed according to the particular aims of the organisation.

Community organisations: the voluntary organisation

Having distinguished the non-statutory from the statutory organisation, the voluntary organisation can be further defined. A voluntary organisation is therefore an independent organisation that acts outside the sphere of governmentprovided health and social care provision. It is voluntary in the sense that its activities can be defined by its own members, rather than by government and legislation. The voluntary organisation is constituted as a charitable organisation and will have a guiding constitution or Memorandum and Articles of Association that is monitored by the Charities Commission. Additionally, the voluntary organisation may be legally set up as a limited company and its activities will therefore also be monitored by Companies House, which oversees all limited companies (the majority of which have commercial functions as their primary activity).

It would seem that the voluntary organisation has a two-fold function of being ‘charitable’—not being motivated by commercial profit but by what might be termed social profit or benefit—as well as having some of the qualities of a commercial venture in its need to provide services responsive to the demands of the community it identifies. In doing so it must possess what might be seen as the commercial qualities of responsiveness and innovation, i.e. responding to ‘gaps in the market’ (the market referred to here being the provision of social/health services rather than commercial activity).

Development and growth of voluntary organisations: a general historical perspective

Historically, the role of voluntary activity has been a very significant one in encouraging and enabling the growth of social and health services within communities. It is only in relatively recent years that governments have accepted responsibility for the provision of extensive social and health services. This has been a gradual process over the last 150 to 200 with the initial impetus for the improvement of better social and health services coming from very different sections of society: from the voluntary and charitable activity of wealthy, socially conscious benefactors as well as from the organisation of local and national trades union and social reform organisations committed to improving the lot of their fellow workers. It has largely been the case that, because of the action of committed individuals and groups, the development of what we consider now to be basic individual rights in a modern society such as health care, social care and housing are available to us. Of course, such rights to basic services come about gradually over time due to an amalgam of individual action, social change and political pressure. However, government legislation that solidifies and makes explicit such rights is inevitably influenced by the work already put into practice through local initiatives and individual action. For example, the growth of social housing provision in the 19th century made possible by such benefactor activity as the Peabody and Guinness estates was later taken on by government in the subsequent acceptance of the role of the state in providing basic housing for the economically poorer section of society.

Development and growth of community-based counselling services and the role of voluntary organisations

Voluntary action at a community level has then often been the impetus for larger aspects of social change and development. Within the present development of counselling and psychotherapeutic services, it is interesting to observe how the growth of counselling provision within local communities has occurred in what today we call the primary care sector of GP clinics and community-based services. The provision of ‘talking treatments’ has tended to be something largely confined to the private sector where economic considerations—the ability to afford counselling or psychotherapy—has meant that less well-off sections of society have had restricted access to this type of psychological treatment (Holmes and Lindley 1989). Psychotherapy services within NHS settings have tended to develop and stabilise over the past 50 years and therefore have been perhaps more generally available. In recent years however they have faced their own difficulties, competing with newer drug treatments and differing views about the origins of psychological disturbance and mental illness.

Shifts within our society’s general perception of the value of counselling and talking treatments appear to have encouraged the growth of counselling services in the community. Whilst debate continues over the complex origins of psychological disturbance, in parallel to the sophistication of our understanding within professional circles, there has been this growing general awareness of the value of a psychological understanding and treatment of presenting problems such as depression and anxiety. This seems to be rooted in cultural and social changes, which place greater value on the understanding of our emotional, psychological and sexual lives.

In this context, at ‘grass-roots’ level in our society we are experiencing what amounts to a greater demand for counselling services. In essence, there is increasing social pressure to provide alternatives and new approaches. Whilst the demand for effective medication to treat depression, stress and anxiety continues to grow, there is also a demand for non-medical interventions such as counselling. Voluntary organisations have played a role in these changes by publicising the value of alternative treatments and by providing direct services in local communities, particularly in very recent years. For example, the organisation in which I work grew originally out of a local community health project set up to monitor and improve the health needs of the local population. The explicit aim of this group was to improve physical health through health education in areas such as smoking, sexual health and diet. The group found that the people visiting them increasingly wanted to talk about the emotional aspects of their daily lives and relationships and this led to the setting up of a counselling service. In this way, organisations such as my own have managed to develop services that have responded to the changing pattern of demand at community level. Additionally, we are now seeing how these counselling activities are being taken up by the statutory sector through the growth of primary care counselling provision within GP practices.

Whilst this growth of counselling provision at local level would appear to be a solid and hopeful development, a note of caution is necessary. A less promising development is one in which voluntary organisations are in fact filling gaps in social and health provision caused by a restricted NHS and local authority activity due to reduction in government spending. Whilst counselling services are growing, we are directly seeing counsellors in voluntary organisation and primary care settings having to cope with complex psychological presenting problems that are more realistically the domain of hard-pressed psychiatric departments or psychotherapy services. Community-based counselling services are struggling to fill the gaps and often find themselves providing a ‘first aid’ service when, in fact, more resources than the counsellor can provide are necessary. One hopes that voluntary organisations engaged in this sort of experience will perform an effective function to society by certainly attempting to fill gaps where possible, but also by recognising their limitations they can perform a wider ‘consciousness-raising’ task: to encourage government action to further improve community-based mental health services.

