Assessment is a crucial element in the power relations between counsellor and client. Whether or not a counsellor makes a formal assessment, he or she makes an important decision — to proceed or not. If the decision is to proceed with counselling, an assessment has been made that the counsellor understands the client well enough to calculate the likelihood of therapeutic success. If not, the counsellor decides either that the client will not benefit from counselling or refers the client to another counsellor or agency — most usually for specialist help. Thus the counsellor controls who has access to counselling, who will undertake it, what form it will take, and how long it is likely to last. Clients have no power over these issues, other than the power to vote with their feet. There is considerable evidence that clients do vote with their feet: drop-out rates from counselling have been estimated at approximately one-third (McLeod, 1998).This gives the client some say over how long counselling will last, but it does not give the client any power over access. As we saw in Chapter 2, clients with longstanding, intractable problems and those with multiple socio-economic difficulties are the least likely to be accepted for counselling; it is therefore possible that assessment as unsuitable for counselling may further oppress the most needy clients.
KeywordsEating Disorder Child Protection Case File Case Conference Therapeutic Environment
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