behind the counselling culture?
By Alex Howard, Dr Janice Russell & Dr Jennifer Cunningham
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.
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
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
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
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
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
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
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
You are avoiding my question. You seem to be afraid to answer
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
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
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
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
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
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
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
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'.
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
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
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.
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.
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.
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.
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
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.
I know there are people here who work in pregnancy counselling
settings, and it would be good if they could comment from their
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.
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.
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.
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.
Perhaps we should look at counselling as part of abortion services,
and suggest it should happen at a group level, rather than individually.
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
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.
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
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.
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.
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.
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.
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
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
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.
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.
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.
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.
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'.
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.
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.
I'll bring the panel in now to sum up.
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