Counselling guidance

What is counselling?

Counselling may be thought of as the process through which an individual is assisted to make a decision from the many choices available, in an understanding and confidential atmosphere. Individuals are encouraged to express their thoughts and feelings to understand their feelings and to clarify their situation so that they can come to terms with any difficulty more objectively, and with a reduction in anxiety and tension. 

Counselling may occur face to face, in a group, via email, over the phone, or through online chat services. Counselling has developed as a branch of psychological clinical practice, offering a range of therapeutic communication skills, and also has its own knowledge-base and body of human science research. It is therefore a profession in its own right. 

Responsibilities

Speech and language therapists are not professional counsellors. Professional counsellors will be registered with the Professional Standards Authority. 

Use of counselling skills (as opposed to being a counsellor), relates to where there is intentional use of specific interpersonal skills that reflect the values of counselling, and when the practitioner’s primary role (for example, SLT or support practitioner) is enhanced without being changed. Therefore the individual perceives the practitioner as acting within their primary professional or/caring role, which is not that of being a counsellor. 

Counselling is part of the SLT’s repertoire of clinical skills. The extent to which a counselling approach is adopted will depend on the needs of the particular individual in the therapeutic process. It may be appropriate for the SLT to use counselling skills to address emotional issues brought up by individuals, providing the issues are related to the communication disorder. Speech and language therapists may work with third parties to support access to counselling, by supporting communication skills. 

Guidance

All speech and language therapists should have undertaken basic training in counselling, listening and communication skills. Counselling should be part of a holistic approach to intervention for communication difficulties 

All SLTs should have access to support and clinical supervision.  

Where counselling skills are used as a main therapeutic approach, it is vital that the: 

• focus of therapy is explained and agreed with the individual at the outset of the contract 
• SLT has undertaken a postgraduate counselling skills course 
• SLT has enhanced access to clinical supervision and support. 

SLTs using counselling skills as a primary therapeutic intervention must ensure that their manager is fully aware of their practice, and that this is reflected in their job description. If advanced postgraduate counselling skills are essential for the job, then the grade as well as the job description should reflect this responsibility. 

SLTs should not pass on information gained during counselling to colleagues without the individual’s permission. If the SLT feels uncomfortable in a counselling role, supervision may either clarify the need to refer the individual on or eliminate the need. The SLT may have the appropriate skills but lack confidence. All SLTs should be aware of the limits of their competence in the counsellor role, and should refer on, if necessary. 

The SLT needs to be sensitive to the fact that suggesting the individual needs to be referred on can give the impression that the individual’s problem is too big for either the SLT or the individual to cope with. SLTs should inform individuals of the number of sessions they can have, and they should prepare individuals for their last session, rather than it be presented suddenly. It may be advisable to recommend that the individual can return for an SLT review after a course of counselling. 

SLTs may need to consider whether it is the individual who has difficulty leaving therapy, or the SLT’s own difficulty about letting go of an individual. 

Some agencies for referring individuals on to: 

• GP 
• Child and adolescent mental health service 
• Psychology or psychiatry department 
• Some voluntary bodies employ counsellors, but their training may vary 

Resources

Please note: the resources on this page are provided for informational purposes only. No endorsement is expressed or implied, unless otherwise stated. While we make every effort to ensure this page is up to date and relevant, we cannot take responsibility for pages maintained by external providers. 

• NHS Choices – A guide to mental health services in England 
• NHS Choices – Counselling  
• BACP (2023) – School-based counselling – the essential guide for school leaders, mental health leads and commissioners 
• NHS England – NHS Talking Therapies, for anxiety and depression programme 

Resources such as those listed below, may help support communication around counselling issues: 

• VASES – Visual Analogue Self-Esteem scale 
• SAQOL-39 – stroke and aphasia quality of life scale 
• Connect: Communication Disability Profile 
• Talking Mats 

Further reading

Burnard Phillip (2006) Counselling Skills for Health Professionals. Cengage Learning EMEA; 4 edition

Counselling in speech and language therapy: denial, grief and blob people – therapy ideas blog by Rhiannan Walton

Hilari K, Boreham L (2013) Visual analogue scales in stroke: what can they tell us about health-related quality of life? BMJ Open vol. 3, issue 9.

La Trobe University – The ASK trial is exploring how to decrease the incidence of depressive symptoms in people with aphasia and their carers – due for completion 2018.

Hilari K, Byng S, Lamping DL, Smith SC (2003) Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): evaluation of acceptability, reliability, and validity. Stroke. Aug;34(8):1944-50. Epub 2003 Jul 10.

Contacts

• British Association of Counselling and Psychotherapy
• Counselling Directory – Find a counsellor near you
• UK Council for Psychotherapy
• The National Counselling Society

Charities that may offer counselling

• Relate – for relationship advice and counselling
• Samaritans – for people to talk about whatever’s troubling them at any time

Contributors

Kathryn Cann

Wing yee Lam, Practice Development Speech and Language Therapist (2025 update)