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• I can remember my mum passing on a golden rule when I had lost her in the covered market. I was small and, tempted by the toy stall, had lost sight of her as she joined the butcher’s queue. I found her eventually, having run up and down the market’s avenues a few times in panic, and she gave me her ‘ask a policeman’ advice in case such a thing should happen again.
  
  It is lovely advice. It speaks of a world where everyone has a clear and defined purpose and remit. A world where expertise is clearly located, and it is one which has occupied my thoughts, it seems, for the duration of my counselling course so far. This desire to measure, to have some sense of progression, has evolved recently into the question of who would be the people to ask – the experts – about therapeutic success? As students, we have a network of support to provide checks and balances: tutors, placement mentors and supervisors, independent supervisors, fellow students. These allies provide very valuable ears and eyes.
  
  The first port of call, according to this second academic year, however, is ourselves. We are all required to develop the ‘internal supervisor’, to learn to employ the third eye, to be our own beneficence police. But, however honest I am in reporting my own counsel, it is still my version of events. Can I really be the expert on my own counselling? What of the client?
  
  To imagine a medical parallel: if I were a doctor, I could testify that I had made the correct diagnosis, designed the appropriate programme of intervention, prescribed the textbook drugs… but the patient still died! The medical analogy is of limited use however. As the doctor is dealing with the chemical and the biological, a fixed measure of cause and effect, he can offer the legitimate defence that he did what he could – if that did not work, there was nothing we know of that might have worked better.
  
  The counsellor does not have these fixed points of secured knowledge. On the contrary, research suggests that (as previously discussed here and elsewhere) the quality of relationship is the most decisive factor in delivering ‘successful’ therapy.
  
  But who did those researchers ask? And who can any of us ask to rate the efficacy of the counselling relationship? All roads then do lead to the client, but, arriving at the client, we are faced with several dilemmas about the voracity of client feedback.
  
  Increasingly NHS counselling services are measuring client outcomes – in recent years the impetus to collect such data has been strengthened by changes to commissioning and the implementation of the Improving Access to Psychological Therapies (IAPT) programme. The IAPT programme has an outcomes framework that includes CORE 10 (Clinical Outcomes in Routine Evaluation), the GAD-7 and the PHQ9 forms in an attempt to measure the mental health of clients before and after therapy. The questions are thoughtful and focused, but because they are handed out by the counsellor to the client, there exists an unavoidable social imperative in the exchange of this information. If I am a client who feels well disposed towards my counsellor, I will want the form and its findings to encourage them and may talk up my own wellbeing. If a different kind of transference has taken place, I may feel a destructive urge and deliberately present a negative outcome. In any case, it is also the nature of this client group to be troubled witnesses. Surely we must acknowledge that this impacts on their reliability.
  
  The economy went to hell in a handcart when the recession hit. All the economic and business sages said so. After the Northern Rock and RBS debacles, these voices were unanimous in their condemnation of high-risk borrowing, the culture of subprime mortgage lending and corporate greed, but they were not expert enough to see it, or anything like it, coming. Yet where do we turn for wise words on likely recovery and quantitative easing if not to Robert Peston?
  
  And if we want to know how therapy is working out, who are the experts if not the fragile and vulnerable individuals who present themselves for counselling? They are not the flawless experts that my mum’s mythical policeman promised to be, but they are the nearest we have. We should be careful, though, as we should have been in garnering financial advice, not to take their testimony as gospel.

• Some names have been changed to protect identities.