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Fourth Edition
An
Introduction to
Counselling

John McLeod
Open University Press
McGraw-Hill Education
McGraw-Hill House
Shoppenhangers Road
Maidenhead
Berkshire
England
SL6 2QL

email: [email protected]
world wide web: www.openup.co.uk

and Two Penn Plaza, New York, NY 10121-2289, USA

First published 1993

Reprinted 1994 (twice), 1996 (twice), 1997
Second edition published 1998
Reprinted 1999, 2000, 2001
Third edition published 2003
Reprinted 2003, 2004, 2005 (twice), 2006, 2007, 2008
First published in this fourth edition 2009

Copyright © John McLeod 2009

All rights reserved. Except for the quotation of short passages for the purpose of criticism and
review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, recording or otherwise,
without the prior written permission of the publisher or a licence from the Copyright Licensing
Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from
the Copyright Licensing Agency Ltd of Saffron House, 6–10 Kirby Street, London EC1N 8TS.

A catalogue record of this book is available from the British Library

ISBN-13: 978-0-33-522551-4
ISBN-10: 0335225519

Library of Congress Cataloging in Publication Data

CIP data applied for

Typeset by RefineCatch Limited, Bungay, Suffolk

Printed and bound in the UK by Bell and Bain Ltd, Glasgow

Fictitious names of companies, products, people, characters and/or data that may be used herein
(in case studies or in examples) are not intended to represent any real individual, company,
product or event.
Dedication
For Julia
 Table of Contents

Preface vii
Acknowledgements xi

1 An introduction to counselling 1
2 The social and historical origins of counselling 21
3 Theory in counselling: using conceptual tools to facilitate understanding
and guide action 48
4 Themes and issues in the psychodynamic approach to counselling 81
5 The cognitive–behavioural approach to counselling 128
6 Theory and practice of the person-centred approach 168
7 Working with family systems 208
8 Constructivist, narrative and collaborative approaches: counselling as
conversation 221
9 Transactional analysis: a comprehensive theoretical system 249
10 Existential themes in counselling 268
11 Multicultural counselling 288
12 New horizons in counselling: feminist, philosophical, expressive and
nature-based approaches 322
13 Combining ideas and methods from different approaches: the challenge
of therapeutic integration 356
14 The counselling relationship 390
15 The process of counselling 424
16 Issues of power and diversity in counselling practice 462
17 Virtues, values and ethics in counselling practice 499
18 Different formats for the delivery of counselling services 540
19 The role of research in counselling and psychotherapy 583
20 Being and becoming a counsellor 612
21 Critical issues in counselling 655

References 674
Index 759

v
 Preface

C ounselling is an activity that is at the same time simple yet also vastly compli-
cated. What can be simpler than talking to a concerned and interested listener
about your problems? But it is what is involved in the telling and listening, knowing
and being known, reflecting and acting, that can be so complex. In counselling,
people talk about anything and everything. The relationship between the counsel-
lor and the person seeking counsel is simultaneously taking place at a physical,
bodily level, and through language, and in the thoughts, feelings and memories of
each participant. This is what makes it so complicated, and this is what makes
counselling a big topic. Counselling is an interdisciplinary activity, which contains
different traditions and schools of thought, and spreads itself across the discourses
of theory, research and practice. Counselling has generated a rich and fascinating
literature, and a range of powerful theories and research studies. I believe that it is
vital for counsellors to be able to find their way around this literature, to tap into all
these different knowledges.
Reading a book like this is somewhat similar to looking through a window
into a room. In the room there are people doing something, but their world is
always on the other side of the glass. Counselling is a practical activity, and can
only be grasped through the experience of doing it, as client and counsellor.
Real knowledge about counselling can never be gained through reading a book. It
requires immersion in an oral tradition, physically being there and doing it and –
crucially – feeling what is happening, rather than merely looking at words on a
page. Given these inevitable limitations, in attempting to provide an introduction
that does justice to its topic matter, this book has been organized around a set of
guiding principles. What the book tries to do is:
G provide a comprehensive overview of as many aspects as possible of the rich
array of ideas and practices that constitutes contemporary counselling;
G within each specific topic that is covered, to offer enough information to give
the reader an initial understanding, and ‘feel’ for the issue, and then to provide
clear suggestions for further reading through which readers can explore topics
in greater depth;
G invite readers to adopt a critical, questioning stance in relation to the field
of counselling, by placing theory and practice within a historical, social and
political context;
G exemplify and reinforce the role of research and inquiry, by adopting a
research-informed approach throughout;
G provide sufficient case vignettes and examples to enable readers to develop
a sense of the ‘lived experience’ of counselling.

