REVIEW OF RELATED LITERATURE
Various studies have been made in relation to counseling. The major the focus of the studies though has been on the clients and the psychological significance of counseling in varied problematic areas of the lives of each patient. However, the studies pertaining to the other side of the coin, i.e., the fate of the counselors in the counseling profession seems, to be studied on a lesser degree.
This brief survey of literature deals with defining, in an operative sense, the term counseling and the probable risk of the profession to the counselor. By surveying the albeit limited literature on the negative aspects of in counseling, this review seeks to establish that there exists emotional harm in the counseling on the part of the counselor him/herself.
Counseling as a ProfessionBelkins (1984) described counseling as the fusion of many elements. Included are a “compassionate treatment of mental health problems… psychodynamic insights of Freud and psychoanalysis, the scientific scrutiny and methodology of the behavioral approach, the quantitative science of psychometrics, the humanistic perspective of client-centered therapy, the philosophical bases of existentialism, and the practical… applications that evolved from the vocational guidance movement. Belkins description of counseling remains appropriate today because it captures the comprehensiveness of the activity known as counseling. In helping clients enhance their lives, professional counselors apply knowledge, skills, and techniques derived from their studies in human growth and development, social and behavioral sciences, and counselor education. The work may involve individual interpersonal relationships, social or small-group interactions, or community-wide involvements. They also may be involved with personal, social, familial, or vocational concerns. And finally, they may be involved with either direct or indirect service delivery.
As a result of the comprehensiveness of counseling, specialty areas have developed attempting to delineate the broad counseling specialties. However, being distinct from one another is difficult because professional counselors with different specialties have much in common. Primarily, all counselors are concerned with helping people develop, prevent difficulties, and overcome problems. Also, broadly speaking, all counseling specialties include principles and theories of behavior. Some focus on mental-health counseling, while others are concerned with student personnel in higher education or school counseling. Regardless of specialty, there is a common linkage among professional counselors: the goal of helping people “cope” and find effective solutions for problems that can arise at any point in the lives of otherwise normal people. As members of the group of mental-health professionals, counselors distinguish themselves by the applied nature of their work. The following are the specialties in counseling: Mental-Health, Marriage and Family, Student Development Practice in Higher Education and School Counseling.
Loesch and Vacc’s (1993) work has provided the profession with an empirical description of counselor practice. What it does not do, however, was to provide information about the relationship of counseling to other mental-health specialties such as psychology or social work. To develop a working contrast of the professional counselor and other mental-health professionals, it is necessary to rely on the description of roles, functions and responsibilities of these professions. However, this is beyond the scope of this review.
It must be stated, however, that the counseling profession is based on certain assumptions, some of which are definitive and fully agreed upon by the professional counselors. Others, however, are implicit; they are not specifically stated or readily acknowledge and, in many cases, not clearly perceived. Two factors that most counselors view as important to successful practice are the counselor’s (1) knowledge and skills in professional and counseling and (2) personality. Without useful knowledge, a professional counselor is unable to practice effectively. Likewise, in order to practice, a professional counselor needs to be able to respond to clients in ways that promote their willingness to profit from the counselor’s efforts. Relatedly, a professional counselor must exhibit personal characteristics that allow clients to be receptive to the counselor’s efforts.
Studies on the Risk in CounselingBasically, what is counseling? It is a two-way relationship between a client (which is commonly referred to as a patient) and a person with an appropriate training, usually medical in nature. The goal of counseling is to aid a client in determining his or his feelings, opinion, and attitude toward the issue at hand. By doing so, the counselor will be able to assist the patient in making an informed decision concerning the said issue. It is important to point out that the need for a training in medicine is preferable because, most, if not all decisions that are to be made are usually health related. A counselor needs to gain the patient’s trust as the counselor is sworn to confidentiality. In making a decision, the counselor should give the patient freedom of choice or choices. He should not dictate the patient, in fact he is expected to encourage independence in the decision making process. The patient’s decision should be his and his alone. The counselor just acts as a facilitator.
The counselor is there to help the patient. He helps in such a way that he is there to make his understand what his problem is. He assists in identifying which issues are significant thus making the dilemma identifiable and lucid. In doing so, he also needs to satisfy the needs of his patient. He helps in making the patient share his needs, worries, and other concerns.
He needs to receptive of the problems of his patient. Being responsive is encouraged, so as to let the patient reveal his problems. That kind of response makes the patient uninhibited. By doing so, it is possible to reduce the patient’s uneasiness and anguish if he is uninterrupted and free from criticism as of yet.
Like what was mentioned above, confidentiality is a pertinent issue, as most patients wish to remain privy about their problems. Although there are cases where records can be subpoenaed by the court, but that is another matter. During the course of counseling, the patient will be asked and he should answer the questions brought up by the counselor. These questions are basically about the medical history of the patient and other personal details, whatever the counselor deem relevant. The counselor acts as a detective, and he this interview serves as a part of his investigation. One should be truthful when being interviewed. As one would be when he is giving a statement under oath (“Do you swear to tell the truth and nothing but?”). This is necessary because the counselor needs to have a background on his patient. He needs to know these types on information so he could determine what the individual needs of his patient are.
