Counseling in Ireland
Padraig O’Morain, Garrett J. McAuliffe, Kayte Conroy, Jennifer M. Johnson, and Rebecca E. Michel
Journal of Counseling & Development ■ July 2012 ■ Volume 90 371
Ireland and the Irish culture may be somewhat familiar in the United States because of St. Patrick’s Day, which many Americans celebrate; but there is much more to know about this small European island. The narrative of Irish life, as told for more than a century, has been largely a story of poverty and colonization with a consequent fatalism and emotional repression. As a result, many Irish people were encouraged to seek a better future at home and abroad. More recently, the hand of modernism in Ireland has resulted in massive changes in Irish attitudes toward sex, religion, emotional expression, and authority. These themes, especially the more recent ones, are important for counseling.
The still unfolding story of Irish counseling will be told in this article. Specifically, we will present the history of counseling in the Republic of Ireland. We will also explore the development of counseling and its current status, includ- ing common practices, counselor training, and credentialing.
The island of Ireland is divided into two political entities. The Republic occupies most of the island, with a population of 4.5 million people. It occupies approximately the same number of square miles as the state of West Virginia in the United States (U.S. Central Intelligence Agency, 2011). The Republic comprises 26 counties (some of which are subdivided into smaller administrative units, also called counties). The six counties of Northern Ireland are part of the United Kingdom. Both the Republic and the United Kingdom are members of the European Union. For convenience, we will use the word Ireland to refer to the Republic of Ireland because counseling in the Republic is the focus of this article.
In Ireland, the services provided by counselors (spelled coun- sellors in Ireland) and psychotherapists are seen as distinct from the services provided by psychologists. Psychologists, unlike counselors, are eligible for insurance reimbursement on some insurance plans. Regarding the distinction between counseling and psychotherapy, it seems fair to say that the public makes no such distinction. The same body that accredits counselors accredits many psychotherapists. In this article, we use the term counseling to refer to counseling and to psychotherapy.
Irish history has many dimensions, but the narrative that stands out is the one of conquest and colonization. Like many countries, Ireland has experienced a tumultuous history of invasion, assimilation, and rebellion. In the Irish narrative, independence was lost with the arrival of the Normans in 1169 and regained in 1922 following the War of Independence (Curtis, 1990). For the next 50 years, the Republic of Ireland was a largely isolated, Catholic, agricultural democracy characterized by poverty and emigration (Curtis, 1990). The makeup of the country began to change in the 1960s when a program of free trade and industrialization triggered the be- ginnings of a modern industrial society. Also in that decade, television and other influences increased Ireland’s connection with the outside world, particularly with the cultures of Britain and the United States. The conservative Catholic clergy and others greeted that modernization with chagrin.
Catholicism provided a complete guide to behavior and thinking for most of the Irish people until the 1960s. The influ- ence of religion provides one explanation for why counseling had barely been heard of until the 1970s and 1980s. Moreover, the Irish Catholic Church was resistant to any intrusions into family life, especially in the area of sexuality. It would not be accurate to say that the Catholic Church actively prevented the development of counseling prior to the 1960s. It had no need to do so; no space existed in which counseling as it is known today could take root and flourish (Chamberlain, 1983).
Counseling in Ireland has experienced rapid growth in the past 30 years. Public attitudes toward counseling have become more positive, especially with the increasing secularization of a once strongly religious Catholic society. Licensure is nonexistent but there are certification bodies that attempt to ensure qualified practice. There is no third- party payment, so access to counseling for impoverished individuals is a problem. Training programs are quite varied. Efforts are being made to standardize training and to develop licensure requirements.
Through the 1960s, mental health services were provided in heavily stigmatized, overcrowded, and poorly resourced mental hospitals (Scheper-Hughes, 2001). Paralleling some aspects of the pre-1970s American approach to mental health, the approach in Ireland was to confine mental illness behind high walls and hide it rather than provide appropriate treat- ment. However, the 1960s saw the beginning of a change in attitudes toward social and health needs. This change was accompanied by slow growth in the availability and popular- ity of counseling. Through a series of scandals, this growth accelerated in tandem with the decline of the church’s status as a source of counsel, in the broadest sense of that word.
