Review

Counsell meeting

Counselling and Social Work
J Brearley
Counselling in Medical Settings
P East
Open University Press, 1995

These two books form part of a series on counselling in a variety of settings and situations: ten so far, and more expected. This may be a strength and weakness: strength in that the quality of these volumes, if typical, will encourage sales for the others; perhaps a weakness in that a tight editorial hand is evident. Both authors have a clear understanding of their subject matter from a theoretical and practice base, and are not afraid to use both to illuminate their message, making the text comprehensible and relevant to academic and practitioner. Both authors have an accessible style, which generally avoids jargon.

The main contrast between the two volumes is that Brearley seems rather more interested in social work issues than counselling, with the reverse being true for East. This is understandable in the context of the history and nature of social work which Brearley discusses. Brearley seems particularly concerned to identify why social work has not always embraced counselling, which should be a core activity. Brearley produces an interesting set of explanations, but at the risk of losing the interest of the non-social worker. It is curious that she does not discuss at length two situations where counselling is of special relevance. The first is adoption record access counselling, introduced by the Children Act 1975, which was the first time that counselling achieved statutory status in the UK. The second was under the provisions of the Human Fertilisation and Embryology Act, which East discusses.

Social workers are exposed to roles in medical settings, in particular, where assessment and counselling may become confused. Stereotypically for a social worker, Brearley seems reluctant to use the research evidence for the helpful deployment of counselling in a social worker’s role. Altogether, though, an account which social workers and others will find helpful.

East locates the development of counselling within the development of medicine. The biographical sketches she uses to clarify the place of specific theoretical approaches are especially helpful. Like many others she tussles with the definition of counselling, particularly in relation to advice and guidance on the one hand, and psychotherapy and psychoanalysis on the other. That she is not entirely successful is no criticism; but both authors are too preoccupied with their psychoanalytic visions of helping to give proper weight to the specialism of behavioural psychotherapy. This may be highly focused and short term, not focusing on fundamental personality and long term, as their attempts to distinguish counselling from psychotherapy would predict. The crucial distinction between using the skills of counselling and performing the role of counsellor would have been helpful in her analysis. Hers is an up to date and well referenced discussion of the field. The glaring omission is the lack of discussion of gender, both of clients and workers; in discussion of team roles this is a significant area. Nor does she do justice to criticisms of counselling which argue that it does not serve marginalised groups well and may be in itself discriminatory and damaging.

Both authors have provided effective apologias for giving counselling a high profile in training and service provision. If counselling has power to help, it also has power to harm and neither author perhaps satisfactorily acknowledges this uncomfortable fact.