Welcome to Edition 231 of Institute Inbrief! Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) are said to affect two to three percent of the population. As a therapist, what can you give to obsessive clients and their families to encourage personal initiative toward conquering symptoms? This is the focus of this edition’s featured article.
Also in this edition:
- Latest news and updates
- Articles and CPD information
- Wellness tips
- Therapist Q&A
- Social media review
Enjoy your reading!
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And Assisting People Every Day Lead Better Lives
It’s rare these days to hear people talk about their work with true passion. You hear so many stories of people working to pay the bills; putting up with imperfect situations; and compromising on their true desires. That’s why it’s always so refreshing to hear regular stories from graduates living their dream to be a Counsellor. They’re always so full of energy, enthusiasm and passion. There’s no doubt that counselling is one of the most personally rewarding and enriching professions.
Just imagine someone comes to you for assistance. They’re emotionally paralysed by events in their life. They can’t even see a future for themselves. They can only focus on their pain and grief. The despair is so acute it pervades their entire life. Their relationship is breaking down and heading towards a divorce. They can’t focus on work and are getting in trouble with their boss. They feel they should be able to handle their problems alone, but know they can’t. It makes them feel helpless, worthless. Their self-esteem has never been lower. They’re caught in a cycle of destruction and pain.
Now imagine you have the knowledge and skills to help this person overcome their challenges. You assist to relieve their intense emotional pain. You give them hope for the future. You assist to rebuild their self-esteem and lead a satisfying, empowered life. As a Counsellor you can experience these personal victories every day. And it’s truly enriching. There is nothing more fulfilling than helping another person overcome seemingly impossible obstacles.
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When psychologists, counsellors and therapists use fine, practical and effective methods and approaches with clients, the chances for improvement and positive results are usually good. However – when therapists apply these approaches to themselves during times of challenge and times of ease – it is likely that they may have even greater beneficial impact through their work with and for clients. In this free webinar, Dr. Debbie Joffe Ellis will describe pivotal features seen in an effective therapist, and share striking examples of the great benefit to therapists and clients when therapists practice what they preach.
Self-help Strategies for OCD and OCPD
Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) are said to affect two to three percent of the population for OCD (that is: more than 500,000 Australians) and one percent for OCPD, although three to ten percent of the psychiatric population is said to have it (Long, 2011). Many cases probably go untreated.
As a therapist, what can you give to obsessive clients and their families to encourage personal initiative toward conquering symptoms? This is the focus of this article.
Four Steps for Conquering Symptoms of Obsessive-Compulsive Disorder (OCD)
Psychiatrist Jeffrey Schwartz advises clients dealing with OCD to take the following steps:
Relabel. Challenge yourself to recognise that intrusive, obsessive thoughts and urges are being engendered by OCD and relabel them. For example, you can get in a habit of saying, "I don't think or feel that my hands are dirty. I'm just having an obsession that my hands are dirty." Or, "I don't feel that I have the need to wash my hands. I'm having a compulsive urge to perform the compulsion of washing my hands."
Reattribute. Intensive, intrusive thoughts or urges are caused by OCD via a biochemical imbalance in the brain. You can say to yourself, "It's not me—it's my OCD," to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
Refocus. Focus your attention on something else for a few minutes when experiencing OCD thoughts and urges. Do another behaviour instead. Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior." You could walk, exercise, listen to music, make a phone call, or work on a creative project. The point is to do something for at least 15 minutes which distracts you from the obsessive thought. At the end of the period, reassess the urge; in many cases, it will be less intense. The more you can delay the urges, the more likely they are to change.
Revalue. OCD thoughts are not significant in themselves and should not be taken at face value. Here you can tell yourself, "That's just my stupid obsession. It has no meaning. There's no need to pay attention to it." You can't make the thoughts go away, but neither do you need to pay attention to them. You can learn to go on to the next behavior.
(Westwood Institute for Anxiety Disorders, in Robinson et al, 2013)
OCD: Further tips for self-management
In addition to the four steps above, OCD sufferers are encouraged to follow three general tips for successful self-management. They revolve around challenging the obsessive thoughts and compulsive behaviours, maintaining good self-care, and reaching out for support. Beyond that, we have included a list of tips for well-meaning family and friends, which your OCD client can give them in order to ensure that your client is supported in the most helpful way possible.