In the context of the aforementioned environment, it is ironic that much of the impetus for the growth of counseling from the 1960s onward came from the Catholic Church and, to a lesser extent, the (Protestant) Church of Ireland. Therefore, it is hardly surprising that when a counseling service emerged in the 1960s, it was, for the most part, set firmly within a Catholic worldview and under the auspices of the Catholic Church. The Catholic Marriage Advisory Council, as the names implies, began to offer marriage counseling to Catholic couples in Ireland in 1962. Today, this counseling agency, funded by state bodies and the Catholic bishops, is known as Accord, and continues to flourish (Accord, 2010). During the same year (i.e., 1962), the minority Irish Protestant population saw the establishment of a marriage counseling service for (Protestant) Church of Ireland couples. It later became a non- denominational service and, like Accord, continues to flourish. Some of the individuals who were trained for this marriage and family work later became independent counselors and were involved in the establishment of the Irish Association for Counselling and Psychotherapy (IACP), which is the leading counseling organization in the country (IACP, 2011).
A second phase of counseling also began in the 1960s in Ireland, when career guidance counseling was introduced ini- tially to vocational training schools in Dublin (Chamberlain, 1983). These schools, which focused on preparing students for an occupation, operated outside of Church jurisdiction, which did not have power over the vocational schools. How- ever, the church did largely control primary and secondary education. (The term secondary schools refers more to academic preparation schools as compared with vocational training schools.) Although the secondary schools were seen as more academic than vocational, the idea of providing career guidance counseling spread to them in the 1960s as well (Chamberlain, 1983). The psychological service of the Irish Department of Education and Skills supported this development. As part of this movement, University College Dublin introduced a course for career guidance teachers in the 1960s, emphasizing counseling as well as career choice. More recently, the term guidance counselors has been adopted (O’Leary, 1990), which is the equivalent of school counselors in the United States.
The Institute of Guidance Counsellors (IGC) was founded in 1968 to further promote professionalism among counselors within second-level schools (i.e., middle and high schools), third-level schools (i.e., colleges and universities), adult guidance services, private practice, and in other settings in Ireland (IGC, 2011). However, despite these beginnings, the concept of counseling in Ireland did not take hold in the general population until the 1970s.
During the 1970s, at least four counseling-related phenomena emerged in Ireland: the beginning of employee assistance programs, the establishment by a formerly Protestant adoption society of a nondenominational counseling service for single pregnant women, growth in school guidance counseling, and a counseling service for women who had been sexually as- saulted. In addition, both the Catholic Church and the smaller Protestant Church of Ireland’s marriage counseling services continued training new counselors in the 1970s. Many of them later provided general counseling services.
There was a general increase in social services during this era, most of which did not include counseling. Explicit references to counseling during this decade were still rare. This absence is illustrated by the first author’s professional experience working in the 1970s in social services that were provided voluntarily by community groups. These services included chiropody, meals on wheels, information on rights, and child care. In particular, the Combat Poverty Agency began establishing community groups and projects throughout the country. However, again, there was no reference to counseling in the index to the agency’s final report (National Committee on Pilot Schemes to Combat Poverty, 1980).
The 1980s and the 1990s were the decades in which coun- seling became established in Ireland as a profession in its own right, no longer confined to specific areas or institutional control. A possible landmark event was the founding of the IACP in 1981, reflecting a concern regarding unqualified people engaging in practice while calling themselves coun- selors. Another landmark event occurred in 1985 when the IGC began inviting William Glasser to Ireland to teach choice theory and reality therapy (Lennon, 2006). This initiative was highly successful, with large numbers of people studying and practicing this approach.
In the 1990s, there was a deepening of the crisis of au- thority in the Catholic Church. Child sexual abuse scandals contributed significantly to the decline of that authority. It is probably not coincidental that the Irish Church scan- dals have been accompanied by a growth in the demand for counseling as people turn away from the Church as a source of guidance. In contrast to past practice, few people today think of going to the local priest for advice on personal issues.