Qualities of voluntary/community organisations that enable their role in society

Voluntary organisations have a range of qualities that enable them to perform an important role to society in the enrichment of social and health services. I shall discuss what I see as important qualities under the headings below.

Proximity or closeness to community need

Community-based voluntary organisations tend to grow out of the local community—one could say that the community creates them. For example, in the case of my own organisation (as described earlier), the service evolved out of a response to the demand for counselling. Various aspects of the organisational structure of voluntary organisations consolidate the importance of proximity to the community and its needs. For example, a voluntary organisation may have a constitution or governing objective to involve local people in its management, thus ensuring it represents local people. It may additionally be located in an accessible physical setting such as a community clinic or centre.

This suggests that a community-based voluntary organisation has the capacity to ‘know’ the community and its needs. Of course a local community can be a rather nebulous and diverse entity, especially in an inner city area where many differing needs and different ethnic communities are represented. A voluntary organisation may represent a particular section of that community and be less able or willing to represent other sections. Yet its very proximity to the local people suggests a potential capacity to reflect the diverse population. The recent history of voluntary organisations is one of a general attempt to see such organisations representing local ethnic groups and addressing this in service planning and delivery.

Accessibility and use by the local community

The fact that community-based voluntary organisations are located within communities makes it more likely that people in the community will use their services. This may sound like a truism. However here I am emphasising voluntary organisations as potentially more ‘stigma free’ than statutory services. Within the field of counselling and mental health especially, yet also more generally, they may feel less threatening to visit. They may be more accessible in a very physical way by being close by—located on a housing estate or community centre—but, more importantly, they can offer a different sort of ‘closeness’ by being less identified with the often intimidating setting of a hospital or other statutory service. For example, statutory services may feel less confidential. There may be a fear of information being passed around to other unknown government departments or simply the very size of hospitals and the formal, uniformed atmosphere may lead people to fear bringing their concerns about their physical or mental health. In the mental health field particularly there is a common fear of being ‘labelled’—being thought ‘mad’—if one attends a psychiatric service. These are the common concerns of people who attend community-based organisations - there they may feel more ‘at home’ and in safer hands. Of course, these fears may be unfounded as hospitals and their staff have similar human concerns as the staff in voluntary organisations. Nevertheless, this is a real factor that is often addressed by voluntary organisations. It is interesting to note here how the recent developments in primary care as the focus of health service delivery seem to mirror a desire to be local, accessible and less institutional.

Proximity and accessibility: a psychoanalytical note

Using the analogy of society as a family, one could describe the role of voluntary organisations as mirroring a maternal function in that family. I would see this as occurring as follows. First, the voluntary organisation has this quality of proximity and accessibility to the community that one could equate with the mother and baby relationship, in contrast to the more paternal and distant relationship of the statutory/state sector. Second, the voluntary organisation potentially meets and processes the needs of the community, providing a ‘transitional space’ (Winnicott 1975a) between the as yet unstructured needs of the community and the structured framework of the statutory/state sector.

Within this second quality lies the potentially creative role of the voluntary organisation in developing services that fill the gaps and address needs which cannot be met by statutory services. Of course, in describing this role I do not wish to suggest that the statutory sector does not contain a maternal or creative capacity. I am assuming a certain more fixed (and perhaps paternal?) role of the statutory sector in having certain defined tasks.

Problems of Voluntary Organisations in fulfilling their role in society

Voluntary organisations face a variety of problems in fulfilling their role. I would define these problems as falling broadly into the two categories of external and internal problems.

External problems

Securing the resources—funding

Because voluntary organisations in the community are constituted as independent organisations with their own aims and objectives and run by their own members, they exist outside the structured statutory services that are provided and funded by government. Simply put, voluntary organisations have to raise their own funds to pursue their aims. This faces the voluntary organisation with its first obvious challenge —to secure the financial means to carry out its aims. Of course, this problem in itself can be a motivating factor. The belief that resources should be provided by society to meet certain unmet needs is the drive behind the organisation’s existence. This necessity to secure funding can therefore provide a voluntary organisation with its particular blend of energy and zeal. Yet it brings with it an insecurity about the reliability and continuity of the organisation’s resources. It is true that as voluntary organisations become established over time their funding should also become more consolidated. However it is often the case that as the needs which the voluntary organisation is addressing are not fully established and proven in the eyes of potential funding sources, the reliability and security of resources cannot be guaranteed.

Making the case—relations with external organisations

A related aspect of the necessity to secure resources to carry out the work is the need to work with external agencies such as local statutory services and charitable donors to make the case for the importance of the work undertaken by the voluntary agency. The relationships between the voluntary organisation and the local statutory services can be a mixed affair. To a degree the very existence of the voluntary agency may be a critique of local statutory services; i.e. that these services are not providing something in the community which the voluntary organisation perceives as necessary. However, a more constructive relationship with local statutory service providers can develop with those services encouraging voluntary organisation activity on the basis of recognition of the organisation’s particular qua...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Notes on contributors
• Acknowledgements
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Chapter 9
• Chapter 10