Counseling is a two-way process; it is an outpouring of information. Although the final decision rests on the patient, the aptitude in which the patient decides is not altogether independent of the counselor.
With the presence of a counselor, one makes an informed decision. At least one is expected to create an informed decision. Whereas when we are alone, we tend to misjudge things. The counselor may act as a devil’s advocate. When we are with a counselor, we make our decisions more consciously. Another advantage is the avoidance of hearsays and half-truths. The media and even some of our relatives and peers usually feed us with these. How many medical “facts” turn out to be fallacies? Hearsays and half-truths more often than not cloud up the issue and oftentimes result in an unpleasant outcome. We make a bad decision.
Having stated these, one can surmise that counseling is more than just talking and blabbering. It deals with real people, real issues, and real lives. The most obvious aspects of our lives that are affected are our mental and emotional health; but this is not limited to our lives (meaning us as patients) but more so to the lives of the counselors.
If one is obsessed or engrossed with one’s work, as any other professional would, he loses time for his family and himself. But being in a career such as counseling, another factor sets in. Dealing with a lot of emotional and mental problems will drive one to insanity if one is not careful. But before we get into that, the sense of identity is sometimes lost. How does a psychiatrist or a counselor see himself? How does he identify himself?
It is sometimes inevitable for a counselor to get attached to a patient. One must realize that a counselor is a person too. And he feels the same way as the patient does. He can be emphatic at times. Personal attachment to a patient is difficult to resist once he becomes familiar and comfortable with the patient. For how can one maintain a productive is session if one is not interested in his patient? Boredom might set in make the session come to a halt. This patient is sharing his problems with him. Now multiply that ten times, or maybe even twenty, or fifty, depending on the number of patients the counselor has. Imagine the impact of bearing that knowledge, those are not happy thoughts. It is also common knowledge that those who visit counselors are those having problems. People have different problems, some of which can sometimes be grievous some fatal, others petty and to a lesser extent psychosomatic. But knowledge like that can sometimes be hard to bear, too much to handle. It is at this moment that they begin to experience mental and emotional difficulty.
Counselors are not supermen or superwomen. Like any other profession there are some who cannot be spectacular as they should be. Reports have it that some psychiatrists were driven to insanity to the point of committing suicide. What drives them to this is transference, a term coined by Sigmund Freud which, in a sense, refers to transferring of emotions (and other attributes) toward the therapist. It comes to a point wherein the patient becomes hostile towards his therapist, and becomes violent. It is basically rooted in anger, a patient’s anger. If a patient is angry, he directs his anger towards his therapists. How that anger is manifested can vary. It may be violent. It may not be. Therapists, especially novices, have difficulty in dealing with this problem. Especially, when the patient becomes violent. Some avoid it altogether and thus restricting the progress of therapy.
Transference is one of reasons why the suicide rate among psychiatrists is very high. The suicide rate among psychiatrists is significantly higher than those of any of the other sixteen specialty groups listed by the American Medical Association. Adams (2001) wrote:
What's the most suicidal occupation? I won't venture an opinion for the world of work overall, but among health-care types it may well be shrinks. In a study of 18,730 physician deaths from 1967 to 1972 (men and women), psychiatrists accounted for 7 percent of the total but 12 percent of the 593 suicides (source: Rich et al., Journal of Clinical Psychiatry, August 1980, and pp. 261ff).
Hannotte (1974) writes an interesting article on “mainstream psychiatrists.” He claims that they are selective with their patients. They do not favor those who they think are not good enough for them. These people are those who espouse the following attributes.
o One who thinks for himself
o Those who live in an unconventional way
o And those who see the psychiatrist as their equal
He goes on to say that a psychiatrist’s training reduces “his emotional responses” to an impersonal level; one that is based on output and efficiency. He just calculates and acts on his responses in such a way that he thinks will be most effective but disregarding human emotion altogether. We can compare this to a factory; a factory that prefers quantity over quality (something to that effect). He makes another bold claim concerning the manner on how a psychiatrist prescribes treatment of a patient. Because of his superiority complex, he sees himself as a perfect entity. No one is perfect, and no one has proven the opposite; even the Law of Thermodynamics state that perfection is impossible (3rd Law of Thermodynamics). He fails to question his shortcomings and he sees himself as a model, “what he's calling therapy may boil down to a dishonest game to brainwash you into believing you're being helped.”
Though it has been stated previously that the patient can trust his therapist, and the counselor should be receptive and responsive to his patient, Hannotte claims that the therapist alienates his patient. He uses the following statement, taken from Roche Laboratories' booklet Interviewing Techniques:
“To establish a healthy therapeutic relationship and to help the patient ventilate his problems, an attitude of receptivity, of dynamic passivity, and been recommended, with the physician responsive but non-judgmental. This encourages the patient to speak freely, to present his difficulties as clearly as he can. The patient's distress is likely to be reduced if he is permitted to talk without interruption or criticism. Expressions of interest, without signs of emotional reaction from the physician, can help create the necessary therapeutic rapport.”
