The role and function of consultation in counseling practice

Counsultation in the field of counseling is a concept by which a person is able to consult with a counselor in order to develop a better sense of self. There is often a biblical aspect to this type of counseling, but that is not a requirement. People can also be counseled by those who address financial concerns, tax implications, or other types of personal and professional issues. Anytime someone sees a counselor for a counsultation on his or her status in some aspect of life, this type of activity takes place. Often, a counsultation takes place as the first line of defense in treating a mental health issue. A counselor can look over information provided by the patient as well as any past medical history in order to make some determinations about patient care and potential problems. At that time, there can be a counsultation appointment scheduled that will allow the patient to see a counselor (usually for one hour). Once that has been completed, the counselor can make a determination as to whether further counseling is necessary, or whether the counsultation was sufficient to provide a diagnosis.

Addressed here will be several aspects of this issue, including a history of its development to the counseling field, the importance it has within that field, and the major themes to which it can be linked. Additionally, the ethics, function, and identity of the counselor providing the counsultation is very important to address, because not all counselors are "cut out" to provide the initial counsultation with an individual. There are often biblical values and insights provided in the initial counsultation appointment, and those must be addressed along with other consideration into the topic.

Brief History and Development

Consultation has been around for some time in the counseling field, but counsultation is newer. This is, essentially, a blend of an initial consultation and a counseling session, because it has been shown to be effective in many cases where individuals did not need long-term counseling but may need just slightly more than an initial consultation appointment to determine what medications they should be taking and/or if there are deeper issues which they should explore through therapy or other means. Originally, people went to counselors for counseling, and they often went back each week or on whatever schedule was agreed upon by the patient and the counselor (Belkin, 1999; Worden, 1991). These patients often also took medication to help them through the worst of their symptoms, but that was not a requirement. Some of them attended Christian counseling, and others focused on a counselor who was more secular in nature Clinton & Ohlschlager, 2002; Doka, 2002). Either way, there were options to consider.

It was eventually determined that it would be easier for a person to have an initial consultation to see if they needed long-term therapy or whether there was something else that could be done for them that would be easier on the patient and easier on the counselor. One of the ideas that was successfully tried was the counsultation, whereby a patient would have a combination of an initial consultation and a counseling session. That could allow the counselor to make a better determination of whether the patient actually needed counseling or whether he or she needed a medication or some other type of therapy or medical treatment in order to get past the problem he or she was facing. Overall, there are many issues that can be treated with a counsultation instead of sending someone to therapy for the long-term or assuming that a consultation is all the patient needs.

Importance to the Counseling Field

Counsultations are very important to the counseling field because they provide a mix of a good consultation along with some level of beginning counseling. That can help a patient "get a jump" on his or her problem, instead of feeling as though a consultation is all he or she gets and it is necessary to wait until the next appointment before the counseling actually starts. While this may not work for all patients at all times, it is certainly easier on many patients and can provide them with what they need and want in a counseling appointment. It is also more efficient for both the patient and the counselor, which makes it difficult to overlook when considering the best way to address an issue with a patient. When a counsultation takes place, both patient and counselor can get a better feel for whether they like one another and whether they feel as though they will work well together. Patients who do not feel comfortable with their counselors are not as successful in therapy as those who like the person with whom they are working (Benner & Hill, 1999; Boss, 1999; Rynearson, 1984). The same is true with counselors who do not like their patients or who do not feel as though they have any kind of connection with their patients.

Of course, that does not mean that all patients and counselors will benefit from the counsultation, or that they will all make the right choices as to whether they can work with one another. That is something that is very individual to each person and has to be addressed as such. Despite that individuality, it has been shown that counselors who get to know their patients and whether they can have a good relationship with those patients are better able to determine whether they can care for those patients properly. Patients who take the time to get to know their counselors are generally more likely to work with those counselors on an open and honest basis, and to share what they feel more easily (Benner & Hill, 1999).