Challenge the obsessive thoughts and compulsive behaviours. In addition to refocusing, the OCD client can learn to recognise and reduce stress. Some of the strategies here are counterintuitive. You can urge clients to "go with the flow" by writing down obsessive thoughts, anticipating OCD urges, and creating "legitimate" worry periods. Tell them to:
Write down your obsessive thoughts or worries. Keep a pen and pad, laptop, tablet, or smartphone nearby. When the obsessive thoughts come, simply write them down. Keep writing as the urges continue, even if all you are doing is repeating the same phrases over and over. Writing helps you see how repetitive the obsessions are and also causes them to lose their power. As writing is harder than thinking, the obsessive thoughts will disappear sooner.
Anticipate OCD urges. You can help ease compulsive urges before they arise by anticipating them. For example, if you are a "checker" subtype, you can pay extra attention the first time you lock the window or turn off the jug, combining the action with creating a solid mental picture of yourself doing the action, and simultaneously telling yourself, "I can see that the window is now locked." Later urges to check can then be more easily re-labelled as "just an obsessive thought".
Create an OCD worry period. Rather than suppressing obsessions or compulsions, reschedule them. Give yourself one or two 10-minute "worry periods" each day, times you are allowed to freely devote to obsessing. During the periods, you are to focus only on negative thoughts or urges, without correcting them. At the end of the period, let the obsessive thoughts go and return to normal activities. The rest of the day is to be free of obsessions and compulsions. When the urges come during non-worry periods, write them down and agree to postpone dealing with them until the worry period. During the worry time, read the list and assess whether you still want to obsess on the items in it or not.
Create a tape of your OCD obsessions. Choose a specific worry or obsession and record it into a voice recorder, laptop or smartphone, recounting it exactly as it comes into your mind. Play the recording back to yourself over and over for a 45-minute period each day, until listening to it no longer causes you to feel highly distressed. This continuous confrontation of the obsession helps you to gradually become less anxious. When the anxiety of one worry has decreased significantly, you can repeat the exercise for a different obsession (Robinson et al, 2013).
Maintain good self-care. A healthy, balanced lifestyle plays an important role in managing OCD and the attendant anxiety (generally present with OCD, even though the disorder is no longer classified as an “anxiety disorder” per se), so the helpfulness of the following practices – truly not rocket science – cannot be underscored. Encourage OCD clients to:
- Practice relaxation techniques, for at least 30 minutes a day, to avoid triggering symptoms.
- Adopt healthy eating habits, beginning with a good breakfast followed by frequent small meals - with much whole grain, fruit and vegetable - throughout the day to avoid blood sugar lows and to boost serotonin.
- Exercise regularly; it's a natural anti-anxiety treatment. Get 30 minutes plus of aerobic activity most days.
- Avoid alcohol and nicotine, as these increase anxiety after the initial effects wear off.
- Get enough sleep; a lack of it exacerbates anxious thoughts and feelings (Robinson et al, 2013).
Reach out for support. Staying connected to family and friends is the best defence an OCD client can muster against intrusive obsessions and compulsive urges, because social isolation exacerbates symptoms. Talking about worries and urges makes them seem less threatening. Also, involving others in one's treatment can help maintain motivation and guard against setbacks. To help remind the client that s/he is not alone in the struggle with OCD, ask him or her to consider joining a support group, where personal experiences are shared and attendees also learn from others facing similar problems.
Helping a loved one with obsessive-compulsive disorder (OCD)
Give the following list of tips to your OCD client to give to friends or family members who want to support them. Stress how crucial it is for supporters to educate themselves about the disorder, as reactions to a loved one's OCD symptoms can have a big impact.
- A calm, supportive environment helps improve treatment outcomes. On the other hand, criticism can make OCD worse; as a support person, focus on your loved one's positive qualities.
- Don't tell someone with OCD to stop doing their rituals. They can't, and pressure will only worsen the behaviours. Remember, you are seeing OCD symptoms, not character flaws.
- Praise any attempts to ignore urges. Each sufferer needs to overcome problems at their own pace. Encouragement to continue healing and a focus on positive elements in the person's life will go much further than scolding.
- Do not go along with your loved one's OCD rituals. You want to support the person, yes, but not their rituals. Aiding them in carrying out those will only reinforce the behaviour.
- Do not let OCD take over family life. Work out how, as a family, you will tackle your loved one's OCD symptoms. Aim for as normal a family life as possible in an environment as low-stress as possible.
- Stand up to the OCD by communicating directly and positively. Find a balance between maintaining boundaries around the OCD and not further distressing your loved one.
