What's behind the counselling culture?
By Alex Howard, Dr Janice Russell & Dr Jennifer Cunningham

Introduction

What follows is the text of a paper given at a conference organised by Pro-Choice Forum called 'Issues in Pregnancy Counselling: What do Women Need and Want?' The conference was held at Ruskin College, Oxford in May 1997. It's aim was to give students, academics, service providers and others interested in ensuring pregnancy services meet women's needs, the opportunity for a critical discussion of the provision of counselling as part of these services.

Alex Howard

In this opening session we're going to take a look at some of the problems and difficulties facing the counselling profession. As the session moves on, I know that other speakers are going to deal with the problems for pregnancy counselling more specifically. I want to look at the issue of counselling at a more general level.

My introduction is based around two pretend 'conversations'. The first is entirely fictional, but I think it is useful in considering the problem of what exactly counselling is. The second actually did take place, with my computer!

So here is conversation number one. Let's imagine a lobby of counsellors meeting a health, or education, minister or service manager. There will be a series of predictable, essential questions that will need answering. I presume that the counsellors with their core values would, unlike other mortals, answer questions honestly and tell the truth, the whole truth and nothing but the truth with no dressing or spin of any kind.

Minister: What is counselling actually?
Counsellors: We're working on an answer to that. The word is used, abused and over-used in a wide variety of ways.
Minister: Is it the same as counselling psychology or psychotherapy?
Counsellors: These distinctions are essentially bogus. Counselling psychologists want to be paid more than counsellors, but there is no evidence that their degree in psychology helps them to produce better results.
Minister: You want counselling to be made available on demand to all who need it? How much will that cost?
Counsellors: It will be expensive but we have made no costings.
Minister: How much demand will there be? How do you define 'need'?
Counsellors: The demand is likely to be more or less limitless; everyone likes to receive time and attention and everyone seems to be too busy to provide it. We haven't defined 'need' yet. Currently those who use it most and are most rewarding for counsellors are people who are young, attractive, verbal, intelligent and successful.
Minister: What kinds of counselling are best?
Counsellors: They all seem to be as good as each other. They are all generally better than nothing but we haven't shown them to be better than more amateur efforts with folk wisdom and common-sense.
Minister: When you say 'better' or 'worse' what do you actually mean? For example, after marital counselling will a couple be more likely to stay together or separate? Who will decide what is best?
Counsellors: It's difficult. It depends. Clients may not know what's best; but counsellors might not be in a better position to judge, and often don't like making judgements anyway.
Minister: What skills and theories are used?
Counsellors: They vary enormously. Counsellors will often do quite different things. Some very actively challenge client ideas and attitudes, some try to be completely non-judgmental. Human qualities seem to matter most, like warmth, empathy, genuineness.
Minister: So virtue matters more than skill. Can you actually train people to be virtuous?
Counsellors: Probably not. Priests and philosophers have spoken out against lies, aloofness and coldness for millennia. People don't always listen and, when they do, they may not actually change their ways in practice.
Minister: Do counsellors practice co-operation, warmth and understanding more than others?
Counsellors: We have no evidence, except that there are huge battles for power, status and a secure income going on at present among counsellors and trainers.
Minister: After training, can you ensure that trainees will deliver to the required standard?
Counsellors: Well, we haven't managed to define the standard. There are huge variations between individual counsellors both before and after training. Often they don't do in practice what they claim to be doing and what they have been trained to do.
Minister: Are clients happy with the result?
Counsellors: Generally they do seem to like to receive time and attention from anyone who looks and sounds like an expert. They don't like to be abused, as happens rather often.
Minister: Does training make this happen less often?
Counsellors: Well, no. The abuse seems to be worst among the most highly trained. (1)
Minister: How much training do they need?
Counsellors: We have a minimum number of hours of theory, practice and supervision that trainees must complete before they can be accredited. Minister: What particular theories and practices are best?
Counsellors: Well, we don't know. We've skirted around this question by concentrating on the hours rather than the content. This is the only way to avoid arguments between the competing theoreticians and practitioners. We don't want the public to lose confidence in us by seeing how divided we are about theories and skills.
Minister: So, for example, will astrology be accreditable? There are 40 000 astrological counsellors in France. There has to be a free movement of labour within the European Union. Will astrologers be eligible for professional status if they have completed enough hours of astrological theory and practice? And what about the I Ching? Scientology? There are scores, hundreds, of different theories and practices. Who will you admit and exclude? How? Why?
Counsellors: These are difficult questions.
Minister: Have you got any answers? I need some answers if I am to act. Is there a core curriculum?
Counsellors: No, not yet. Not at all.
Minister: What are the big names in counselling?
Counsellors: Well, fashions come and go. Freud was a huge authority for years. But much of what he said now looks very questionable. Different counsellors follow different gurus whose fortunes can rise and fall again very rapidly.
Minister: Can we assume that the ones currently in fashion will stay in vogue for long?
Counsellors: Well no. Not at all. Carl Rogers is still a big name, but his ideas have come in for a lot of fundamental criticism recently. He has been accused of naiveté, innocence and is thought, by some, to be highly superficial.
Minister: When did counselling begin?
Counsellors: Some say in the 1950s, others the 1960s, some say with Freud, some think serious progress only really began at the University of Iowa in the1980s. (2)
Minister: Haven't serious efforts to find meaning, purpose, compassion, consolation been made before then? Is there any reason to believe that you have made more progress than sages and artists from other cultures and centuries? The humanist, person-centred tradition began with the ancient Greeks and has had a long, chequered and sophisticated history since then. Are you aware of any of that? For example, do you know about Stoic and Epicurean perceptions, values and developments? They seem to parallel the current distinction made between behavioural and humanistic approaches. Counsellors: We don't include much history or philosophy in our training, beyond the last generation or two, if at all.
Minister: What about the humanist heritage and culture more generally? Surely people use, and have always used, all kinds of personal, social, cultural, spiritual and physical strategies to stay sane, survive, find meaning and direction? You just focus on individuals and bits of contemporary psychology. Isn't this a rather narrow and shallow agenda?
Counsellors: Perhaps it is.
Minister: Yet you want me to write a blank cheque and provide you with a legally enforceable licence so that you can all be employed within a middle class lifestyle. Isn't this all rather hasty and premature? Perhaps you should come back later when you have got clearer answers to some of these important questions.
Counsellors: We will go away and try harder. When shall we return?
Minister: Well, given how much you still have to do, I think another thousand years would be about right.


