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Book review – Feltham, C. (2013). Counselling and critical psychology: A critical examination. Heredfordshire, UK: PCCT Books

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Elisabeth Shaw, Clinical and counselling psychologist Private practice, Drummoyne, NSW 

 

Colin Feltham is Professor of Critical Counselling Studies at Sheffield Hallam University in the UK. He has written and edited 20 books, which focus on skills development in counselling and supervision as well as critical analysis about the professions of counselling and psychotherapy. This book falls into the latter category, offering an interesting and wide ranging critique about the nature of human suffering, how our professions have evolved in relation to suffering, its political and social context, and the way it is also shaped by community expectations, government regulation, and professional rivalries.

Counselling, like all similar social phenomena, has a history, phenomena and set of expectations. The individual client, for all his anxiety and uncertainty, comes only to unburden himself, whereas the counsellor or counselling psychologist meets every client with a set of professional preoccupations and protocols in mind. Counselling paradoxically is both a fuzzy, complex and unpredictable business and a process crowded by self conscious expectations (p.77).

In establishing the territory of the book, Feltham notes that while critique is more likely within academia, within the professions themselves critical analysis has often been confused with attack. Instead he suggests that we remind ourselves that “counselling itself is a critique of the unexamined life and different models of counselling are inherently critical of others” (p. 18).

He commences the book with a review of the history and development of counselling, as it has been characterised by a number of key founding figures and traditions. While models are often argued to have developed in relation to particular presenting problems and conditions, in fact they are just as influenced in their techniques and focus by the era in which they exist; that is, the preoccupations and permissibility of the time. Our explanations for human suffering are inextricably linked to our model of therapy, culture, religion and individual preferences. As Feltham says, “[t]he psych-professions have evolved according to perceived social needs, professional self interests and within a certain time and place” (p.8).

He traces the early epistemological links to philosophical traditions, and how the shift towards the rationality of science ultimately set psychological theories apart from their philosophical roots. The professions have further developed in response to greater public interest and enquiry, often in relation to malpractice and regulation in general. Feltham argues that this has been important in distinguishing psychological professions from cults (p.7).

Feltham draws distinctions between professional groups early in the book, for example noting the greater link between philosophy and psychotherapy, while psychology, “has been controlled by its cerebral nature and its alignment with conventional culture,” which makes it difficult for it to accommodate, “emotional, dramatic, subjective and spiritual phenomena and countercultural values” (p.8). However he also notes the commonalities. For example, the talking therapies as a whole have developed significantly outside of―or in “uneasy coexistence” with―academia, yet also distinct from other (often seen to be more suspect) healing arts such as crystal reading, astrology and so on. This speaks to the Australian experience as well, where counselling courses do exist inside university, but an extensive range of services operate in the private sector as well. This results in freedoms, but also, until recently, a lack of clarity about what unites them and what the community might reasonably expect from a counselling intervention.

As the book progresses, Feltham turns his attention to particular “problems”, that is the problem of counselling theory, counselling practice, counselling research, and counselling as a profession. He notes the proliferation of theories is in itself a problem, resulting in a lack of gatekeeping, product/service control, and income generating strategies which can pass for “quasi-professional services” (p.47). Further, it suggests that there is no real consensus on what theory should contain in terms of its constituent parts, or standards of measurement for an acceptable theory. Given the greater literature available on CBT that already exists in the public domain, Feltham chooses to focus his discussion on psychodynamic and person centered approaches, exploring their theoretical robustness and depth as well as their appeal. His critique is challenging. He writes that “psychodynamic theory comes across as attractively complex, inserting itself into many nuances of our psychological lives that are not well understood or explained by other disciplines…yet there remains a chasm between its theoretical complexity and any widespread, convincing evidence of effectiveness” (p.54). He challenges the trend towards eclecticism and integrationism, and how professionals can feel compelled to describe their skills in this way. He notes that this should involve highly skilled, careful discernment about techniques, rather than what he observes in practice, as “a ridiculous and unhelpful mess” whereby approaches multiply all the time and we run from workshop to workshop gathering ideas and assuming all we need to or that can be integrated into a coherent strategy for intervention. He offers a 10 point test (p.73) by which all counselling theories could be measured, if they wish to be considered scientifically based, noting that despite the independence of theory, in the current climate most schools of therapy wish to be considered as “scientific” in approach.   

His chapter on “problems of counselling practice” will resonate with many who work within training institutions (pp. 76-106). He writes about the difficulty of applying theory to practice i.e. having to make do with the few organisations willing to have student placements, variability in screening techniques for suitable cases for trainees and variable supervisory practices. He writes of counselling as an “unnatural” enterprise. For example, counsellors are required to be “neutral to personal, religious and political values” (p. 82), which is at odds with how human beings actually operate. It also denies that counsellors have needs that are being met in the role, and that over time discussion about the self in the work is often not explored in any detail. He argues it requires “unnatural” behaviours of clients: to be punctual, speak freely and in detail to someone who won’t reciprocate, have feelings that are explored as transference, manage uncomfortable silences and get used to their counsellor parroting back what they say. The relationship will operate according to rules about time, length and location. Feltham looks at this “unnatural” enterprise in terms of its ability to cure, what “cure” might actually mean, what difference context (public or private), variations in delivery and time limited therapy makes and whose purpose it serves, and why debates about these issues are important.

There is an interesting section of the book on “what counsellors agonise about” (pp. 94-5). It includes suicidal ideation, transference and countertransference, “success” and effective endings. The section on counsellor ambivalence about research will speak to the experience of many: the desire to have theories validated and receive recognition, and at the same time already “knowing” that their work is effective. His section on “what can’t be researched” (pp. 125-129), such as clients who may not be traumatised by a sexual relationship with their therapist, or whether unsupervised practice is necessarily unsafe, is challenging and controversial.

For much of the book Feltham writes of counselling, psychotherapy and counselling psychology together, and in the main this works well enough. However there are differences which often really intrude into and shape different practices. For example, in Australia there is different access to third party payments and requisites for delivery of services under these programs depending on your qualifications; differences in professional regulation and registration, as two examples. So grouping them together can be an uneasy fit at times and this is a little distracting. However, he explores these differences more in his final chapter, looking at their separate professional identities, registration provisions, insurance requirements, fee structures, ethics, training and practice standards. He also looks at the influence of gender as a key variable in professional life, given the majority of practitioners are women, as well as noting that counselling is also provided by other professional groups such as mental health nurses and other allied professionals, and where ultimately psychiatry is often seen to still “rule.”

Feltham notes, quite aptly, that while outcomes from counselling research are overwhelmingly positive, “counselling is usually far from the linear process leading to wonderful outcomes fantasized and reified in most models. Chaos theory probably captures more of the reality” (p. 105). This book provides a rich discussion and critical analysis about where we have come from, why we have developed the way we have, how we experience professional life and through what lens we view the future. For those who like to challenge themselves and think about professional life from different and uncomfortable perspectives, who can tolerate critique and self analysis, this is a very worthwhile book. Ultimately critical analysis is not interesting if it is approached cynically or at the level of superficial potshots. Instead this book, being written by an “insider”, offers us a chance to clarify our thinking on the way to being more conscious of, and articulate about, what we are doing, and how greater awareness might lead to professional development and improvement. 

    


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