vii
viii Preface

This is a book that is intended to be used by students who are engaging in

degree-level (advanced undergraduate or Masters) study of counselling, and by
experienced practitioners who are interested in updating their knowledge around
recent developments in the field.
It may be useful to think about the book as comprising four distinct parts:
G Part 1 (Chapters 1 and 2) defines and introduces counselling, and locates
counselling in its social context.
G Part 2 (Chapters 3–12) discusses the main theoretical perspectives that
currently inform counselling training and practice. This part of the book
begins with a chapter that considers the role of theory in counselling, and
provides a framework for ‘reading’ theory that can be applied to the chapters
that follow. The sequence of substantive chapters within this part of the book
begins by examining the ‘big four’ therapy approaches that dominate the
contemporary scene: psychodynamic, person-centred, cognitive-behaviour
therapy (CBT) and family/systemic. The sequence ends by considering
some emergent approaches that are likely to become more important in the
future.
G Part 3 considers the issue of how different approaches can be combined or
integrated. Chapter 13 introduces and discusses strategies for integration,
while Chapters 14 and 15 explore the ways that different perspectives can
be brought together to create an integrated understanding of the therapeutic
relationship and the process of therapy.
G Part 4 focuses on a broad range of professional issues in counselling,
encompassing such topics as: ethical decision-making; organizational factors;
different delivery systems; meeting the needs of specific groups of clients;
counsellor training; supervision and professional development; and making
use of research findings.

Throughout the book, there are cross-references to sections in different chapters

that consider related aspects of the topic that is being discussed on that specific
page. The book closes with a brief chapter that looks back on the book as a whole,
and identifies some of the key issues that weave through the whole story. The
closing chapter can be considered as going ‘beyond an introduction’ – it functions
as an invitation to the ongoing dialogue and debate that allows counselling to
continue to renew itself in the face of social and cultural change.
As well as containing many suggestions for further and broader reading, An
Introduction to Counselling is supported by two companion texts. The Counsellor’s
Workbook: Developing a Personal Approach includes a wide range of self-
exploration learning tasks and group exercises that are linked to particular topics
covered in An Introduction to Counselling. A further text, Counselling Skill
(McLeod 2007) is a book that focuses primarily on ‘how to do’ counselling, and is
aimed primarily at those whose counselling is embedded in another professional
role (teacher, nurse, social worker, doctor). An Introduction to Counselling is also
 Preface ix