Absence of Regulation
In recent years, there has been growth in the demand for and popularity of counseling services and in the number of people seeking to join the profession of counseling in Ireland. Counseling services are generally paid for by clients without reimbursement by health insurance companies. This payment structure contrasts with the practice in the United States, where individuals have widespread access to third-party insurance reimbursement for seeing licensed counselors.
The cost for counseling is a significant problem in Ireland. Although the government pays for counseling for some spe- cific groups (e.g., people who are infected with Hepatitis C caused by contaminated blood products), most counseling is private and must be fully paid for by the client. Health insur- ance companies do not reimburse the cost of counseling. Therefore, the decision to seek counseling depends largely on an individual’s income. Consequently, people with lower incomes cannot afford the counseling fees.
Settings and Demographics
Although it is clear that Irish counselors work in a variety of settings such as community mental health, private practice, and schools, in the absence of a statutory registration system, it is not possible to say how many trained counselors are working in Ireland overall. Therefore, it is also challeng- ing to provide a comprehensive breakdown on how many counselors work in each of the various sectors. It is known, however, that approximately 1,200 practitioners work as guidance counselors, mostly in secondary schools (IGC, 2011). Until recently, about one fourth of schools (those with more than 500 pupils) were allowed to employ a full- time guidance counselor, in addition to their normal quota of teachers. However, this arrangement was terminated at the end of 2011 as the government reduced spending on public services (Murray, 2012) as part of its agreement with the International Monetary Fund, the European Union, and the European Central Bank. The number of teachers is falling because of cost-saving measures, and school administrators may now reassign counselors to teach subjects for which there is no teacher. The effect will be to reduce the presence of school counselors in the counseling role.
Private practice is the area in which there is the largest number of counselors. Statistics on whether these counselors are working full time or part time are not available. Anec- dotal evidence suggests that the overwhelming majority are working part time. Many of the agencies using the services of counselors do so on a part-time or panel basis. It is also known that the average age of Irish counselors is relatively high. According to a recent IACP membership questionnaire, the average counselor is between 45 and 55 years old (IACP, 2011). The older age of Irish counselors may be attributable
to the relatively recent development of counseling in Ireland, as explained earlier, making the profession a second career for many individuals. It is difficult to make a full-time living in private practice as a counselor in Ireland, primarily because of the lack of insurance reimbursement for services rendered.
Professional Counseling Associations and Credentialing
The aforementioned IACP currently has approximately 3,500 members, suggesting a rapid growth in interest in counseling during the past decade. The IACP is not oriented toward a particular counseling approach. A second accrediting body, the Irish Association of Humanistic and Integrative Psycho- therapy (IAHIP; 2011), was formed in 1992 as an association specifically designed to represent humanistic and integrative psychotherapists in Ireland. In 2011, there were more than 700 accredited psychotherapists who were members of IAHIP.
Although other bodies provide accreditation in certain spe- cialty areas such as addiction counseling, the IACP and IAHP are currently the main accrediting bodies for counselors and psychotherapists. They recognize each other’s supervisors, and dual membership in IACP and IAHIP is not uncommon. Despite the growth in IACP and IAHIP accreditation, any individual can continue to call himself or herself a counselor and set up a practice. There is no current mechanism in place to license counselors in Ireland. This situation contrasts with that in the United States, where there is now counselor licen- sure in all 50 states (Counseling Today, 2009).
At this time, 12 Irish helping professions have been listed for statutory registration by the Health and Social Care Pro- fessionals Council (2010). The council was made possible by 2005 legislation. The list includes psychologists and social workers but it does not include counselors. Of the twelve helping professions, the process of registration has been completed only for social workers. If counseling must wait until the other 11 professions on the list have been registered, then regulation will be quite some time away.