Major Themes and Their Relevance

Caring for people is something all counselors do and should strive for. In doing that, they should consider five things: ethics, empirically-based evidence, compassion, their own identity, and the identity of the patient (Benner, 1999; Clinton & Ohlschlager, 2002). It is not always easy to consider all of those things, mostly because some counselors will have very strong feelings one way or the other about a patient or potential patient. When that is the case, some individuals do not want to work with others, or they feel the need to work with a particular person even if there are compelling reasons why they would want to refer that person to someone else. Ethically, counselors must do what is right. If they can consult with a patient and get to know that person, they can determine if there are any ethical conundrums to which they might be subjected if they were to treat that patient. They can also get a feel for their level of compassion toward the patient, which can be a critical factor in whether they do their best for the patient from a counseling standpoint, or whether they simply do not connect.

The identity they have created for themselves, and the identity they see in the patient matter, as does the empirically-based evidence for what is "wrong" with the patient and how best to address it based on the determined reasons behind the problem (Benner, 1999). When a counselor and a patient have very different identities, it can be hard for them to work together in any way that allows for deep meaning and personal growth. Patients often benefit greatly from counseling, but counselors can also receive benefit and insight from their patients in some cases. If there is no connection between the identities of the counselor and the patient, that is much less likely to take place. Additionally, counselors have to understand the problem the patient is facing, and that patient has to be willing to understand the changes that need to be made in his or her life to overcome that problem.

Counselor Identity, Function, and Ethics

Who the counselor is as a person means more than some would think. There is a misperception that the function of a counselor is almost as an automaton who will help a patient through something tragic. Grief counselors, for example, work to help people get through the lost of a loved one, or sometimes that patient's own impending death (Engel, 1961; Fast, 2003; Lindemann, 1944; Neibuhr & Wilgoren, 1999). Their ethics require them to act a particular way and perform at a specific level, but that does not mean they should fail to be human (Office, 1999; Pine, 1976). In other words, any counselor should also be able to show the patient that the counselor is a real person who is capable of feelings and thoughts that go beyond the professional world of counselor and patient. Without being able to provide that level of understanding and compassion, there is little benefit to many counseling relationships. Each counselor is a human being first, and a counselor second. When counselors remember that, they can provide much more value to any patients they treat. Naturally, how much of himself or herself a counselor put into sessions with a patient will depend on the counselor's personality, the receptiveness of the patient, the ethical issues surrounding the problem, and the function the counselor is serving for the patient in dealing with his or her problems.

Ethics are often at the heart of anything the counselor feels he or she can do or not do (Benner, 1999). In other words, the counselor has a duty to remain ethical no matter what else is taking place. Breaking that ethical code simply to comfort a patient or provide camaraderie is not acceptable, even if it is sometimes desired. Counselors who handle things that way often end up out of work in their chosen profession because they are not able to keep their personal life and professional life separate enough to be acceptable to those who set the ethical rules for counselors. Breaking ethical codes is a serious infraction. In counsultations, the same ethical rules apply. There is no "leeway" because a counseling session and a consultation blend into one another, or overlap in some way.

The function of a counselor is to ensure that the problem(s) faced by the patient are the focus of the session and that those problems are treated with sincerity and respect (Bowlby, 1977; Bowlby, 1980). It is certainly true that some people have problems, difficulties, fears, and phobias that would seem "silly" or downright ridiculous to others, but it is not the place of the counselor to judge. If the problem or difficulty is important and serious to the patient, it should be important and serious to the counselor from a treatment standpoint, regardless of how the counselor personally feels about the issue (Bowlby, 1977). A counselor who cannot accept the seriousness of a patient's issue may not be the right counselor for that patient, and it may be better if the counselor suggests the patient see a different counselor who can, perhaps, be more helpful in treating a particular problem. There is no reason to assume that every counselor and every patient are going to get along well or have a good relationship with one another.

Getting to know the counselor is something important for a patient, because many patients find that they have to visit several counselors before they find one they actually like and with whom they are comfortable. That is not always the case, of course, and some people just "click" with their counselors right away, but there are certainly cases where patients will need to "shop around' to a certain extent until they reach a counselor they like best and can relate to. That is often not because a particular counselor is doing something wrong, but because of the counselor's identity. Each person is an individual, no matter what his or her profession. Because of that individualism, personalities may clash or working with a particular counselor simply might not "feel" right to a patient. Listening to that inner voice is important to make the best counseling decision (Clinton & Ohlschlager, 2002).