supported by its own website: www.openup.co.uk/mcleod. The website carries a

glossary of key terms, links to relevant internet resources, and additional material
on a range of topics.
It may be relevant to some readers to know about the background of the author,
in order to become more aware of the biases that have shaped his treatment
of certain topics. My initial educational experience was in psychology, followed
by a primary training in person-centred counselling/psychotherapy and additional
training experiences in psychodynamic, CBT, narrative therapy and other
approaches. A significant part of my career has involved doing research, and
encouraging others to do research (McLeod 2001, 2003, 2008). My practice has
involved work with a range of different client groups. I believe that, in as far as I can
be aware of such things, there are three positions with which I strongly identify, in
respect of counselling theory and practice, and which I feel sure have influenced
the writing of this book. First, I believe that good counselling is based, in a funda-
mental way, on the personal integrity of the therapist, and his or her willingness to
‘go the extra mile’ in terms of responding to each client as a unique person and
creating a relationship of value to that person. Although specific therapy techniques
and interventions can be useful, a technique will not be effective if the recipient
does not trust the provider. Conversely, if a client and counsellor have a good
enough relationship (and if the latter is not shackled by adherence to a therapeutic
ideology), most of the time they will be able to improvise the procedures that are
necessary in order to tackle any problem.
Second, I feel frustrated and annoyed by the territorial wars that exist within
the counselling and psychotherapy professions, regarding the relative merits of
different approaches (CBT vs. psychodynamic vs. person-centred, and so on). I
believe that these inter-school arguments are inward looking, distract attention
from the needs of clients, and are a waste of time. I take a historical perspective on
the question of ‘pure schools’ as against integrated approaches: the profession
began its existence organized around discrete schools of therapy, but now it is
time to move on. I am personally interested in all approaches to counselling/
psychotherapy, and believe that each one of them has something valuable to
offer.
My third source of personal bias concerns the relationship between counselling
and psychotherapy. In my initial training, I was taught that counselling and psycho-
therapy are basically the same thing. I later encountered the widespread (but
typically unvoiced) attitude that counselling is a ‘little sister’ profession – it is what
you do while you are waiting to be accepted on to a psychotherapy training
programme. I no longer believe either of these positions (while acknowledging
that each of them is ‘true’ in the sense that many people would endorse them).
Increasingly, I see counselling as an activity and occupation that has strong links
with psychotherapy, but is nevertheless different from it in significant ways. The
distinctive features of counselling are that it views the person with his or her social
context, and that it does not seek to impose any one theoretical model on to the
experience of the person seeking help.
 Acknowledgements

Any author knows that what he or she writes does not come freshly minted from
their own personal and private thoughts about things, but is in fact an assemblage
of words and ideas borrowed from other people. I have been fortunate to be in a
position to learn from many people. Among those I would particularly like to thank
are a number of generous friends and colleagues who have helped me in many
ways: Lynne Angus, Kate Antony, Joe Armstrong, Sophia Balamoutsou, Mike
Beaney, Ronen Berger, Tim Bond, Julia Buckroyd, Anne Chien, Mick Cooper, Edith
Cormack, Angela Couchman, Sue Cowan, Robert Elliott, Kim Etherington, Colin
Gillings, Stephen Goss, Soti Grafanaki, Robin Ion, Colin Kirkwood, Noreen Lillie,
Gordon Lynch, Dave Mearns, John Mellor-Clark, David Rennie, Nancy Rowland,
Alison Rouse, John Sherry, Alison Shoemark, Laco Timulak, Mhairi Thurston, Dot
Weaks, William West and Sue Wheeler.
I also thank, in a different way, my wife Julia, who has provided unfailing
support and encouragement, and my daughters Kate, Emma and Hannah, who
have constantly reminded me of how much else there is to life. I owe them more
than I can say.

xi
 An
introduction
to counselling
Introduction

C ounselling is a wonderful twentieth-century invention. We live in a complex,

busy, changing world. In this world, there are many different types of
experiences that are difficult for people to cope with. Most of the time, we get on
with life, but sometimes we are stopped in our tracks by an event or situation that
we do not, at that moment, have the resources to sort out. Most of the time, we
find ways of dealing with such problems in living by talking to family, friends,
neighbours, priests or our family doctor. But occasionally their advice is not
sufficient, or we are too embarrassed or ashamed to tell them what is bothering us,
or we just do not have an appropriate person to turn to. Counselling is a really
useful option at these moments. In most places, counselling is available fairly
quickly, and costs little or nothing. The counsellor does not diagnose or label you,
but does his or her best to listen to you and work with you to find the best ways to
understand and resolve your problem. For the majority of people, between one
and six meetings with a counsellor are sufficient to make a real difference to what
was bothering them. These can be precious hours. Where else in our society is
there the opportunity to be heard, taken seriously, understood, to have the focused
attention of a caring other for hours at a time without being asked to give anything
in return?
Being a counsellor is also a satisfying and rewarding work role. There are times
when, as a counsellor, you know that you have made a profound difference to
the life of another human being. It is always a great privilege to be allowed to be a
witness and companion to someone who is facing their own worst fears and
dilemmas. Being a counsellor is endlessly challenging. There is always more to
learn. The role of counsellor lends itself to flexible work arrangements. There are
excellent counsellors who are full-time paid staff; others who work for free in
the evenings for voluntary agencies; and some who are able sensitively to offer a
counselling relationship within other work roles, such as nurse, doctor, clergy,
social worker or teacher.
This book is about counselling. It is a book that celebrates the creative simplicity
of counselling as a cultural invention that has made a huge contribution to the