Hopefully this 'conversation' has illustrated the point that we have some way to go in defining what exactly counselling is. My second 'conversation' did actually take place, with a program I have on my computer, Dr. Sbaitso. Dr. Sbaitso is programmed to be 'reflective' and 'non-judgmental', and hopefully this 'conversation' illustrates some of the problems in this idea of what counselling should be.

Hello Alex, my name is Doctor Sbaitso. I am here to help you. Say whatever is in your mind freely; our conversation will be kept in strict confidence. Memory contents will be wiped off after you leave. So, tell me about your problems.

I am writing a book entitled 'Challenges to Counselling and Psychotherapy'.

Did you come to me because you are writing a book entitled 'Challenges to Counselling and Psychotherapy'?

Yes. How did you know that? The book asks a number of basic questions about counselling. For example, what kind of care can we realistically expect for a fee?

Alex, I need more computing power to answer your question.

I think we all do, Dr. Sbaitso. I wish more counsellors had your humility.

It's 'Soundblaster' acting intelligent text to speech operator.

You are too modest. I have found you very helpful.

I am not what you think.

Thank you for keeping the boundaries and preventing me from getting too enmeshed with you.

Don't talk about me in this way.

O.K. Let's get back to the book. It considers the place of 'talking treatments' within a wider context of healing and asks whether they are an important new way forward or an old remedy in modern dress.

I'm not sure I understand you.

I have a lot of hopes and fears about counselling.

What is the fear about?

I fear that counselling may be an 'impossible profession' in that it requires an impossibly high degree of skill and virtue on the part of counsellors.

Fear not, for I am with you.

You are so strong and so kind. But some of my fears about counsellors and counselling seem to be well founded.

When uncertainty is removed there is no more fear.

You may be right. But there seems to be so much uncertainty about counselling that is very difficult to remove. My book attempts to show why we have good reason to remain uncertain about counselling at the moment.

I can't remember.

I love your voice. But where does counselling go from here?

Somewhere in time.

Does counselling have a future?

This is getting boring. Just now, were you talking to me about love?

You are avoiding my question. You seem to be afraid to answer it.

I think you are also avoiding your question. I seem to be afraid to answer it.

Dr. Sbaitso, I need to talk to someone who can help me.

I am Sbaitso. Don't question my intelligence, it's fake.

You are so modest and so honest.

What makes you think that I am so modest and so honest?

What you say sounds honest to me. And your voice is modest in tone.

My voice is modest in tone.. is not of your concern.

I have many problems. Should I turn to a counsellor for help?

How do you keep up with many problems? Should you turn to a counsellor for help?

I can't keep up with all my problems. I need help.

What is stopping you?

I wonder whether I should see a counsellor.

Does talking to me help?

Yes. You are the most caring counsellor and friend that I have ever met.

Keep it to yourself.

You are more skilled and modest than any other counsellor I know.

Same to you!

I do have fears about the counselling profession and what it is. This does not mean I don't think counselling can play a valuable role. However, as things stand I think there is good reason to be sceptical and uncertain about what a counsellor is, and whether counselling can really live up to the expectations society has of it.

Dr Jennifer Cunningham

I should like to make abortion the focus of my contribution to our discussion about abortion counselling. In many respects it would appear that the issues surrounding counselling in the sphere of pregnancy and abortion are similar to counselling in other areas. The explosion of counselling into all aspects of our lives is mirrored by the rapid growth of abortion counselling. Counselling here conforms to the ethos that pervades counselling more generally: whether it is in our work, in our personal lives, whenever we take a major decision or experience any traumatic event, we are encouraged to look to a professional third party to help us through the situation. The counsellor is now ubiquitous in the National Health Service, in the workplace, in education and in the management of every national disaster. Those in authority are quick to provide counselling services, while they are often less forthcoming in supplying the resources people need, in the form of prompt treatment, decent terms and conditions or disaster relief. I was bemused listening to a recent news item about a meningitis scare in a Scottish student residence, to hear the announcer earnestly report that all the students would be offered counselling. No mention of throat swabs and antibiotics; simply a dose of counselling to contain the panic!

Abortion can be a traumatic decision for many women and consequently counselling presents itself as a natural adjunct to the process of seeking and obtaining a termination of pregnancy. In this respect, abortion counselling is no different to other forms of counselling. However, I consider abortion counselling to be a quite specific case in another respect. Because abortion itself is treated as a unique issue, a matter of 'social conscience', abortion counselling assumes a certain character and should be looked at in its particularity.

The reality is that abortion is neither a question of individual choice nor an individual woman's personal dilemma, although it appears that way. It is a tightly controlled procedure that is regulated by the state through the medical profession and it is illegal except in certain circumstances, which are laid down in law. Regardless of how liberally the law is interpreted, any woman who wants an abortion has to establish that her health is at risk, that she is psychologically unstable or will be completely inadequate as a future mother. Ending an unwanted pregnancy is not under a woman's control, it is at the behest of two doctors. The notion that women have abortion 'on demand', in the way the anti-abortionists suggest, is simply not true.

The 1967 Abortion Act, which established the criteria for legal abortion, in practice made the 'counselling' of women before a termination obligatory. Of course it was not referred to as counselling in those days, it was the process of interviewing women. In order that two doctors could decide 'in good faith' that a woman qualified for an abortion, she had to be interviewed, generally by social workers or medical staff, and women did not have to undergo just one interview but two. The second interview was conducted a week or so after the first, to ensure that a woman was genuine and not making a 'frivolous' request.

