It is clear from the graphs above and can be seen in the complete data in the appendices that many respondents to the survey for people with M.E. who received counselling gave varied responses to the items. In some of the graphs the ratings for this group appear polarized, i.e., ratings tended towards extremes of high and low and contrast noticeably with graphs from respondents with MS who as a group appear to rate some items with a broader range. Inspection of the data for individual respondents (see appendix 2) reveals that a number of respondents provided almost invariably high or almost invariably low ratings for all of the items. Of the M.E. respondents who received counselling and submitted the 15 highest and 15 lowest overall ratings with the survey, all but 4 included comments with their data which tend to verify these ratings. The vast majority of individual responses can be seen to include more variation.
45% of the M.E. respondents who received counselling rated ‘Counselling helped’, 3 or lower, indicating that they did not find counselling helpful. 26% rated this item 1. Respondents were contacted through online support groups. It is possible that some respondents are therefore better informed about M.E. through access to the wealth of information and research available on the internet. It may also be that some respondents are more aware of the political aspects of the illness and the prejudice and stigma that can be seen associated with this disease. Whether or not these factors mean that some respondents are more sensitised, I believe that what they have reported through the survey is their genuine experience of receiving counselling. While the generalizability of the data cannot be confirmed here, it appears that there is a problem which questions the efficacy of counselling for some people with M.E.
The results from the survey for people with MS who received counselling are markedly different to those from the M.E. group, yet still raise concerns. 59% of MS respondents rated ‘counselling helped’, 5 or higher. MS is not a ‘contested illness’ (Engel et al. 2002) as M.E. sometimes is, yet some respondents with MS also indicate negative experiences of counselling. Comments from the MS group suggest that such negative experiences are sometimes connected to their counsellor’s lack of understanding about the illness and its affect on the respondent.
The research suggests that for respondents client learning and work are closer indicators of efficacy than rated counsellor qualities. Because of the nature of counselling and the recognized importance of the relationship, how clients rate their counsellor’s qualities may be more emotionally charged, and it must be acknowledged that respondents may have rated items relating to work and learning with a different perspective. When rating items relating to work and learning, a respondent’s rating for items might partly depend on who they perceive as being responsible for work and learning. Murgatroyd (1996, pp 41-42) observes:
Many of those who seek the help of counsellors… utilize what is known as ‘the medical model’ of helping. They assume that, once they have described what is happening to them (described the symptoms), the helper will understand (diagnose) their problem (illness) and give advice (offer a cure) which will lead them to resolve their problem (get better) and function normally. They expect their helper to undertake most of the work. But the reality should be that it is the person in need that does most of the work.
For some respondents rating work and learning items might represent rating themselves – the work they did and achieved, for others this might represent rating the counsellor if they perceive these items as the counsellor’s responsibility. With the data available these possibilities cannot be explored and this might be an important factor. An additional influence that can occur when a person is asked to attribute success or failure is called the ‘self-serving bias’. Landau (2004) observes:
Attribution experiments have demonstrated a tendency in observers to attribute the successes of others to situational factors (e.g., systemic efficiencies), whereas they ascribe their personal successes to their own disposition (e.g., hard working). The reverse is the case for observed failures. This pattern has been termed the self-serving bias.
Notwithstanding the possibility of the
self-serving bias and other factors having an influence
on how some respondents rated items within the survey,
perhaps creating the appearance of a high proportion
of poor results in counselling - an alternative possibility
might be that the respondents who rated efficacy low
were in fact quite accurate in their assessment. Dineen
(1999, p.97) refers to Allen Wheelis saying about
'few analysed persons are critical of psychoanalysis.' He notes that if a patient does acknowledge the lack of usefulness, he 'will blame himself and exonerate the psychoanalysis. The most common outcome, however, is simply to pretend that the analysis was successful.'
It is not possible to determine here
whether respondents had a better or worse outcome
from their counselling than might be expected for
clients with different problems, but it is clear from
respondents ratings that some felt their counselling
helped, and others felt their counselling did not
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