Defining and delivering effective counselling and psychotherapy

Defining and delivering effective counselling and psychotherapy

Lawrie Moloney

CFCA Paper No. 38 — March 2016
Couple sitting on couch listening to therapist

Key messages

Differences between counselling and psychotherapy are largely in the eye of the beholder; both are relatively recent, mainly personally focused approaches to centuries-old traditions of providing culturally appropriate responses to "problems of living".

Medically informed models of how counselling and psychotherapy "work" continue to inform much theory and practice, and have prompted thousands of studies seeking evidence for and against the relative efficacy of different "treatment" approaches.

Almost all well conducted studies of mainstream counselling interventions have concluded that regardless of the model used, the average effect size of counselling (discussed in the body of the paper) is substantial and compares well with effect sizes achieved in established medical practice.

Unlike medical interventions however, the effect size has little if anything to do with the particular model of treatment employed; rather, effects are linked to factors found to be common to all counselling interventions.

Somewhat counter-intuitively, there is no convincing evidence that counsellor gender, qualifications, theoretical orientation, professional discipline or even years of experience impact noticeably on outcome; there is evidence that effective counsellors tend to be consistently effective, while ineffective counsellors tend to be consistently ineffective.

Counsellors (as well as commentators and researchers) continue to struggle to reconcile models of individual counselling, focused mainly on internal emotional and cognitive processes, with couples or family counselling models focused mainly on quality of interactions between individuals.

In both individual as well as couples and family counselling however, the focus of practice and research is increasingly turning to how the common factors that drive successful counselling interact with each other, and how counsellors gain, retain and develop their therapeutic expertise; research comparing the efficacy of differing models of counselling is unlikely to yield useful results into the future.

Counsellors' willingness to systematically elicit, record and make use of client feedback in the context of establishing a sound therapeutic alliance appears to be strongly associated with good outcomes; the use of validated client feedback protocols also allows for the routine monitoring of outcomes by counsellors themselves as well as by counselling organisations and funding bodies.

Following a brief historical summary of three mainstream approaches, this paper addresses the similarities and differences between the terms counselling and psychotherapy. After settling on counselling as the default term, the paper then provides a comprehensive definition, explores counselling's essentially voluntary nature and examines the practice and research divide between individual, couples and family focused work. Though there is good evidence for the effectiveness of individual, as well as couples and family counselling, it is acknowledged that amassing the evidence with respect to couples and family work has proved to be a more challenging task. The finding that the strength of counselling effectiveness has altered little over the past 40 years is then linked to the question of how counselling works. The evidence points away from a medically grounded focus on differential effects of particular models of counselling, towards common factors - especially the nature of the counsellor-client alliance - that appear to be present in all successful counselling outcomes. The common factors findings, in turn, suggest the need for a shift in focus from the relative efficacy of differing models of counselling to research into counsellor training and the ongoing development of counsellor expertise. A key correlate of this continued development has been shown to be counsellors' capacity and willingness to seek and act upon client feedback. Moreover, the formalisation of a feedback-informed approach via validated, user-friendly client feedback protocols permits the monitoring of outcomes on both a case-by-case and aggregate basis. This in turn provides a way forward with respect to developing an ongoing accountability framework for counsellors, counselling agencies and their funders.

Authors and Acknowledgements

At the time of writing Lawrie Moloney was a Senior Research Fellow at the Australian Institute of Family Studies and Adjunct Professor at La Trobe University, Melbourne, Australia.

My thanks to Stephen Andrew, Cathryn Hunter, Bruce Smyth, Ruth Weston and George Wills, who read and commented on drafts of this paper. Thanks for administrative and editing help from Joanne Commerford and Lauren Di Salvia. My special thanks to Banu Moloney, whose wisdom as a counsellor and therapist permeates these pages. Shortcomings and omissions are of course my own.

Cover image ©

Publication details

CFCA Paper
No. 38
Published by the Australian Institute of Family Studies, March 2016.
29 pp.
Suggested citation:

Moloney, L. (2016). Defining and delivering effective counselling and psychotherapy (CFCA Paper No. 38). Melbourne: Child Family Community Australia information exchange, Australian Institute of Family Studies.

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