- Find the humour. If you can get your OCD sufferer to see the humour and absurdity in some OCD symptoms, it can really help them become more disidentified (detached) from the disorder. Naturally, this strategy only works if the OCD person really finds the thing funny (Robinson et al, 2013).
OCPD: Self-help strategies for survival
For both the person diagnosed with OCPD and also for his family and friends, dealing with this disorder requires patience, compassion, and fortitude. To start with, the ego-syntonic nature of OCPD means that the person does not necessarily agree that he has anything wrong at all. For those who staunchly continue to insist that their relational problems arise because of others' faults, treatment is complicated. Given the OCPD's general world view of "I am correct; you are wrong", the prognosis for change is often poor. Transformation is likely to occur only when the OCPD's relational skills and outlook are shifted. This is not a job for medication (at least not for long and not alone), and yet psychotherapy is not always available. When it is, the OCPD is not always willing to avail himself of it.
Regardless of this less-than-ideal context for managing OCPD, there are some things that the client himself and also friends and family can do to alleviate some of the tension and conflict that goes with living with the disorder. As a therapist, you can encourage the client and those around him to utilise some of these strategies.
Bibliotherapy. It's a good idea to read up on OCPD, not only in order to know what to expect, but also for tips in dealing with it. Your client may also come upon writings that link some behaviours and lifestyle choices to the disorder in ways not understood before. When comprehension deepens, so, too, does the prospect of compassion.
Gentle confrontation (agreed beforehand). While we agree that OCPD clients have a mammoth need to be right, those clients who truly seek to feel better may be willing to make agreements with family and friends in which OCPD behaviours, when noticed, are gently challenged; the operative word here is gently.
Self-insight through journalling or tape-recording. We noted above that many OCPD clients are intelligent, sensitive people. Thus, keeping a diary or making voice recordings to note anything upsetting, anxiety-provoking, overwhelming, or depressing is a step toward the self-insight that will eventually help to manage the disorder. Too, family and friends may agree to note their observations and share them in a constructive, non-confrontational manner.
Good self-care. OCPD is a disorder about exaggerated need for control, so keeping on an emotional even keel can help reduce the unconscious need to micro-manage all of life. Strategies to achieve this are listed above under Tip 2 for maintaining self-care with OCD. They revolve around the basic life efforts of practicing relaxation techniques, adopting healthy eating and exercise regimens, getting decent sleep, and avoiding excessive alcohol/drug consumption (the last is not hard for the OCPD).
Reaching out for help. OCPD individuals tend to be loners, and relationships are hard for them to build and maintain. Nevertheless, it is helpful to the ultimate reduction of OCPD-engendered tension to go for support. This can be in the form of self-help groups, informal support from partner, family, and friends, or even from joining online communities of people dealing with the disorder. Whatever the form of the support, it may be helpful for OCPD clients to own their places of dysfunction when they see others owning their imperfect humanness – and surviving (Robinson et al, 2013)!
This article was adapted from the Mental Health Academy CPD course “Understanding Obsessives”. This course is about understanding what is constituted in each disorder, and how you can recognise the symptoms in clients and others.
Long, P. (2011). Obsessive-Compulsive Personality Disorder. Internet mental health. Retrieved on 18 April, 2013, from: hyperlink.
Robinson, L., Smith, M., & Segal, J. (2013). Obsessive-Compulsive Disorder: Symptoms and treatment of compulsive behaviour and obsessive thoughts. Helpguide.org. Retrieved on 24 April, 2013, from: hyperlink.
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Understanding the emotional patterns that underlie procrastination
It’s 10:00 pm on December 24th, and you’re just beginning your Christmas shopping. You lost $1000 in extra taxes because you didn’t prepare or file your documents properly, on time. Your boss is upset because of all your missed deadlines, and your partner is truly “over” all your undone domestic work. If this resonates, you are one of the 20% who chronically procrastinate, and you are undoubtedly paying a high price.
Definition and characteristics
Procrastination has been called a self-defeating behaviour pattern marked by short-term benefits and long-term costs in which less urgent tasks are carried out in preference to more urgent ones. It is not, experts say, a question of time management or planning. Rather, it is a maladaptive lifestyle which costs us money, time, health, and good will – and sees our performance drop.
Reasons abound for becoming a procrastinator. Let’s look at the different personalities you could be displaying if you typically put things off.