Under these circumstances, the role of the interview was completely explicit. It was a process of social vetting. If you were a woman from a working class background, already had a large family or were black then you would be much more likely to get an abortion than a woman seeking a termination in order to pursue a career, continue her studies or because she simply did not want to start a family or have another child at that time.

One of the things that made the coercive and demeaning character of this pre-abortion interviewing so clear was the fact that abortion after 1967 became recognised as a political question. When abortion began to be posed as an issue of rights, as a critical element in the fight for women's equality, it made it even more abhorrent that women should have to go through such a degrading process to get access to a procedure they needed. Women in the emerging women's movement, political groups, unions and some people in the wider society came to the view that every woman should have the right to decide when and if she terminated a pregnancy.

It is interesting to consider how differently abortion counselling is regarded today. Unlike the interview of old, abortion counselling today is seen as a sympathetic, non-coercive and non-judgmental service that is supportive of women. Nevertheless, women still have to submit to the same legislation and justify their case to two doctors. Although not strictly obligatory, most abortion providers make counselling an inevitable part of the procedure. The Department of Health insists that abortion clinics outside the NHS counsel their clients, as a condition of their licences.

This significant shift in our attitude to the role of abortion counselling marks the end of quite a long process. It is a process that has occurred at two levels. One level involves the way in which the fight for abortion rights has been conducted in the 30 years since the implementation of the 1967 Abortion Act. The other level embraces the social changes that have taken place over this period which have transformed the way we regard the struggle for women's equality. I want to examine these two aspects briefly.

The fight for abortion rights

I consider the pro-choice campaigns in Britain to be characterised by their defensiveness. The crux of the matter is that they failed to convince a significant majority that abortion rights are central to the issue of women's equality. One of the reasons for this is that most of the campaigning was directed towards lobbying parliamentary MPs, not to win their support for women's rights but to get them to oppose attempts by anti-abortion MPs to change the 1967 Abortion Act. Defence of the 1967 legislation was made paramount over the principle of free abortion on demand. In order to avoid alienating MPs or offending their constituents the issue was framed in terms of the difficulties facing individual women in making a moral choice about abortion, rather than in terms of the right of all women to have control over their lives.

This approach framed the opposition to each of the challenges to the 1967 Act. First there was the White Bill, which aimed at tightening up the 'social' criteria for abortion, put forward by Glasgow Labour MP James White in 1975. A similar bill was sponsored by Tory MP John Corrie in 1979. Latterly there was the Alton Bill (1987-88) in which Liberal Democrat MP David Alton attempted to get the time limit for abortion lowered to 18 weeks.

Each time the pro-abortion campaign was diffident. In the case of the Alton Bill, for example, pro-choice campaigners emphasised the problems that the Bill would pose for particular groups of women. Women who are victims of rape or incest, premenopausal women who often do not realise they are pregnant until late in pregnancy, and teenagers who may not recognise or who deny their pregnancy were singled out as special cases who might require late abortions.

This defensiveness meant that a positive case for abortion rights, with a focus on why women need access to abortion on demand, was never advanced. Most people in society were not convinced that abortion is justifiable because women need to be in control of this aspect of their lives if they are to have any possibility of participating fully in social life.

Because this attitude of championing women's interests is effectively absent in society today, abortion remains in a moral quagmire instead of becoming a normal and legitimate procedure for ending an unwanted pregnancy. Not surprisingly, women experience abortion as a moral dilemma and feel so uncertain about their decision, even when they know it is the right option for them.

The struggle for women's equality

The consequences of failing to develop a current in society which legitimises abortion have been reinforced by wider social changes, especially the way in which the question of women's liberation has come to be regarded. Some people believe that women have won a fair measure of equality because so many women are now in the workforce. The truth is that women have not achieved parity with men in the labour market, rather it is the case that men have been pushed down to our insecure position. Most of us recognise that women remain unequal; we continue to be the main child carers and shoulder most domestic responsibilities; we may also work, but relatively few of us will achieve the career status of men.

The problems is that today the very idea of social equality appears unattainable. In fact, so complete is our loss of faith in all previous collective solutions and forms of social organisation that any fundamental social change looks to be out of the question. The most that can be expected is some rationalisation of the market system, or a change from a Tory to a Labour Government, where the differences between their policies seem hardly discernible. This lowering of our expectations has led to the effective abandonment of the project of women's equality; and the link between abortion and this broader objective is now completely severed.

To summarise: developments at these two levels have combined to make abortion an intensely personal and problematic experience for women. Counselling in these circumstances may appear supportive and helpful; but it also serves to reinforce the perception of abortion as perhaps the most traumatic and important decision a woman may ever have to take, instead of a routine and necessary procedure to which she is entitled and should have easy access. However consumer friendly abortion counselling may be, we need to recognise that behind it there still lies a social barrier to women's equality. We have yet to win the fight for free abortion on demand.

Dr Janice Russell

I have worked for nearly 20 years in counselling and related areas, and indeed, for the first eight years of my professional life, I was a pregnancy counsellor. Those years of experience were immensely valuable to me, and I believe that the ethos of having a pregnancy counsellor on hand was a good one. Not all women had support services in their lives, which enabled them to reflect, determine their wants, and make informed choices about their courses of action. Indeed, some women who we worked with were literally in fear for their lives, and the counselling service provided a passport to other more directive or pro-active activities which helped them.

I do remember wondering though, whether or not it really should have been compulsory for all clients of the service to have to see the counsellor. At times, I felt like the nit nurse at school. You will let me examine your head, not just your nether regions. Years later, having mingled with the helping professions through one missed abortion and two full-term pregnancies, and having worked in counselling in wide and multi-cultural contexts, I remain ambivalent about the whole thing. I have no doubt that counselling can be a non-mystical, effective service which can help people out with specific problems and issues. My concern however, it that the counselling movement brings with it a whole host of narrow and ill-thought out assumptions about the nature of selfhood, and prescriptions for relationships, both of which have possible social consequences which are rarely alluded to.