Even without licensure, there are ethical guidelines that can protect the public. Citizens of Ireland have personal rights under their constitution and the European Convention on Hu- man Rights Act (2003). For example, the Mental Health Act of 2001 applies to adults and children and promotes principles stipulating that care and treatment should be performed in the person’s best interest; that any decision about care and treatment must respect the right to dignity, bodily integrity, and autonomy; and that persons receiving services must be able express their opinions and views regarding their care (Mental Health Commission, 2001).
In addition to the aforementioned protections, the self- regulatory IACP (2011) has published a Code of Ethics and Practice for Counselors and Psychotherapists that must be followed by all of its members. The Code is divided into two parts. The Code of Ethics outlines the fundamental values of counseling and a number of general principles arising from these, including but not limited to privacy, confidentiality, informed consent, and a complaint proce- dure. The Code of Practice applies these principles to the counseling environment.
Common Counseling Practices
In the absence of statistics on counseling approaches in Ire- land, views on the most common approaches are necessarily impressionistic and personal. The humanistic philosophy is likely the foundational philosophy of many Irish counselors because it is congruent with the traditional and conserva- tive Irish values that were challenged by modernization and technology (Chamberlain, 1983). It seems fair to assert that the person-centered approach is the common thread running through much of the counseling in Ireland. For instance, in the directory of counselors on the website of the IACP, many counselors describe their approach as person-centered, and many others use the term humanistic. These terms may be used interchangeably. Many of the same counselors describe themselves as integrative, using person-centered, human- istic, and cognitive behavior therapy (CBT) approaches as appropriate (IACP, 2011).
Information is generally lacking regarding the specific con- cerns that clients bring to counseling. Thus, the Irish cultural narrative must be taken into consideration to provide infor- mation on typical issues that Irish individuals may encounter (Page & O’Leary, 1997). One issue that stands out is substance abuse. In Ireland, individuals may use drinking as a coping mechanism to drown their anger and anxiety. Therefore, ad- diction counseling is an important field of work in Ireland. The Irish Association of Alcohol and Addiction Counsellors (IAAAC; 2007), which accredits counselors in this area, has almost 1,000 members. Addiction counselors may work as team members in public, community, and private addiction services or individually as private counselors.
In addition to addictions work, counselors also focus on general mental health concerns, marriage problems, and so- cial issues with their clients (Chamberlain, 1983). O’Leary (1990) suggested that Irish individuals were less likely to confront their problems, as compared with Americans. This may cause one to believe that Irish people may be less open to exploring challenges with a counselor. However, this may not be true with the younger generation of Irish university students, who are more accepting to exploring their feelings than are U.S. university students. Page and O’Leary (1997) found that Irish university students had a more positive view of the usefulness of anger and guilt than did American students. This may be because the Irish culture encourages the expression of negative feelings (Page & O’Leary, 1997). However, Irish individuals have been shown to develop trust at a slower rate than people in the United States (O’Leary, 1990), so counselors need to make an active attempt to build rapport and trust at a rate that is comfortable for the client.
Counselor Education and Training
Counselor training in Ireland is a mixture of private and public, degree and nondegree, accredited and nonaccredited training bodies. As such, it may seem like a labyrinth to Americans. (It should be noted that the term course refers to a whole program or curriculum, not to a particular class or module). Courses accredited by bodies such as the IACP tend to have at least three components in common. First, students in Ireland study a variety of theories of counseling. Second, personal development is part of the curriculum. In particular, in contrast to most U.S. training programs, students in Ireland must undergo personal counseling. Finally, students provide counseling under supervision when they reach an advanced educational level. This practical experience is gained through placements with external bodies or through low-cost counsel- ing services run by the institutions themselves.
One initiative stands out because of its influence. This was the introduction by Maynooth University, near Dublin, of an extramural (i.e., part-time, adult education open to all) certificate in counseling skills course in 1984. For most of its history, Maynooth had been a university for the training of young men as Catholic priests. However, it has been part of the national university system since 1997. As an extramural course, large numbers of people who had never attempted degree-level courses in the past were introduced to the pos- sibility of a career in counseling. Many graduates of this academic course have gone on to complete diploma or degree courses that lead to accreditation.