1
2 Chapter 1 An introduction to counselling

quality of life of millions of people. The aim of this book is to provide a framework
for making sense of all the different aspects of counselling that exist in contem-
porary society, while not losing sight of its ordinary simplicity and direct human
value.
The focus of this introductory chapter is on describing the different forms
that counselling can take. We begin with some stories of people who have used
counselling.

Stories of counselling
The following paragraphs reflect some typical examples of counselling, in terms
both of different problems in living that can be tackled through counselling, and the
different counselling processes that can occur.

Donald’s story: coming to terms with the pressures of work

As a manager in a local government department, Donald continually felt himself to
be under pressure, but able to cope. Following a series of absences for minor
illnesses, the occupational health nurse within the authority suggested to Donald
that it might be helpful for him to see one of the counsellors contracted to the
occupational health service. Initially, Donald thought that it would be a sign of
weakness to see a counsellor. He was also worried that other people in the
organization might view him as having mental health problems, and begin to see
him as unreliable. Following further discussion with the occupational health nurse,
Donald accepted that counselling was completely confidential, and might have
something to offer. In the eight counselling sessions that he attended, Donald made
two important discoveries about himself. First, he realized the extent to which he
was driven by his father’s ambition for him, to the extent of never being satisfied
with his own achievements, and as a result being very reluctant to take holidays
from work. He also reflected, with the help of his counsellor, on his unwillingness
to accept support from other people, not only at work but also in the context of his
family life. With the encouragement of his counsellor, Donald began to make some
shifts in his behaviour, in relation to arranging time off, and making opportunities to
speak about his concerns to his wife, and to another close colleague. At the end of
the counselling, he described it as having given him an opportunity to ‘sort himself
out’.

Maria’s story: moving on from abuse

At the age of 25, Maria’s emotional life and relationships were still dominated
by her memories of having been subjected to physical and sexual abuse in her
childhood. She found it very hard to trust other people, or to speak up in social
 Stories of counselling 3

situations. For the most part, Maria had decided that the best course of action for
survival was to be as invisible as possible. Although at various stages in her life she
had tried to talk about her experiences to various doctors, psychiatrists and nurses,
she had always felt that they did not really want to know what had happened to her,
and were more interested in prescribing various forms of drug treatment to control
her anxiety and self-harming behaviour. However, she had made enough progress
in her recovery to decide to go to university to train as a nurse. Once started on her
course, she found herself confronted by a variety of frightening situations – talking
in seminar groups, making new friends, being on placement in busy hospital wards.
Maria decided to visit the university student counselling service. This was the first
time in her life that she had ready access to any form of psychological therapy.
Maria formed a strong relationship with her counsellor, who she occasionally
described as ‘the mother I never had’, and attended counselling weekly throughout
the entire three years of her training. Together, Maria and her counsellor developed
strategies that allowed her to deal with the many demands of nurse training. As
Maria gradually built up a sense of herself as competent, likeable and strong, she
became more able to leave behind much of her fearfulness and tendency to engage
in binge eating.