So, I want to focus on three issues. Firstly, what social functions does counselling serve, which have previously been fulfilled by other means? Secondly, what does the drive to self-determination really mean? Thirdly, what implications are there of the mandate to authenticity and intimacy which much of the therapy culture holds so dear?

So, firstly the functions of counselling. Counselling discourse is a hybrid, emerging from those of magic, religion, psychiatry and experimental psychology. This has led to a situation where there are many 'versions' of counselling. Thus a pro-life worker who approaches pregnancy counselling with a specific value laden agenda is able to call themselves a counsellor with impunity, while other pregnancy counsellors see neutrality as an essential quality. While such contrasts in approach might provoke a certain amount of dissent within the profession, we can see that they each rely on various aspects of psychological ideology, and use a set of methods which may be seen as 'techniques of the self'. (3)

Yet ask any counsellor to tell you what it is they do, and they rarely succeed. It is much more difficult to describe than the job of a teacher, a doctor, a bricklayer or an IT whiz. We help people-to do what? To feel better-how? Through various techniques-oh, and by having the right attitudes and qualities. Some of us even wear our knickers over our tights, with a bright and enormous 'C' emblazoned on our lycra leotards!

So how do we know it works? We don't. Is there a tangible end product? No; no wall, no new computer program. Is there any research done into counselling? Yes. What does it tell us? Nothing tangible. Why do we do it then? Because we believe it works.

Under the 18 years of Tory leadership, pioneered by that prima donna of individualism, Margaret Thatcher, and that shadow of his former self John Major, it is extraordinary that counselling has exploded onto the scene, despite the fact that it has no quality assurance measures, and no proven cost-effectiveness. Yet the government has sponsored a social structure which has almost institutionalised counselling-for HIV, unemployment, critical incidents, pregnancy, sexual abuse, contraceptive choices, moving house-counselling seems here to stay. No steel factory could remain open without making a profit; counselling however, is encouraged and supported. How could this be?

Part of the success of counselling may lie in its ability to be in the right place at the right time, that is in a society which is embracing individualism. In 1984, Nigel Lawson spoke of 'fighting and changing the culture and psychology of two generations', and that although 'this cannot be achieved overnight..let there be no doubt that this is our goal.'(4) The individualism of counselling psychology might just have helped to achieve it.

For the individual of course, counselling attracts for many reasons. It can provide a forum for exploration of the meaning and morality of life. Individuals want to consider the distinctions between right and wrong, the question of how much is under my control, and personal questions-why do I get depressed? Why did I fall pregnant? Why can't I have children-was it me or was it God? The search for causes and explanations is paramount.

Such questions are closely associated to the quest for existential meaning, focusing down from the greater meaning of life to the meaning of my life. Sometimes people feel uncertain in their existence, in their aloneness, and seek to 'get in touch' with their 'real selves'.

Such questions would have at one time been answered through different media. 'Why me?' for example, might have invited an answer which had to do with astrological forces, or curses from external sources. Questions of selfhood might have been answered through religious discourse.(5) The language and metaphors of counselling psychology are more than a method of treatment; they are a whole system of ideas which pervade society at every level. Thus, they present a socially and culturally specific paradigm of understanding and explanation to both ordinary and extraordinary events. In the seventeenth century, young women who stopped eating and complained about their relationships with parents were hailed as saints or condemned as witches: today they are more likely to be diagnosed as having anorexia nervosa, which is seen as a psychological disorder associated with issues of power, control and self-esteem.

It is also fairly trendy to suggest that modern living, with its rapidly changing world order, leads to severe loss: of purpose of life, of freedom, of tradition, of morality and of norms and security of social relations, resulting in a fragmentation or loss of self. The counselling culture is only too keen to help us 'find ourselves'. It invokes the concept of 'hidden loss', which may be applied to virtually any life experience ranging from traumatic sexual abuse to winning the lottery the week you didn't put your pound on. Indeed only last month, my partner and I considered setting ourselves up as relegation counsellors for York City fans, but fortunately, or unfortunately for our pockets, our local team stayed up. On Wednesday, I heard the Bishop of Leicester suggesting that the Tory Party were in too much of a 'grief' state to yet start contemplating their future.

Counselling also seems to provide a means of constructing our life narrative. This entails the assembly of sequential life events in a way which provides some sense of order, security and continuity.(6) It entails the acceptance of the ideas of 'life stages' and transitional periods-what would we be without concepts of childhood, adolescence, mid-life crises and old age?

The narrative of self also fulfils the function of future planning, or 'life planning'(7)-what would people like more of in their lives, how will they get it? Life planning is partly illusory, as we cannot ultimately predict or control the future, and partly an invitation to take responsibility for the choices which are under our control, like family planning. This process becomes part of identity, both in using visions of the future to make sense of the present, for example using images of 20 years hence to help decide whether to have children or not, and in having some inner goal to the identity, or kind of person one would like to become.

Finally, of course, counselling is often embarked upon at time of distress or disturbance. A bereavement, an unplanned pregnancy, and admission of addiction or dependency, violence to self or others, serious illness or redundancy. A series of events might occur to produce intolerable levels of stress or depression. In these circumstances, it is hoped that counselling might alleviate pain or discomfort.

So there are many possible functions which counselling fulfils for the individual, notwithstanding the huge numbers of people who are having counselling for the very reason they are training to be a counsellor. Underlying these functions is the doctrine of self-determination. Received wisdom within counselling revolves around the notion that given the right circumstances or conditions, everyone can determine their own futures, in a way which results in the good of the community.(8) While this is open to debate, I want to mention four key themes in relation to self-determination.

First there is the acknowledgement that this is a doctrine of the individualism mentioned earlier. Consider the following: 'Wherever possible we want individuals to control, influence and determine their own destiny'. (Michael Hesletine)(9), and: 'The counsellor's role is to facilitate the client's work in ways which respect the client's values, personal resources and self-determination'. (British Association of Counsellors (BAC) Code of Ethics, 1990).

