Jillian Walls, Abertay University

Walls, J., McLeod, J., & McLeod, J. (2016). Client preferences in counselling for alcohol problems: A qualitative investigation. Counselling and Psychotherapy Research, 16(2), 109-118. doi: 10.1002/capr.12064

What to say about this research? I developed, like most counsellors, a keen interest in what clients wanted from counselling, what would work best for them and what would keep them attending counselling. This came about as I worked in an alcohol counselling service that had a high non-attendance rate—but from clients who, at assessment, had a strong desire to change their behaviours. My research and studies led me towards client preferences and expectations for counselling. To turn this into a study I interviewed five clients prior to commencement of counselling to ask a range of questions around what they felt they needed from counselling and their counsellor. These were all individuals who had serious, longstanding issues around their use of alcohol.

First off, from the interviews, came a strong sense that clients did have an idea of what would and would not help them, or an idea of both positive and negative preferences for the counselling process. Some of these were similar to each other but many were opposing, showing how individual preferences can be. There were several overarching themes that emerged from the research. One of the main themes was a sense that:

I am open to new possibilities

Each participant did have specific preferences for counselling but when presented with information on various activities that might happen in counselling, they were able to see how these could be of benefit to them and became more open to these new ideas. This demonstrated an expectation that the counsellor should be more active in presenting the various possibilities around techniques and approaches to clients so that they have a more informed basis to make decisions about the help they receive.

I have a sense of the type of relationship that will be most helpful to me

The participants in the study each highlighted the importance of their relationship with their counsellor to the success of counselling. Their ideas of what their counsellor should be like in terms of qualities was more implicit, but someone with whom they felt able to share their story, who would be active in pointing out their blind spots, and would help them to work towards goals. They were all clear that counselling should be a collaborative process. One of the most striking findings from the study was that participants were clear about what their relationship with the counsellor should not look like: they didn’t want to feel forced into something, or that the counsellor was pursuing their own agenda. 

I understand why some things are helpful for me and others are not

Due to the participants’ past experiences with their alcohol problems, they had a good grasp of not only what they needed from counselling now, and what they needed from a counsellor to help them get the best from the counselling experience, but also why these preferences were important to them. For example, several of them said that they were looking for ‘someone who helps me to tell my story’. When asked why and how this would be helpful for them, they talked about how, who they were as people, and what they had experienced in life and previous counselling, had shaped what they needed from counselling now. 

I need to be honest

The final theme addressed clients’ own understanding that to get the most out of counselling, for the counsellor to be able to help them and for them to be able to recover from their alcohol problem, they would need to be honest and committed to change.

Finally, one of the important things I learned personally from this research—that has been really important for me as a counsellor—is how useful it can be to encourage clients to tell you about their preferences, and how much they have to say when given the space to do this. Ideally, I would liked to have taken this research forward in terms of looking at how it could be used to inform practice.