Arva’s story: whether to leave a marriage

Having been married for five years to a man whose family were prominent
members of a leading family within the Asian community in her city, the idea of
marital separation and divorce was terrifying for Arva. Although she was no longer
willing to accept the physical violence of her husband, she was at the same time
unable to envisage that any other life might be open to her if, as she put it, she
‘walked away’ from her community. Eventually, Arva made an appointment to
speak to a counsellor at a domestic violence helpline. Reassured by the acceptance
she felt from the counsellor, she agreed to come in for a face-to-face appointment.
Initially, Arva was very unsure about whether her counsellor could help her,
because it did not seem that the counsellor understood the meaning and implica-
tions, within Arva’s cultural group, of leaving a marriage or publicly accusing a
husband of mistreating his wife. Over time, the counsellor developed a sufficient
understanding of Arva’s experience to allow the counselling to proceed. The
counsellor also helped Arva to make contact with an Asian women’s support group
and a legal advice centre, both of which were helpful to her in providing a broader
perspective on her position. Eventually, Arva courageously confronted her husband
about his behaviour. To her surprise, he agreed to join her in joint counselling, in
which they agreed on some better ways to resolve the conflicts that sometimes
arose between them.
4 Chapter 1 An introduction to counselling

Anita’s story: dealing with loss

Married to Bill for 40 years, Anita was devastated by his sudden death within six
months of his retirement. Although Anita felt herself to be fortunate, in enjoying
regular contact with her son and daughter and several grandchildren, she
increasingly felt that her life was meaningless, and that she would never get over
the loss of her beloved Bill. Nine months after his death, she visited her GP,
who suggested a course of antidepressants. Unhappy about the idea of possibly
becoming dependent on drugs, Anita asked if there were any other alternatives. The
GP then referred her to a bereavement counselling service. Anita only attended the
counselling on two occasions, and did not find it helpful. When asked afterwards
about why she thought that the counselling had not been useful for her, she said:
‘he was a nice man, but he just sat and listened, and I felt worse and worse.
I couldn’t see any point in it’.

Simon’s story: creating a new self-image

By the age of 13, Simon had acquired a reputation as a ‘difficult’ student. Often
required to attend detention on the basis of aggressive and uncooperative
behaviour, Simon was on the edge of being suspended from school. His form
teacher persuaded him that it would do no harm to see the school counsellor. In
his first counselling session, Simon sat with his arms crossed, reluctant to talk.
However, on the basis that speaking to someone who genuinely seemed interested
in his side of things was better than attending maths class, he gradually allowed
himself to open up. From Simon’s perspective, he felt trapped in an image that other
people had of him. Physically strong and mature for his age, and from a family that
believed in the value of standing up for yourself, Simon felt that he had made the
mistake, early in his career at the school, of challenging one teacher who had (in
Simon’s eyes) unfairly accused him of a misdemeanor. Ever since that day, it
seemed, not only other teachers, but also his classmates, seemed to expect him
to ‘rise to the bait’ whenever a teacher reprimanded him. He admitted that he felt
‘fed up and stuck’ with this pattern, but could not find any way to change it. With
the counsellor’s help, Simon identified some key trigger situations, and ways of
responding differently when they occurred. He also began to cultivate a subtly
different image within the school, and within his own imagination – the ‘joker’
rather than the ‘troublemaker’.

Defining counselling
The case vignettes presented above give some brief examples of what can happen
when someone goes to see a counsellor. But what is counselling? What are
the ideas and principles that link together the very different experiences of these
counselling clients? How can we understand and define counselling?
 Defining counselling 5

These are some definitions of ‘counselling’ formulated by professional bodies

and leading figures in the field:
“Counselling denotes a professional relationship between a trained
counsellor and a client. This relationship is usually person-to-person,
although it may sometimes involve more than two people. It is
designed to help clients to understand and clarify their views of their
lifespace, and to learn to reach their self-determined goals through
meaningful, well-informed choices and through resolution of prob-
lems of an emotional or interpersonal nature.
(Burks and Stefflre 1979: 14)”