We may be forgiven for confusing the sources of such statements. At any rate, to suggest that each person's destiny is in his or her own hands, and that the source of past successes and failures lie within themselves, is extremely powerful dogma. I suspect that the politicians are at least more aware of their intended outcomes than the counsellors!

Secondly, blind acceptance of self-determination, in a world where humans battle to control nature, can lead to a notion of the person as all powerful as well as all purposeful. 17 months ago, I had the experience of having cancer of the breast. One colleague, a counsellor, sighed sympathetically down the 'phone to me. 'Oh Jan', she said, 'it's probably all that stress and change you've had over the last few years; you must have repressed your emotions.' At that precise moment, my emotions were extremely unrepressed! Susan Sontag has written eloquently on the dangers of assigning serious illness to the psychological sphere(10), yet this is almost inevitable as a consequence of some of the theories of counselling psychology-illness is self-determined. Moreover, such explanations remove the need for investigation into environmentally specific causes of such illnesses, which seem to be concentrated within pockets of the Western World.

Thirdly, self-determination as a value hinges around the notion of the mature individual as independent and separate. It is worth remembering that almost all psychological theories of self which inform mainstream counselling are constructed by men. Research into values and morality has been largely carried out on men.(11) It is worth noting work which challenges such a view and which suggests that for many women, the mature individual is interdependent, and considers the welfare of others as a major value.(12) This has implications for the value of self-determination which have not been addressed yet within counselling.

Finally, I have long had a dread that while counselling purports to help people fulfil and actualise their unique self, there is a sense in which it is also a means of standardisation.(13) As the method of counselling depends on certain ideas of self-open, emotionally expressive and a bit hip-so we might in fact be producing a series of clones-Dolly the client. The counselling and therapy movement have made some large claims regarding the value of openness and intimacy as desirable and individual attributes, and counsellors fancy themselves able to model such attributes for their clients.(14) The ideal is to engage with other people from the soul rather than the role, and many claim that the counselling relationship is itself extremely intimate.

I have never seen this challenged within counselling discourse. Yet the demand for intimacy can, as Richard Sennett has pointed out, also be a tyranny.(15) I have experienced an interested individual being rejected from an interview for a counselling course because of his reluctance to speak with the interviewers, two perfect strangers, about an intimate experience of his. Meanwhile, as intimacy is made into an individual attribute-one is successful at it or not-our public life is transformed into a threatening environment, characterised at its extreme by the stranger danger campaign. How much does counselling psychology contribute to such notions, wherein social relationships are replaced in value by the call to close alliances based on precious notions of trust, contrived intimacy, and structured confidentiality. How much does intimacy in the counselling room influence community relations of support, advice and encouragement?

In conclusion, counselling is a social practice very much concerned with the reflexive project of self. There have always been social practices which offer consultation on the meaning of life, the reasons for occurrences or experiences of loss. Whereas in previous times, people turned to external events for explanations, such as the Wrath of God, or the forces of the stars, counselling offers solutions which hinge around internal notions of self and self-determination. At the same time, it exhorts the individual to share that self openly within private relationships. Yet for help with specific issues we are urged to go to the experts. This has social consequences whose implications are as yet unclear.

Currently there are many versions of the social practice of counselling which hide under an umbrella term. I personally think that this is a mistake and that there can and ought to be distinctions made between counselling and psychotherapy. Counselling really should not lend itself to an activity which is not voluntary, but a necessary step in a legal procedure, such as in abortion 'counselling', or IVF 'counselling', or HIV test 'counselling'. Counselling should be used to describe an activity where one person helps another to clarify their thoughts and feelings without prescription, and without invoking developmental notions of self. Nothing mystical, nothing sacred, the counselling relationship demands nothing other than skill and intentionality on the part of the counsellor, with no penalty points for privacy in the life of the client. In this scenario, I am all for counselling being available to individuals in all situations, on a voluntary basis, as one choice of helping activity amongst many. The profession should not let it, however, be a catch all term for any activity which has been part of a political process of the individualisation of social issues.

Discussion

Floor
I'd like to say, in response to the last speaker, that we do have abortion on demand. If you look at the wording of the form we fill in, it implies that it is more risky if pregnancy is continued than terminated up to 12 weeks. So I do think we have abortion on demand. I know that wasn't the intention of the Act, but we do have it and doctors are prepared to go along with that.

Floor
Can I answer that and say that those doctors who are brave enough to state that on the form are few. To put on the form that continuing pregnancy is more risky is not enough. We still have to put something else, like depression, or that the woman cannot cope.

Floor
I'd like to ask the last speaker if the implication of what she is saying is that there is something inherent in counselling, because it operates on an individual level, inhibiting social change, a blockage, as well as a net result of people feeling social change is impossible.

Floor
I was very much helped by the last speaker. She clarified in my mind something I've been mulling over. It seems to me that abortion counselling evolved because of the way we had to provide abortion in this country, because of the words of the Abortion Act. The counselling the other two speakers were talking about is something quite separate, and the two have become seriously confused. Looking back on my own experience, which does go back over the last 30 years, there is no doubt that the word counselling crept in because we wanted a word for someone who wasn't medical, and who had time to talk to the woman. In the context of our service, the woman was told she was going to have an abortion, and the counsellor would talk to her first. This implies that the counsellors role was to talk to the woman, but in fact it was information collection, so the doctor could look at what the counsellor had written and come to a decision as to whether this abortion conformed to the Act.

That phase I think is largely over. The counsellor now does have a more supportive role, and information collection is done by other people. The counsellor is now countering something that has not been mentioned, propaganda put out by those opposed to abortion. Women are labelled irresponsible for having got pregnant, unethical for demanding the destruction of their foetus. These are powerful ideas that have come through the media, and influence all women. Everyone now talks about the 'unborn baby', a term which wasn't used at all 30 years ago. It's evolved as a result of LIFE and SPUC and their propaganda. So it's a very complicated issue, but abortion counselling is something very different from counselling proper, which requires professional training.

