Why I . . . see a counsellorBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m745 (Published 09 March 2020) Cite this as: BMJ 2020;368:m745
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In highlighting the value of using some form of facilitated reflective practice in sustaining good practitioners and good practice, Austin Carroll and Helen Jones implicitly underline the problem of finding a name to describe what the process actually is.
They use the term ‘counselling’ for this ‘not-counselling’ activity perhaps because Carroll consulted a counsellor. However, it is a process which can be facilitated by practitioners from a variety of professions some of whom may have accreditation with a counselling organisation, but many others will be accredited by other health and psychotherapy bodies. The underlying principle for this form of consultation is that what is offered to the consultee is assistance with elucidating what facilitates of inhibits the fulfilment of their professional responsibilities. It is an aid to orientating the practitioner to the influences on them in their practice: these influences may derive not only from scientific and clinical knowledge but from personal, interpersonal, organisational, societal, cultural, religious or political sources. In order to best focus on the primary task, which, in the clinical situation, is the responsibility to the patient, a core principle of the consultant’s role is that the role and responsibility is separate from line management and clinical direct supervisory responsibilities (1).
The problem of choosing a name is also evident in O’Carroll’s recommendation of “going for something generic rather than taking a Freudian approach”. I don’t know of a “Freudian approach” in this area of work. If he means avoiding someone who does not understand that this process is not personal psychotherapy or counselling for a clinician, then I heartily agree. However, the psychoanalytic tradition has contributed greatly to this form of facilitated reflective practice with individuals and with groups. Appreciating the manifestations of unconscious processes, particularly transference / countertransference and projective mechanisms (whichever parties to interactions these derive from), group dynamics and the wider unconscious attributions and misattributions which occur in organisations and societies can prove invaluable to consultees. These take their place alongside clarification through seeking detailed accounts of events, being able to call upon ethical analysis and respect for the complexity of clinical work in sustaining the practitioners we all need.
Perhaps the tittle of the piece should more properly be “Why I… see a counsellor… but not for counselling.”
(1) Hughes, L. and Pengelly, P. (1997) “Staff Supervision in a Turbulent Environment” London: Jessica Kingsley Publishers
(2) General Medical Council “The duties of a doctor registered with the General Medical Council” https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/goo... accessed 30th March 2020
Competing interests: I offer psychodynamically-informed work discussion / facilitated reflective practice to health care practitioners.