In some cases, the student works toward a diploma. A diploma may take 2–3 years to obtain, or the student may work toward a more comprehensive degree, which usually takes 4–5 years. Often, both can be gained through study at the same institution.
Unlike counselor training in the United States, counselor training in Ireland is not uniformly attached to universities. A nonuniversity training school may award the diploma or the degree if it is accredited by the state’s Higher Education and Training Awards Council. Alternatively, a university may also award the diploma or degree, either through a program being directly provided by the university itself or through a partnership with an autonomous school. To complicate the picture further, an autonomous school may award a diploma that meets the standards set by accreditation bodies for pro- fessional practice. Following the completion of their studies, students are required by the IACP to complete 450 hours of client counseling before they are accredited by IACP (2011). This accreditation (commonly called certification in the United States) is not licensure but is an acknowledg- ment that a counselor has met certain standards. Students
graduating from courses that omit clinical placements and/ or personal development are unlikely to be accredited by the leading accrediting bodies, regardless of whether the student is earning a diploma or a degree.
Change in the cost-of-counseling situation is not likely soon. There is no evidence to show that the government agenda includes the direct provision of counseling services to those who cannot afford private counselors. Given the economic and fiscal challenges facing the country, which is currently reliant on some support from the International Monetary Fund and the European Union, no government in the near future is likely to think about, let alone propose, counseling as part of the state’s provision of health care.
Under the national health care, every Irish citizen is en- titled to free hospital treatment, including inpatient mental health care. About half the population pays for private health insurance, which allows the individual to gain quicker access to medical care. However, those private health care companies have not shown movement toward reimbursing the cost of outpatient counseling. In fact, little or no demand for such reimbursement has come from the bodies representing coun- selors. Licensure will likely need to precede the possibility of insurance reimbursement.
One interesting model for the provision of low-cost coun- seling has emerged, namely, the provision of counseling in the community by training schools. In Tallaght, a large suburb of Dublin, for instance, the Institute of Integrative Counsel- ling and Psychotherapy (IICP; 2010) is training counseling students to the degree level. The degree is officially recog- nized as equivalent to a university degree although the IICP is not itself a university. The institute has also established a low-cost counseling service, called the Village Counselling Service, which is provided mainly by advanced students and graduates (IICP, 2010). The service is funded in two ways: through core funding from the state mental health service and through fees paid directly by clients. This model, if followed more generally in the country, could provide counseling for those who otherwise could not afford it.
The future of counselor training in Ireland is being reviewed by the Higher Education and Training Awards Council (2011). The Psychological Therapies Forum (2008), which represents a wide range of counseling bodies, rec- ommended that a state registration system should require a master’s-level degree for psychotherapists and a degree for counselors (Psychological Therapies Forum, 2008). Although no such state registration system exists, the rec- ommendation suggests that the trend within the profession will be toward degree-level and master’s-level training. In sum, despite credentialing limitations and cost barriers, the counseling profession is growing rapidly in Ireland.
Counseling, which had hardly been heard of in Ireland in the 1960s, is now an accepted and familiar part of the landscape. However, counseling remains unaffordable for many and is unregulated on a statutory basis. Future developments are likely to see continuing moves toward regulation and toward greater access to counseling for people on low incomes. The speed at which these moves will take place, however, is entirely unpredictable.
Padraig O’Morain, Institute of Integrative Counselling and Psychotherapy, Dublin, Ireland; Garrett J. Mcauliffe and Rebecca E. Michel, Department of Counseling and Human Services, Old Dominion University; Kayte Conroy, Department of Counseling, School and Educational Psychology, State University of New York at Buffalo; Jennifer M. Johnson, Department of Educational and Human Services, University of Central Florida. Correspondence concerning this article should be addressed to Padraig O’Morain, Institute of Integrative Counselling and Psychotherapy, Partas Killinarden Industrial Estate, Killinarden, Dublin 24, Ireland (e-mail: firstname.lastname@example.org).
© 2012 by the American Counseling Association. All rights reserved.
Journal of Counseling & Development ■ July 2012 ■ Volume 90 367
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