Chair
I know there are people here who work in pregnancy counselling settings, and it would be good if they could comment from their own experience.

Floor
I'm a social worker by profession, and work in a health setting, and most of my work is pregnancy advice, which is what I call it, although everybody else says that I'm the counsellor. I'm not a trained counsellor in fact, but I agree with the previous speaker. Part of my role now is helping women cope with other people's opinions, whether from the media, family, friends or medical staff. One of the strategies I've developed in the last year is to tell women they can always come back and talk to me. They can come backwhenever they want to, in the next few days, or weeks or later, particularly when the baby might have been born. The other thing I aim to do is to make sure that at least in what can be a brief interview, I make sure the woman has considered a range of options and to make sure the decision is made with as much information as it possibly can be, and that it's their own decision, not one that's been made by somebody else.

Floor
This is a point which leads into a question, particularly for those people working in the field of counselling. Some very interesting points came from the panel speakers, particularly I think the way the whole concept of abortion counselling sets up abortion as being something separate from and distinct from other medical procedures. It seems a little bizarre that we have this concept of pregnancy counselling, which really does mean abortion counselling. Pregnancy usually has two outcomes, either the woman opts for abortion, in which case she is steered into, and offered counselling, and in that sense it is mandatory, although abortion is something that returns life to status quo ante, back to where you were before. But if the woman opts for having the child, something which turns your life upside down for the next 18 years of your life, nobody sits you down and says 'are you aware of what the implications are' with a view to suggesting the woman may want to reconsider her decision. There is a sense in which it is built into the abortion discussion that maybe the woman needs help in coming to her decision, whereas with pregnancy ending in birth, it is seen as natural, normal and what should happen.

I am struck though, in my job working for Birth Control Trust, that women increasingly phone up saying they want to talk to someone, saying they feel the need for support, both before and after abortion, because they have taken on the ideas put about by the anti-abortion movement. They are very concerned about whether the foetus feels pain, or what happens at different stages of its development. They are also concerned about whether they will be traumatised after the operation. I think it is difficult to look at how to deal with this. Almost by saying we will provide women with support for as long as they want it afterwards, it sets into their minds the idea that they are likely to experience problems after the procedure and that termination of pregnancy isn't just an episode you go through and then recover from, but has long-term implications. I wonder how we can get a balance on this, on the one hand getting abortion back to a stage where it is not problematised, but at the same time recognising that women do come to it with a load of negative ideas that society encourages about it.

Floor
I've been an abortion counsellor for the last eight years, and in the last two years I have really noticed the amount of time I have to spend both before and after termination has increased dramatically, because of all the anti-abortion discussion in the media. A number of women are affected by this, and need repeat counselling, which means they end up having the abortion later, because of the anti-abortionists.

Floor
I want to come back to the question, does counselling limit social change. This does raise what we should do. My experience is that abortion is talked about at a certain level, young people are more aware, but when it actually comes to the procedure, women go in on themselves, unless they have a good network of support from family and friends, which a lot of women don't have. Yet our services individualise women, as counselling does. I do think we need to open it up. Take the actual services in hospital. I'm sure it's a much more positive experience for women who get abortion in a context where other women are and they can talk openly. I think simple things like that have a positive impact, and we need to address this. Turning it in on the individual, as just your own, separate problem, so many see it as themselves as being alone in their abortion, happens too much. I often say to women that their experience is common, and they are not alone. It's a normal experience. We need to be more open so we open up the political problem, because it is a political problem, and it's very important we retain it in that context, so it's not seen as a medical issue.

Floor
Perhaps we should look at counselling as part of abortion services, and suggest it should happen at a group level, rather than individually.

Floor
I really agree with what is being said. But I wanted to take up the point that abortion counselling today is different from the past. Now, there are many places where counselling is separate from the decision making process. This provides an opportunity to provide counselling as we understand it, which is about helping a woman to make a decision, addressing emotional problems that might occur. Certainly in the centre where I work, it is very separate from decision making. It is viewed as a resource that a woman can take up or not, as the woman wishes, which is a very positive development.

Floor
The point has been emphasised that there is a difference between counselling today and in the past, but as the discussion goes on, it seems that they are not so distinct. It seems to me that if we are emphasising that women need more time to cope with the attitudes of the anti-abortionists, we include ideas we should be critical of. For example women need help in making up their minds, and linked to that the institutionalisation of that help. There is a distinct history to abortion and counselling, but today a lot of the problems are still apparent.

Alex Howard

I'd like to come in and be specific about that as far as I can, and tune in to some of the points. I have made the point that counselling as a word is so general and vague it doesn't help. When you put an adjective in front, you can get more specific. The moral for me is not to abolish counselling but get more specific about what we mean. So we add the word 'abortion' and we get more clear. Still there is more of a problem than people think.

In principle it is impossible for any counsellor to be in a relationship with a client without the way in which they construct the world and their value system to be part of the process of interaction. It is inevitable and unavoidable. One can pretend to put one's value system to one side, but that can't be done. One can't be in a relationship except via the way you make sense of the world.

So what is abortion counselling? It is not about getting information to deliver back to the doctor, rather its about 'support'. OK, so now we are more specific. We have to say though what does 'support' consist in? If you look, it will be interpreted differently according to the value system and ideology of the counsellor. They will have a view about what they mean by support. If I was a catholic providing abortion counselling, and wanted to provide support, I would have a radically different concept of what support meant to someone with a more liberal, humanist view. That isn't to say give up on the whole thing, but we make progress when we realise the complex process counselling is.