Thoughtful Considerations on the Topic

There are many things to consider when it comes to counsultation or any kind of consultation or counseling service. Ethics are highly valued, as are counseling services that are empirically based. Additionally, biblically grounded counseling services are becoming more important to some, even if they do not identify themselves specifically as Christian counselors. Even secular counselors are beginning to see the value of basic biblical insights and values in their counseling practices. When they realize the value these insights have, they begin to incorporate them into their practices and they start showing what they have to offer to their patients. Most counselors are either religious or secular, and few counselors offer both. This stands to reason, because those who are strong believers in Christianity can have trouble giving secular advice that might contradict the bible. Others who have no interest or belief in Christianity may struggle with counseling people to follow biblical ideas. However, the more these secular counselors explore biblical ideas the more they see that the values and insights in the bible are not just about "being Christian," but about living a life with kindness, compassion, and integrity.

Those are values and insights from which all people can benefit, no matter their belief system or how they feel about something to which they are exposed in the office of their counselor. Basic tenets that are seen in the bible revolve around caring for others and treating them with respect, as well as being a valuable person and doing things for others and for society. Not doing harm to anyone else is a significant way to live one's life, and can be more difficult than expected. It is very easy today to say an unkind word or do something that is not compassionate because one is in a hurry or the other person is different in some way that is not deemed to be "acceptable." With that in mind, of course, it is important to consider how biblical insights and values can affect counseling and how they can show patients that there is much more to their lives than the issues they face.

Often, counseling is not just about helping a person with his or her specific problems. It is about showing a patient how to live a life with which he or she can be happy and feel fulfilled. If that is not the case for a patient, he or she must make adjustments. Sometimes medication and extensive therapy are necessary, depending on the patient and what he or she is facing or has faced in life. However, there are many times when small changes and new ways of thinking about things can help a person change his or her perspective enough to begin to see differences and start to feel better about life. When a counselor has a counsultation with a patient and helps that patient focus on something that is not related to the patient's difficulties, patients can begin to explore the idea that there is more to life than just what they are currently experiencing. Sometimes, a little bit of perspective is all that is needed to set a person onto the right track for future success.

Overall, there is no "right" or "wrong" answer for how a person should get or receive counseling. For those who provide biblically-grounded, ethical, and empirically-based counseling services, however, there has to be a deep commitment to that provision. Changing how a person counsels others in order to be more accepted is not the right way to go about counseling. Instead, it is important to understand that those who feel a conviction to provide counseling services that are biblically-based have a reason behind that. It is not a coincidence, and it is far too significant of a calling to ignore. Many people who come to counseling can be helped by the insights and values found within the bible, and it takes a compassion and caring - as well as a committed - counselor to help them see the ways in which they could change their life for the better.

Conclusion

Not everyone is receptive to counseling that is based on the bible. Additionally, not every counselor is comfortable providing counseling based on the bible. However, there are many counselors who are seeing the values and insights that are offered in the bible, and how those could provide much more to their patients than they previously realized. Other counselors have already known of this value, and have not wavered in their desire to provide only counseling that is bible-based. No matter what a counselor chooses - and that can vary to some degree based on the patient that counselor is seeing at any given time - there is clearly something to be said for counsultation that offers biblically-based information to a patient. There is hope and healing in the bible, along with many ideas of how to live one's life with honor and integrity. Regardless of whether someone believes in the bible as the Word of God, the values that are provided within it ring true.

Each and every counselor must decide for himself or herself what kind of counseling he or she is going to provide. That only makes sense, but it is hoped that more counselors will be drawn to the insights and values in the bible. They can teach those values and insights to their patients, who will go out and use them in the world. In that sense, the counselor may actually help many more people than just the patient, simply by giving the patient important tools he or she can use in his or her interactions with others. The quality of those interactions can change how all parties to the interaction see the world, which can provide for a much higher level of value to all of the people who interact with those who have received counsultations from counselors offering biblically-based assistance.