Your put-it-off persona involves a deficit of self-control. You sit down to do your report, but decide to “just check a few emails”. Soon your report-writing time has been chewed up with distractions. If you drink alcohol, you probably don’t know when to stop. Taking a “Big Five” (trait) personality test, you are low on “conscientiousness”. With little ability to stay on-task, your potential for finishing school, getting important work done, or even accomplishing your goals is seriously jeopardised.
Your big word is “avoid”. You continually handicap yourself because of deep-seated fears of either success or failure. You turn in your work right at the deadline and are one of the many whose performance suffers for this (although you claim you are more creative under pressure). Truth be told, you are deathly afraid to succeed (and have to live up to it) or fail (and have others think you have no ability). Better to do a last-minute job and have them think you just didn’t put the effort in. Your parents may have placed excessive emphasis on accepting you for what you could do rather than who you are.
First cousin to the self-saboteur, you might actually miss the deadline, because you are fussing with details. It’s never really good enough (or is that the voice of your parents with high standards we are hearing?), so you keep toiling and “tweaking”, not wanting to face the inevitable appraisal of “not good enough”. With all areas of life continually being tweaked, you are burned out and exhausted. “Compassion” is not a word you are familiar with.
Why do today what you can put off until tomorrow? Tomorrow you may feel more inspired, or perhaps more emotionally “up” to the task. Present-focused and out for short-term hedonism, you are a true bon-vivant. You optimistically believe you can get it done quite quickly once you begin. Your parents modelled enjoying life, and you want to uphold their ideals.
Distantly related to the pleasure-seeker, you also get your kicks from having a good time, but for you, it’s most thrilling when you are one stroke short of a catastrophe and energised by trying to avert it. You love flirting with danger, so you set up situations where you must get that loan from the bank or the time-extension for the project or the taxes. It’s no fun if it’s all done in an orderly way with time to spare; where’s the adrenalin rush in that?
You had similar parents to the self-saboteur and the perfectionist. They made the consequences for decisions so huge that a decision – any decision – is a fraught process which you avoid at all costs. You live life by default, so important stuff gets delayed because it’s too scary to decide how to do it – or whether it should be done. You might suffer from mild anxiety and/or depression, so requests for decisions are just too hard. Putting it off until tomorrow might mean that it resolves itself.
Getting it done
I hope I haven’t discouraged you with these profiles. If you are a chronic procrastinator, all is not lost. The impulsive needs to work at building self-control gradually, with increasingly larger issues. The self-saboteur and the perfectionist could employ Cognitive Behavioural Therapy, where they learn to replace maladaptive thoughts (like “I can’t do this” or “This isn’t good enough”) with more encouraging thoughts. Developing self-compassion helps.
The pleasure-seeker can employ CBT, too, reminding him/herself that research has shown how much more procrastinators suffer (in terms of both mental and physical health) than non-procrastinators as the deadline looms, even though they are less stressed when the deadline is far off.
The thrill-seeker may be encouraged to seek that adrenalin rush in a way that doesn’t have such severe consequences. Missing the long-haul flight because of delaying packing to the last minute, for example, is rather expensive. “Just” catching it makes the airport personnel irritated. The decision-dodger needs to work on self-esteem, self-compassion, and developing that inner authority that allows standing behind one’s decision, whatever the consequences. Procrastination has been described as a self-inflicted wound that chips away at our most valuable resource – time, but hopefully with a few insights into the emotional patterns underlying it, time can be on our side.
Written by Dr Meg Carbonatto B.S., M.A., and Ph.D.
This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.
Suicide: Supporting People with Special Needs in Grieving
How can you best offer support to someone who is bereaved by suicide? What attitudes, translated into caring actions, can best facilitate the bereaved person’s coping in the immediate and short term, and their healing in the longer term? In a previous article we provided you with a guide to clarify what you can do to help the suicide-bereaved. In this article we explore special issues and unique grieving needs for a number of groups of people, including parents, children and young people, older people, people with disabilities and minority groups (lesbian, gay, and bisexual people).
Social media: Breeding Ground for Multiple Relationships
It starts out innocently. You email the client a scanned copy of an article relevant to something that came up in session. She emails you back to say thank you, and then asks a question related to her therapy, which you feel duty-bound to answer, so you do; before you know it, there is regular email exchange taking place. A few weeks later, she rings on your cell phone to clarify something you said in session, so you take the time to explain and she hangs up happy – only to ring again a week later about something else. Then you find she has visited your professional Facebook page, “Liked” it, and left comments – nice, complimentary ones – but ones which could identify her as your client.