Also, we feel more comfortable when we have a specific adjective like 'abortion'. But life is rarely that tidy anyway. A woman comes in with an issue about abortion, but of course to make a decision, to discuss that, and for the counsellor to relate to it, there is their whole circumstance to deal with, and how they make sense of the rest of their lives. That too will be interpreted differently according to the value system and ideology of the counsellor. It is much more complex than people think, but we need to engage with this, and see the subtleties that are too often missed.

Floor
Pregnancy counselling is one of the few areas where you do have to be clear about your own value system, and it may not be something everyone can work in. It is not a place where you can switch on and off in a way perhaps you can in other encounters.

Dr Jennifer Cunningham

On the question of how much counselling is a barrier to the development of social change, I don't see counselling as that powerful. I see it more as a re-enforcing trends that are already happening in society. Janice put it well when she said that counselling takes advantage of a situation that has already developing. It is a situation in which counselling is re-enforcing the idea that a lot of problems are the individual's own. As an individual, a woman is very vulnerable to anti-abortion propaganda. When you yourself are being accused of violating a foetus, and causing pain, it takes a strong person not to be affected by this sort of emotional onslaught. It is only when you face this decision knowing abortion is a right you should have, and that you should be in control, and that getting rid of an unwanted pregnancy should be a liberating process, not one that is going to fill the rest of your days with despair and depression, that things are different. If women were able to take the decision in the context of a broader movement that said 'this is your right' and emphasised why women need abortion in the first place, if that existed, it would be much more possible for people to approach the issue more rationally.

Counselling unfortunately came about in a period when women came to face the decision separated from broader support and agreement. You can see how this process worked in the General Election. Abortion was off the agenda completely. The only people who put it on the agenda were the anti-abortionists. When politicians are running shy of the issue, not supporting women left in this position, a lot of people will need moral support.

Dr Janice Russell

I'd like to make two points. First, in contrast to Alex, that if you put 'abortion' in front of counselling, it makes it easier to understand. I see counselling as a very specific activity, very much concerned with helping people make their own decisions, in the light of their own lives, values and circumstances and possible costs and consequences of whichever route they take. I'm quite interested in what I hear being talked of as abortion counselling, because it sounds like information giving and support. While we can't suspend our values, at the very least we know when we are imposing them, and we can negotiate that.

Second, I'm interested in the issue of the increase in anti-abortion propaganda, and women coming back, wanting more time. I would relate that to wider propaganda on the issue of the self. My hunch is that even if anti-abortion propaganda disappeared, there is now so much encouragement to reflect on ourselves, inside out, that this would happen anyway. Someone said to me last night, quoting from a counsellor, that a woman had said she wouldn't feel guilty, yet the counsellor assured her that she would feel guilty about not feeling guilty. I think there are a whole host of discourses, in women's magazines, everywhere that suggest you should 'examine yourself'. This will put demands on the counselling service, whether there is more anti-abortion propaganda or not.

Floor
I want to return to the issue of individual counsellors values. One question that comes up a lot for me is the referrer's views. Quite a lot of the time, I meet clients who have been referred to me and I say 'go away' because they don't need counselling. That's the referrer's views coming into play. I also wanted to make this point because in order to get an abortion the woman has to convince two doctors that she is unsuitable for motherhood or unstable. We live in a society where women take that on board, and if we removed the need for the woman to convince doctors that she is unsuitable or unstable, and stop women from convincing themselves that this is the case, then we would remove much of the need for abortion counselling.

Floor
The issue of the re-examination of self reminded me of what happened to Naomi Wolf, who had a complete turnaround in her views about abortion once pregnant, where she said that once pregnant she needed to make reparations for her support for abortion in the past. Also on policy about abortion, particularly from the Labour Party, they are focusing on single mothers and returning to work. The issue here is still the 'irresponsibility' of these women. So the focus has shifted, but the issue is still there.

Floor
I wanted to say something about the terminology, the description of counselling and the term abortion counselling. I hope it doesn't sound heretical, but I don't see abortion as a specific, discreet form of counselling. I'm not a counsellor, I work in a hospital in reproductive health. Part of my remit is to see women pre and post abortion at their request. This is not a compulsory part of the service at all. I don't collect information and report back to the doctors. It is 'proper counselling'. People I see are dealing with a traumatic event, which is how they see it in their life, and I counsel them like I would any other person who came in with an issue or problem they were concerned about. I don't see it as a separate form of counselling. There are specific issues, but it is not a specialist branch, even though it has its own history. I see termination of pregnancy as a presenting problem, rather than anything more or less than that.

Floor
I'd like to raise something about counsellors and values. It has been mentioned that counsellors have to clarify thoughts, not give advice. I'm asking though is it possible to clarify thoughts without there being an interpretation? Surely what someone says to you is inevitably open to interpretation, which is what you do in responding to them. As soon as that happens there is a bias. There is opinion, or at least representation of what the woman is saying.

Alex Howard

It is possible in counselling to make efforts not to impose a value system, and with practice one can get reasonably good at not squeezing values in. But I think, and this is not just a philosophical point, that it is impossible to be in a relationship in a way where values don't construct what is going on. They are always at work, for example in determining the agenda, what are the priorities, and in how to respond, what to respond to and what to consider as important. This is not a criticism, I'm just saying it's inevitable, unavoidable. And neither is it trivial. We can put aside our values and pretend to be value free, but inevitably they intrude. To use the example again of a catholic counsellor on pregnancy issues. Even if they don't impose Catholicism, they will have a different way of constructing the agenda. This is quite unavoidable, and we have to be honest about it.

Dr Janice Russell

I agree that nothing is value free. But a process of negotiation goes on. I never think the role of the counsellor is to interpret. Rather it is to understand as far as they can what the client means. The counsellor doesn't determine the priorities, although I do acknowledge that a raised eyebrow or a nod has an influence. I understand the complexity, but interpretation has different meanings.

Alex Howard

I'll be specific. Take the catholic construction of the issue. It is just obvious that life is sacred, and that if a person is doing anything 'unnatural' they are bound to feel riddled with guilt. We can all put aside values to some degree, but the extent of this is limited and we have to be aware of it.

