Professional Counselling

There are many definitions of the counselling profession. After review of a sampling of definitions, Sommers-Flanagan & Sommers-Flanagan (2004) defined counselling as, "a process that involves a trained person who practices the artful application of scientifically derived principles for establishing professional helping relationships with persons who seek assistance in resolving large or small psychological or relational problems" (p. 9). This definition illustrates that counselling is not exclusively for the mentally ill but is inclusive of individuals facing normal crisis situations. For example, a West Indian migrating to America and encountering transitional issues such as marginalization and racism can seek counselling. Baptiste, Hardy and Lewis (1997), highlighted the widespread mentality of Caribbean people towards counselling by stating:

In the Caribbean there also is the prevailing cultural belief that only crazy people seek mental health services. Because a majority of Caribbean people share the belief that craziness is genetically transmitted, involvement in therapy can also reflect negatively on one's family. Thus, both psychotherapy and those who seek it are stigmatized. (p. 345)

Decades of research have document psychotherapy and its effectiveness. According to Norcross and Lambert (2011), qualitative and quantitative reviews of scientific studies have indicated about seventy-five to eighty per cent of clients benefit from psychotherapy; across a variety of therapy formats.

Effectiveness of therapy include indicators such as remediation of client's symptoms related to their problem/s, enhanced interpersonal and intrapersonal functioning, improved client functioning, reduced suffering and treatment retention (Lambert & Cattani-Thompson, 1996; Norcross & Lambert, 2010). Factors such as how accessible and available therapy is for a client, the financial resources of the client, the beliefs, values and attitudes of both counsellor and client, treatment method employed by the therapist, the therapeutic alliance between the counsellor and client and the client contract also impact on counselling outcome (de la Coudray-Blake, 2012; Norcross & Lambert, 2010, Watson, 2012).

Sommers-Flanagan & Sommers-Flanagan (2004) outlined common factors associated with all therapy approaches. Lambert's (1992) study identified four common factors associated with psychotherapy outcome and estimated how much each factor typically contributes to treatment outcome as follows:

* Extratherapeutic factors (40%).

* Therapeutic relationship (30%).

* Expectancy (15%).

* Techniques (counting for 15%) (as cited in Sommers-Flanagan & Sommers-Flanagan, 2004, p. 14).

Sue & Sue (2008) refers to Beutler's (2004) study which note that although there is agreement that common factors contribute to outcome, there is no consensus about the specific percentages cited (p. 23).

Extratherapeutic factors are made up of the client's internal characteristics and external factors. Sue and Sue (2008) asserted "... together with social, cultural and environmental factors, client characteristics often play a key role in outcome..." Severity of disturbance, motivation to change, capacity to relate, ego strength, psychological mindedness and focality of problem have been identified by Lambert, Hunt and Vermeersch (2004) as client characteristics that are predictors of therapy outcome.

Lambert and Cattani-Thompson (1996), noted that clients enter counselling with a range of disorders, backgrounds, stressors and social support networks. The less severe the nature of a client's disturbance and the less symptoms a client presents with, the greater the chances are for a positive counselling outcome (Lambert & Cattani, 1996). For example, an alcoholic client is more likely to have a positive outcome than an alcoholic client with bipolar disorder.

A client's motivation to change refers to how receptive they are to the counselling process, their readiness to reflect on and/or integrate their thoughts, behaviours and feelings (Benjamin, 1991; as cited in Lambert et al., 2004, p.26). Seligman (1995) noted that clients who actively sought counselling had better treatment outcomes. The importance of a client's capacity to relate is highlighted by McKenzie's (1986) study of West Indian-American clients. He stated "West Indians generally are very suspicious of mental health practitioners because they do not understand counseling and its rituals. Talking to a stranger in personal and emotional ways is contrary to the West Indian's indigenous healing modes" (McKenzie, 1986, p. 42).

Lambert et al. (2004) refers to Malan and Osimo's (1992) definition of ego strength as a client's ability to cope with internal and external stressors (p. 28). The concept of a client's psychological mindedness involves their capacity for introspection and their ability to effectively communicate thoughts and feelings to others (Davanloo, 1980; Bauer & Kobos, 1987; as cited in Lambert et al., 2004, p. 29).

Focality of problem makes reference to the client's ability to identify a central concern/s. Lambert and Cattani-Thompson (1996) points to this having a significant impact on the counselling outcome. Lambert et al. (2004) made note of some evidence indicating lack of focality leading to attrition.

Client environmental factors include variables such as social supports, financial and community resources, sociocultural and diversity issues that can influence the course of therapy (Sue & Sue, 2008). External factors can be exemplified by a client whose major stressor is unemployment and lack of finances. The client may fortuitously gain employment during the course of therapy and as such therapy is terminated. Due to the internal and external nature of client characteristics, counsellors must be aware of and monitor closely their clients' commitment level, motivation level, beliefs and attitudes about therapy to ensure positive counselling outcomes as some of these variables are dynamic.

According to Flanagan and Flanagan (2004), there are two main ways that the therapeutic relationship can generate positive therapy outcomes. Firstly, the counsellor connects with the client using core characteristics. Secondly, the formation of a therapeutic alliance.

Researchers have noted numerous core qualities such as the ability to listen, comfort with conversation, empathy and understanding, comfort dealing with a wide range of feelings, ability to accept power with a degree of detachment, ability to set aside personal needs, intellectual competence, capability to adapt to meet the