“. . . a principled relationship characterized by the application of one

or more psychological theories and a recognized set of communica-
tion skills, modified by experience, intuition and other interpersonal
factors, to clients’ intimate concerns, problems or aspirations. Its pre-
dominant ethos is one of facilitation rather than of advice-giving or
coercion. It may be of very brief or long duration, take place in an
organizational or private practice setting and may or may not overlap
with practical, medical and other matters of personal welfare. It is
both a distinctive activity undertaken by people agreeing to occupy
the roles of counsellor and client . . . and an emerging profession . . .
It is a service sought by people in distress or in some degree of confu-
sion who wish to discuss and resolve these in a relationship which is
more disciplined and confidential than friendship, and perhaps less
stigmatising than helping relationships offered in traditional medical
or psychiatric settings.
(Feltham and Dryden 1993: 6)”

“Counselling takes place when a counsellor sees a client in a private

and confidential setting to explore a difficulty the client is having,
distress they may be experiencing or perhaps their dissatisfaction
with life, or loss of a sense of direction and purpose. It is always at the
request of the client as no one can properly be ‘sent’ for counselling.
By listening attentively and patiently the counsellor can begin to
perceive the difficulties from the client’s point of view and can help
them to see things more clearly, possibly from a different perspective.
Counselling is a way of enabling choice or change or of reducing
confusion. It does not involve giving advice or directing a client to
take a particular course of action. Counsellors do not judge or exploit
their clients in any way. In the counselling sessions the client can
explore various aspects of their life and feelings, talking about
them freely and openly in a way that is rarely possible with friends
or family. Bottled up feelings such as anger, anxiety, grief and
embarrassment can become very intense and counselling offers an
opportunity to explore them, with the possibility of making them
6 Chapter 1 An introduction to counselling

easier to understand. The counsellor will encourage the expression

of feelings and as a result of their training will be able to accept and
reflect the client’s problems without becoming burdened by them.
Acceptance and respect for the client are essentials for a counsellor
and, as the relationship develops, so too does trust between the
counsellor and client, enabling the client to look at many aspects of
their life, their relationships and themselves which they may not have
considered or been able to face before. The counsellor may help the
client to examine in detail the behaviour or situations which are
proving troublesome and to find an area where it would be possible
to initiate some change as a start. The counsellor may help the client
to look at the options open to them and help them to decide the best
for them.
(British Association for Counselling and Psychotherapy 2008)”

These definitions each highlight different aspects of counselling. For example,

Burks and Stefflre (1979) stress the idea of the ‘professional’ relationship, and the
importance of ‘self-determined’ goals. The BACP definition places emphasis on
exploration and understanding, and the values of counselling. Feltham and Dryden
(1993) identify areas of overlap between counselling and other forms of helping,
such as nursing, social work and even everyday friendship, and suggest that
counselling involves the application of psychological theories. However, it is clear
that all of the definitions of counselling listed here have one important feature
in common: they are primarily framed from the point of view of the counsellor.
They are definitions that primarily seek to define counselling as ‘something done
by a counsellor’. In taking this perspective, these definitions reflect the aim of
professional bodies to establish counselling as a professional specialism within
contemporary society. However, a profession-centred definition of counselling
runs the risk of ignoring the basic fact that counselling is always a two-person (or
multi-person) activity, which arises when one person seeks the help of another. In
order to reflect a more inclusive meaning of the term ‘counselling’, this book
espouses a user-centred definition:
“Counselling is a purposeful, private conversation arising from the
intention of one person to reflect on and resolve a problem in living,
and the willingness of another person to assist in that endeavour.”

The key assumptions that underpin, and are implied by, this definition include:
1 Counselling is an activity that can only happen if the person seeking help,
the client, wants it to happen. Counselling takes place when someone who
is troubled invites and allows another person to enter into a particular kind
of relationship with them. If a person is not ready to extend this invitation,
they may be exposed to the best efforts of expert counsellors for long periods
of time, but what will happen will not be counselling. The person seeking
counselling is regarded as actively engaged in finding ways of overcoming his
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Eröffnung 22
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