Q&A with Toula Gordillo (Clinical Psychologist)
Q. What is the most effective way to address problem behaviour in students?
A. There are several things we can do to try to understand why problem behaviour occurs, or is maintained. It is important to make the effort to look deeper into the root cause of the behaviours, rather than just trying to address the behaviour directly. This is true of children, youth and adults with problematic behaviours. Understanding must precede addressing the issues, either as part of school counselling or therapy. Building the relationship with the person also needs to precede any intervention, if changes are to be maintained. Punitive measures alone, without relationship, rapport and understanding being established will not lead to permanent changes in individuals of all ages.
It can take time and effort to understand the underlying causes of the behaviour but you can ask yourself a couple of questions to start the process. Firstly, is there a secondary gain for the student/adult to maintain the behaviour and if so, what is it? Secondly, does the person appear to have anxiety, depression or some other internalising problem that may be influencing their behaviour towards others?
Take Alex as an example...
Alex is a ten year old boy who won't listen and do as he is asked both at home and at school. Diagnosed with Oppositional Defiance Disorder, Alex could be deliberately defying his parents and teachers because he gets an adrenaline rush from challenging authority and he enjoys the conflicts. This is called true AWOL behaviour (AWOL is an acronym for A Child/Adolescent Without Limits – meaning that the young person has no self-imposed limits on their behaviour and so they will engage in behavioural outbursts of aggressiveness, bullying, name-calling etc. If he appears selfish, lacks empathy for others and appears to have little or no remorse, then it may be that Alex has true AWOL scorpion behaviour (click here for more information). If he ‘acts out’ in response to a situation that is making him anxious, stressed, depressed, however, then it might also be that Alex is trying to relieve this symptoms by acting poorly i.e., like an AWOL scorpion. Alex may have:
- Undiagnosed mental health conditions (such as anxiety, ADHD or a mood disorder)
- Learning problems masked by problem behaviour
- A food intolerance or sensitivity
- A lack of vitamins, minerals or other nutritional deficiency
- A recent stressful event e.g., death of family member
- Problems fitting in with peers, feeling like he has to be more rebellious to be socially accepted
- Poor self-esteem and an inability to socialise or communicate with others
- Lack of sleep resulting in irritability
There are many reasons why younger and more mature people may make poor behaviour choices. Sometimes they don't know any other way of relating to others, have been conditioned to see themselves acting in a certain way or have significant others in their lives that may also be acting in particular ways that reinforce the behaviour. Young people, such as Alex, may have a negative self-concept, and so they reinforce their behaviour in order to maintain the belief that others have about them, or the belief they have about themselves. In cases such as this, trying to find a 'fresh start' with new teachers/school/peer group etc. can be helpful in order to create a new self-concept. The same can be true for adolescents and adults. Look beyond WHAT they are doing to WHY they are doing it i.e., the underlying cause or function of the behaviour. What function does it serve for the person to maintain or stop the behaviour? What has caused the behaviour in the first place? It starts with trying to understand WHY!
Toula Gordillo is a Clinical Psychologist, AIPC private assessor/tutor and regular contributor for Institute Inbrief. Toula has an extensive work history as a Clinical Psychologist, Teacher, and Guidance Officer. For more information, visit www.talktoteens.com.au.
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How to understand anger
Familiar with this scenario? The idiot cuts in front of you, causing you to nearly crash into him. Your pounding heart, flushed face, tight chest, and gritted teeth tell you: you are angry. Or, maybe someone you know violates you in a despicable way, steals from you or betrays you. You are a “nice” person, so you don’t experience anger, but a dark cloud descends over your life. You stew. Nothing is fun anymore, and you feel grumpy. You, too, are angry.
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"Take everything that’s bright and beautiful in you and introduce it to the shadow side of yourself. Let your altruism meet your egotism, let your generosity meet your greed, let your joy meet your grief…. But when you are able to say, “I am all of the above, my shadow as well as my light,” the shadow’s power is put in service of the good."
~ Parker Palmer
Many students of the Diploma of Counselling attend seminars to complete the practical requirements of their course. Seminars provide an ideal opportunity to network with other students and liaise with qualified counselling professionals in conjunction with completing compulsory coursework.
Seminar topics include:
- The Counselling Process
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- Counselling Therapies I
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- Legal & Ethical Framework
- Family Therapy
- Case Management
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