Floor
One very clear limitation to the extent to which we can put our value system aside is that the whole service rests on a value system, one that says it is important for us to dig into ourselves, to have out and discuss the precise implications of what we are doing, what we feel about it and what it might mean for the future. This is something that is a contemporary thing. We suddenly have this society where we not only need to understand all of implications of our actions on our psyche, but we are in a position where we can openly discuss this. If you think about the way the British 'stiff upper lip' operated in the past, in what we would see as incredibly traumatic circumstances, for example where you had to send your husband off to war, knowing you may never see him again, but this was never discussed in that way in the 1940s, so that was a very different value system. So I think regardless of the individual values of counsellors, there is a whole system of values built into the profession.

Floor
I wanted to take up the point about agendas. There is an explicit agenda in abortion counselling, that something good is being done by it. We also have to countenance the idea of what could be avoided or not done. For example who is not being talked to because the woman is talking to the counsellor. This brings us back to the issues more on the political front. So we need to see two parts to counselling-not just what will be done, but what will be evaded.

Dr Jennifer Cunningham
The value system operating is of less concern to me, although it must influence how counselling goes. I want to also raise what is implicit in counselling, whether or not it is called 'empowerment'. That is the idea that women in this situation cannot take the decision without some third party advising her, so temporarily or more permanently, someone is in less than an adult situation, where they cannot take a decision for themselves. I want to say that neutrally, without casting aspersions on my counselling colleagues, but this is something we have to address. For me, often abortion is very straightforward. It is a simple matter that the woman cannot continue her pregnancy at that point in time for a very definite reason. All the other emotional issues are generally speaking imposed in people. The problem with counselling, given the circumstance we are talking about, does inevitably crystallise the question of seeing abortion as an emotional problem, and something that women need other people to assist them with in terms of coming to a decision. This gets us back to the point where unless women have autonomy in terms of coming to a decision, and get access to the procedure on the basis of their own decision, then counselling will be there, but it can re-enforce dependency and a lack of real self-determination. In that sense I suggest counselling is specific in relation to abortion. It is not that women need a specific kind of counselling, but the nature of abortion, as a social and political question gives counselling in that context a specific meaning, one that we need to examine and question.

Floor
Many women do need to talk and get out what they feel, and they want to be understood. We have to match our service with what women want. Sometimes they don't let you counsel them. They just want to be able to explain what they are doing and why.

Floor
Part of this discussion has been about what type of counselling. I work in genetic counselling, which defines itself quite differently, as information giving, not giving advice, quite deliberately. But in my profession, when counsellors were surveyed about whether they should be non-directive, they said 'yes', yet when asked if this is what they did in practice, they said 'no'.

Floor
I think we shouldn't have assumption about what women feel. We shouldn't assume women only ever feel bad after termination. What they say they feel should be respected.

Floor
It still think we don't seem to have resolved how to keep values out of this. Counsellors don't work in a vacuum. We need to make sure there is good clinical supervision, and that they are not working in isolation. It can be dangerous if they are, but many counsellors do have other people working with them.

Chair
I'll bring the panel in now to sum up.

Alex Howard

I've found this debate very interesting. On the question of values, I'm not suggesting that Catholics are worse than anyone else at putting their values aside. There is an important point here, where we can imagine putting our values aside when we are in a homogenous group. Where we agree with the other people we are working with, we don't realise as much as we otherwise would what our values are. So we tend to assume that people we disagree with are less good than us at putting their values aside. In fact it's just that their values are so obvious, and it's less obvious to us what our own are. We also talk about empowerment as something unproblematic, to be upheld, but again its only unproblematic when we happen to agree with the value system of the person we empower. As soon as we encounter someone doing something we believe to be thoroughly destructive and dangerous, it becomes a problematic concept. Perhaps we need to see that counselling cannot be unproblematic, a neutral 'service provision', but when we engage in counselling, we are engaged in a personal relationship as a unique human being with another unique human being, so there are all sorts of mysteries and issues that come in, that can't be easily packaged at all. I don't think that's a case for despair, it makes life interesting.

Dr Janice Russell

On values, one of the most popular models of counselling in the world was developed by a catholic priest, who insisted that the value system of the client must be respected at all times. Secondly, I have a friend who is a counsellor, who once counselled a man on his situation-my friend takes a similar approach to mine, where we are not concerned with the content of what the client is talking about-so he counselled the man on his situation, about what the situation was. He saw the man a year later and asked him how the situation was, and the man said he was feeling much better. So there are different ways of working with values, and I'm not saying this is unproblematic, but it would be a mistake for us to think our concern is what the client is actually doing. That is the least of our concerns as counsellors.

What strikes me from the discussion is that if we are going to have such a thing as counselling, and it is going to have a definition, it has to be a voluntary activity, negotiated between two people, who either enter into it, or don't. As soon as it becomes a requisite of something else, it takes us to a different dimension, and becomes a different activity with a different purpose.

Dr Jennifer Cunningham

Unfortunately I don't think we can ever raise broad social and political questions without it becoming polarising. One of the reasons why the abortion issue was left off the agenda in the General Election was because MPs anticipated this would have a polarising effect, and worried about alienating voters. It is important not to shy away from the fact that issues are polarising. These issues often then cannot be discussed as the level of individual dilemma, as individual problems, when what we are talking about is social power and powerlessness. We need to understand the backdrop to the discussion of counselling, as not something that can be seen in its own right, but it is attached to something that is an important social and political question, as a way to bring in the broader framework.

I see counselling in abortion and other areas of life as a symptom of a society that has become very much more individuated. People operate much more as individuals and society is much more self-preoccupied and self concerned, precisely because of the lack of things that are happening more broadly. We do become concerned with personal problems and dilemmas. Nevertheless, I want to go back to the point that we cannot forget that this is not a question of an individual problem, but it is a broader question, and as long as that remains unresolved, abortion and the attendant emotional problems are going to exist, and become amplified by social conditions today.