010 – REBT – Endings in Counselling – Ethics versus Culture
In the tenth episode of the Counselling Tutor Podcast, Rory Lees-Oakes take a close look at Albert Ellis’s rational emotive behaviour therapy (REBT), while Ken Kelly explores endings in counselling. In ‘Ask Ken and Rory’, our presenters debate ethics versus culture in counselling.
Rory introduces the modality of REBT using an anecdote from his own life, based on witnessing a car accident and talking to one of the drivers afterwards.
New York-based psychologist Albert Ellis, who is generally considered to be a key originator of cognitive-behavioural therapies, developed REBT (originally known just as ‘rational emotive therapy’: RET). Rory explains the concept of automatic negative thoughts (ANTs), which include:
- all-or-nothing thinking
In REBT, it is believed that an activating (A) event leads to a faulty belief (B) that results in consequences (C). An REBT therapist would look for the belief, and dispute (D) this using evidence (E). Thus, the therapist seeks to remove irrational beliefs and replace these with healthier, more evidence-based patterns.
Rory refers to Karen Horney’s work on ‘the tyranny of the shoulds’, and to Albert Ellis and Robert Harper’s book, A Guide to Rational Living (Image Book Company, 1969). He concludes that REBT, as a less complex modality than humanistic or psychodynamic therapy, focuses on the client’s belief and invites them to ask themselves: ‘Is there another explanation?’
Skill of Ending in Counselling
"Termination is more than an act signifying the end of therapy; it is an integral part of the process of therapy and, if properly understood and managed, may be an important factor in the instigation of change." Irvin Yalom (1975, p. 365)
Ending the counselling relationship is sometimes called ‘termination’. Endings in any part of life can be difficult, especially if unexpected. Some counselling students find endings tricky to navigate, because these are tied into a resistance to change that some clients may feel. Endings can key into our natural tendency to avoid loss.
It is therefore important to look at our own feelings about endings, and our experience of these, so developing good self-awareness that can help inform how we approach the ending of the therapeutic relationship with a client. Many complaints submitted to the British Association for Counselling and Psychotherapy (BACP) relate to endings being poorly handled or even avoided by therapists.
So why do we as humans tend to resist endings? Key reasons include resistance to change and fear of loss. The danger in avoiding endings in counselling is that the client may become dependent on us (and so risk losing their autonomy); Ken describes various warning signs that this may be happening.
He goes on to explore best practice when ending a counselling relationship, as well as looking at different types of endings counsellors are likely to encounter: for example, holidays and breaks, planned endings, unplanned endings, and endings of individual sessions.
If you, as counsellor, are going to take a holiday or break, it is best practice to tell clients as soon as possible (especially if a client has been coming to you for a long time), so providing the maximum notice. As for planned endings, there are three key stages:
- assessing the client’s readiness to end therapy
- picking up on any statement by the client that the presenting issues that brought them into counselling are no longer as troublesome
- empowering the client and aiming for an increase in resilience, linked into the client’s self-belief.
If possible (within the policy of your agency), it can be helpful to remind the client that they are free to return if they are struggling again in the future. It can be difficult if the agency offers a set number of sessions and the client has heavy material: could you negotiate more sessions, or maybe make a referral?
Unplanned endings – where a client just does not return – can produce difficult feelings in the counsellor. Using a process diary and supervision can be useful in this situation. And last but not least, ending an individual session requires specific skills, for example telling the client when the end of the session is drawing near (say, ten minutes before the end).
Ethics versus Culture
Sometimes, we find that ethics and culture clash and it is important to know where to stand when you find yourself in this tricky situation. For example, is it OK to offer a client a cup of tea? Rory thinks in person-centred therapy, it is, if you have the means to do so and the client is not volatile. It can break down barriers, and make the client feel welcome. The view in psychodynamic therapy may be different.
Rory and Ken agree that culture sometimes trumps ethics, in that a group of people get into a particular habit and fail to question what they are doing. Rory teaches his students: do question anything you feel unhappy about. It is really important to ensure you follow the ethical guidelines of your professional body, for example the BACP Ethical Framework.
"Courage is the most important of all the virtues, because without courage you can’t practise any other virtue consistently." Maya Angelou, author of I Know Why the Caged Bird Sings (Virago, 1984)