General Considerations

Principles of the Service Northumberland Mental Health Trust, under the auspices of the Department of Psychological Therapies and Research, offers counselling as a distinct quality service for clients with a defined range of problems. The service is provided by established practitioners with recognised training and skills in counselling practice. The Trust is committed to the following principles in ensuring the positive professional development of the service.

The Role of the Counsellor 

Counsellors use psychological principles: 

Professional Standards 

  1. The counsellor will: 
    1. Be accredited by the British Association of Counselling (BAC) or the British Psychological Society (BPS) or will be eligible for such accreditation; or 
    2. Be a mental health professional (eg nurse, social worker) who has completed counselling training to at least certificate level and 200 hours of supervised counselling practice.
  2. The counsellor will be supervised: 
    1. In line with the standards defined by the BAC; 
    2. By a supervisor eligible to provide suitable supervision in lines with BAC criteria; and 
    3. At a regular agreed frequency (minimum 1 ½ hours monthly); 
    4. Access to guidance of a supervisor will be available at other times according to need.
  3. The counsellor will be expected to undertake relevant continuing professional development.
  4. The counsellor must adhere to the Code of Ethics of the relevant accrediting body (either BAG or BPS).
  5. Northumberland Mental Health NHS Trust is committed to the development of a counselling service of a high professional standard. It will encourage the further training of experienced mental health professionals in developing specialist counselling skills. It is therefore anticipated that some of the service will be provided by the mental health professionals in the process of fulfilling the criteria for appropriate professional training in counselling.

Procedure for Referrals and Contacts with Clients

Accessing the Counsellor 

  1. Referrals should be made in writing from GP's or other appropriate referrers. 
  2. Oral referrals may be accepted initially but should always be followed by a standard referral form (see Appendix A).

Contacts with Clients 

  1. Initial Assessments: 
    1. An initial assessment or screening will normally be undertaken within 4 weeks of referral; 
    2. Initial assessment sessions should be approximately 1/2 hour duration; 
    3. At the end of assessment contacts clients will be given feedback as to their suitability for counselling, expected waiting times before counselling sessions commence, and frequency and duration of sessions; 
    4. In the event of the counsellor having any concerns about possible risk to the client or others at initial contact, the GP will be informed as soon as possible; 
    5. It is expected that GP's will make time available with the counsellor to discuss concerns and review caseload issues.
  2. Counselling Contacts 
    1. At timetable of frequency and duration of contact should be negotiated and agreed with clients following assessment; 
    2. The normal length of a counselling session is 50 minutes; 
    3. Most often, a duration of up to 6 sessions will be agreed with clients; 
    4. At the end of each agreed counselling contract of up to 6 sessions, decisions related to ways forward (including ending contact, referral to an alternative agency, or continuation of counselling for up to 6 more sessions) will be fed back to and reviewed with clients; 
    5. Feedback on clients' progress will negotiated with clients and relayed to referrers where necessary; 
    6. A standard feedback form will be provided to referring GP's (see Appendix B).

Monitoring and Evaluation

Monitoring Tools 

Reviews 

Review meetings may be negotiated with GP practices where deemed necessary by either party to discuss the progress of the service (eg, referral rates, appropriateness of referrals, clinical outcomes, waiting list management, client waiting times, etc). This will include a regular annual review.

Relevant Client Population

  1. Types of Clients Problems The following problems ma
    1. Mental health problems: For example, mild to moderate episodes of anxiety or depression, anger management, self-esteem difficulties. 
    2. Problem associated with life crises. Miscarriage, other pregnancy and birth related problems, coming to terms with disability, coming to terms with terminal illness. 
    3. Problem associated with relationship functioning.' Including marital difficulties, psychosexual problems, and fertility problems (a specialist service such as RELATE may also be considered suitable in this regard).
  2. Clients Considered Most Suitable for Counselling 
    1. Ability to see the psychological nature of their problems; 
    2. Willingness and capacity to face feelings and to "look beneath the surface"; 
    3. Motivation for change, or need for short term support through a crisis/transition; 
    4. Capacity to form a therapeutic alliance; 
    5. Ability to tolerate stress in order to see through difficult phases of therapy; 
    6. A degree of flexibility that allows a capacity for change; 
    7. An expressed preference for counselling (but only in combination with other factors); 
    8. A judgement that the potential gains of counselling outweigh potential losses (as therapy may disrupt the status quo for many in the short term); 
    9. Previous beneficial experience of counselling.
  3. Indicators of Unsuitability for Counselling 
    1. Severe mental illness (eg, psychosis, affective disorders, dementia); 
    2. Severe and complex disorders (eg, eating disorders, severe personality disorders, seriously traumatised individuals, complex anxiety difficulties with major effect on social functioning and relationships, obsessive compulsive disorders; 
    3. Severe drug and alcohol problems; 
    4. Dependent personalities who form attachments which cannot be resolved; 
    5. Individuals with a history of self-destructive, attention seeking, or manipulative behaviour; 
    6. Patients at high risk of suicide.
  4. Referring on to Mainstream Mental Health Services From time to time it may be the case that problems not considered to be conducive to a counselling approach will be revealed once counselling has commenced. ln these instances it may be more appropriate to refer on to the mental health services. Such eventualities will be discussed with referring OP's when they arise.
    Examples include: 
    1. Problems where the initial assessment did not reveal severity; 
    2. Situation where disclosures indicating unsuitability are made during counselling; 
    3. Problems where may increase in severity as a result of counselling.