Further analysis of the data

What has been helpful or not

In all the data submitted with the survey questionnaires for the M.E. group who received counselling, the highest overall ratings were for items pertaining to counsellor qualities as rated by the respondents. As has already been shown these qualities can be related to qualities and skills that many counsellors develop through their training, i.e., congruence, empathy, unconditional positive regard, authenticity, patience, open-mindedness and respect. These and other personal qualities of the counsellor will probably have an influence on the counselling relationship, and it is this relationship that research has shown to be important to the effectiveness of counselling (Clarkson 2002 pp.4-5; Hubble, Duncan and Miller, 2002 p. 133). Yet in this research, some respondents rated their counsellor's qualities high and efficacy indicators low, while others rated counsellor qualities low and efficacy indicators high. The correlation between counsellor qualities and efficacy is certainly a general trend but is quite variable. Other factors appear to be involved in how respondents rated efficacy, and those factors seem to be learning and working within the counselling. In the graphs above it seems that how respondents felt able to rate some learning items - whether learning about themselves, learning to explore beliefs or feelings, they often rated the efficacy criteria in a similar way. Also, how respondents rated working through issues and how useful they rated exploring the items included in the M.E. issues section frequently correlates with ratings for efficacy criteria.

It is interesting to note how many respondents worked with items from the 'psyche' and 'existential' sections. The lowest response for any item in this section was for exploring 'my inner rebel', which 37% of M.E. respondents had explored. Other items from these sections had been explored by more respondents, and sometimes very usefully. The data shows that respondents with M.E. received diverse styles of counselling and explored in diverse ways and for every item included here some found the work helpful and others did not.

The correlation between how respondents rated items related to work or learning in their counselling with efficacy measures is understandable. Respondents who achieved some recognizable change, learning and resolution of issues have tended to rate efficacy items higher. Addressing an outstanding issue, exploring and making sense of a problem or learning coping skills are worthwhile benefits in themselves, and these achievements might additionally provide a sense of empowerment and control. Donoghue and Seigel (2000 p. 74) remark:

The person with ICI suffers from a horrible sense of no control. He cannot control his illness - it has a course of its own. Exacerbations will come and go. He cannot control his fatigue or his pain. He cannot control his future by planning carefully.

Many respondents clearly worked, or would be willing to work at depth. Joyce and Piper (1998) observe:

In terms of expectancies regarding session comfort, the patient should be clear that some degree of session difficulty is associated with the hard work of a successful psychotherapy. After therapy has actually started, one aspect of the therapist's activity should be to engage the patient in a "good" working process and reinforce the patient when this is achieved.

I was surprised at the close correlation of work and learning with efficacy compared to correlations between efficacy and the rated counsellor qualities. This shows my prejudice by assuming that effective counselling requires that the relationship is very important and that the qualities of the counsellor are a significant factor in this. Cecchin et al. (1994, p.9) remark under the subheading, 'THE WOUNDED THERAPIST': [?]1

A theme implicit in this caricaturization of the life experiences of therapists is the story of helping. Thus we have what are called the helping professions. Quite often, implicit in this theme of helping is the idea that what people need is warmth, understanding, and, at times, even love. This is an extremely powerful and common prejudice within our culture today, and one that many of us therapists share. How did we get to this absurd position?

This may be relevant to some clients with M.E., or perhaps every client who seeks counselling. Any assumptions about what a client wants or needs could result in wasting time and effort, and as importantly, fail to discover exactly what the client actually wants and needs. It might be that only when these have been identified that realistic goals can be agreed.

This research has shown some variation in how respondents rated efficacy items according to what type of counselling they received, though limitations of the design and data has meant this aspect cannot be fully explored. More than 30% of M.E. respondents do not know what type of counselling they received, this might indicate a lack of careful matching of client and counsellor and is in any case rather odd. It is clear that some respondents with M.E. did not get what they wanted from counselling and some possible reasons for this have been put forward. Another consideration is that some clients might not get what they want from counselling or from a particular counselling approach because this is not suitable for addressing their needs. A respondent with M.E. remarked:

>Even though I tried several therapists/psychiatrists and several types of counselling (CBT and other), counselling proved ineffective for me; as a matter of fact, it made me worse emotionally by encouraging a victim mentality. (…)

By emphasizing feelings instead of action (what I was feeling about this or that as opposed to what I could do about my situation), I started my own "pity party" and didn't come out of it until I left counselling three years ago. I have recovered emotionally (as evidenced by those around me), am stronger physically, and take charge of my life…

This respondent was not helped by an emphasis on, 'what I was feeling about this or that as opposed to what I could do about my situation…', and improved after leaving counselling. Dineen (1999, p.28) remarks on 'manufacturing victims':

Psychologizing turns what individual victims say about events and their effects into ideas which are very different and even disconnected from the victims' descriptions. Presenting these ideas as facts, psychologists can then apply them to other peoples' lives, transforming virtually anyone into a victim.

The affects of M.E. on some people's lives can be truly terrible, yet counselling cannot be assumed to be the best help for some individuals. The latter respondent felt that counselling, 'made me worse emotionally by encouraging a victim mentality', and as noted above, another respondent felt that asking for help through counselling was not entirely congruent with maintaining self-esteem (see p.69). Some respondents remarked on alternative help they think could be useful:

·>Most people I know, once they have read up on what they are dealing with, manage to discover some helpful treatment options and ways to function (…)To me, it is idiotic to be so concerned about people's behavior/ attitude rather than getting down to the core of the problems and helping myself and others recover to a better and more stable state of physical health and endurance so that we could "resume" our lives with similar level of activity from where we left off years ago.

> I AM losing the war in this illness, but counselling isn't what I need. I need some help in my workplace and some helpful results in research.

> Many, many patients cope very well indeed, and meeting other patients is of paramount importance. (...) Patients speak "the same language", they are in the same boat, they know where the "shoe feels tight", they can support each other and give each other help and advise. When people are struck with this illness, they are too sick to go to any councelling. Councelling demands thinking which takes a lot of energy.

> Sufferers of this horrible debilitating disease are the real experts. Support from each other, and sincere support from friends and especially total support from the medical community is what we need.

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