The terms ventilate, non-judgmental, therapeutic rapport are abstract terms. An over-elaboration of this sort thus “insulate [sic]” the psychiatrist from his patient. He is supposed to be the one who is helping the patient, but Hannotte claims that the psychiatrist falls short of his goal. Being non-judgmental is being uncompassionate. This is a big no-no in an effective treatment. And also there are contradictions in the statement itself. How can one be responsive without judging what the patient is sharing? If one does not judge or even react on what has been shared, on what has been uttered, how he be able to respond? If one is to respond and be receptive, how can he show without displaying emotion? Even hints of it are prohibited by the said manual. In here lies the dilemma facing psychiatrists. Because at the end of the day, whether they like it or not, these matters will haunt them, for they too are human. What separates them from the race of the population? Just a career in counseling.
Hannotte said that for based from his experience, an effective counseling is a fruit of self-discovery; one which is not limited to the patient but to the counselor as well. He maintains that in order to help the patient, one’s self, one’s “critical faculties” should be used. One should be critical, and he should do this out of his own good will. By doing so, he feels as though he is the person that is being treated. One does not take account of how the patient is sick, but how much healthier this person can be.
However, counselors do become engrossed in their career image and social status. Each of their undertaking is dedicated to the improvement of their careers, helping patients is only secondary, it is out of necessity that the treats his patients. He becomes paranoid, uncaring, and dishonest to himself. He may fail to recognize his own shortcomings and this clouds his judgment. As pointed previously, Hannotte claims that the tools and procedures for therapy alienates the patients, he supplements this with another claim. That “the very procedures of therapy can be designed to counter the threat of experiencing real warmth toward his patients.”
As any other college graduate, counselors go into the real world with a sense of optimism. A sense of pride, that they can contribute something to the betterment of mankind. However, they encounter a “rigid hierarchy of superiors” that aims to “cure them of their altruism.” Here’s a perfect example of the system corrupting those who are trying to change it. These young ones are swallowed up by the system. A journey that aims towards a lifetime of service and unselfishness becomes a life that revolves around a “self serving pretension” that feeds on their “exploiting the gullibility of laymen.” With this kind of system, one need not wonder why there is a high rate of suicide amongst psychiatrists.
If one is to choose a medical career, a career in counseling, specifically psychiatry, may not be recommendable, given that it has one of the highest suicide rates among medical personnel.
Counseling may dehumanize a person.
If Hannotte is to be believed, one should consider the consequences of venturing into this career. One should be tenacious and upright, and dedicated, at the risk of being called self-righteous and all-knowing, and of being bombarded with mental and emotional burden that comes with it.
In Gist: The Counseling Profession and the Risk Hitherto AttachedProfessional counselors apply knowledge, skills and techniques derived from the areas of human growth and development, the social and behavioral sciences, and from counselor education. In the addition to professional counselors, there are many types of mental-health professionals (e.g., applied psychologists and social workers) who work in many settings such as private practice, community agencies, and higher education. However, as members of a group of mental-health professionals, counselors distinguish themselves by the applied nature of their work. Further differentiation among the many mental health professionals can be made on the basis of commonly held perceptions with regard to mental-health problems. These can be conceptualized along a continuum from adjustment problems to abnormal behavior. In addition, differentiation can be made between mental-health professionals regarding work orientations that range from scientists to practitioner.
The counseling profession is based on a number of assumptions. To be successful, counselors must possess certain essential personal characteristics such as security, trust and courage. Relatedly, counselors also are assumed to have mastered a body of knowledge and skills. Finally, the professional counselor is a scientist. This role is important, because counselors are required to evaluate the effects of their counseling and to read as well as produce research findings published in professional journals. Counseling as a profession, then, encompasses a diverse number of settings and involves basic assumptions about what is required to be successful.
This survey, it has manifested that in the different realms of life that the counselor finds himself into, the risk of becoming submerged in a pool of emotional and mental distress is not far. This results in the negative consequences of the profession, and imparts high risk to the counseling professionals. Some studies have probed to this issue and in most, it was emphasized that though counseling seems to be self-fulfilling and gratifying, the hides in a chameleon its many negative elements.
References:
Adams, Cecil. “Do dentists have the highest suicidal rate?” The Straight Dope.
2001
Belkin, G.S. Introduction to Counseling. DuBuque, IA: WC Brown. 1984.
Gilca, Boris. “Patient Counseling and Education” Breakout Session Presentations AIHA Partnership Conference. 2000
Hannotte, Dean. ”The View from the Center”. Ninth Street Central Journal 2.
1974.
Kocher, Robert. “Hillary Clinton Must Be Stopped: The Cognitive Dissonance Connection”. The Laissez Faire City Times, Vol 4, No 41. 2000.
Loesch, Larry, Vacc, Nicholas. Setting Minimum Criterion Scores for the National
Counselor Examination. Journal of Counseling Development. 1993.
Radina, Kathy. “The Risks of Counseling”________________. ____.
Vacc, Nicholas, Loesch, Larry. A Professional Orientation to Counseling. 1994.
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