ABSTRACT

Severe and enduring mental illness (SEMI), as has outlined, is a term that describes a constellation of disorders that are chronic and persistent over time and lead to moderate to high enduring dysfunction and disability. This chapter discusses an approach to counselling people with SEMIs, by careful assessment of the presenting issues. Mental health and illness 'presentations' can vary between individuals, across populations, and even within the same diagnostic category. Counsellors working in primary care need to consider themselves as working as part of the primary healthcare team, and as such are not working with this client group alone. The aim of risk assessment is to promote safety for the client and the counsellor, inform care planning and act as a guide to the therapeutic encounter, enabling the counselling work to be done. Cognitive-behavioural therapy (CBT) for psychosis is a clinically proven method for helping individuals with the distressing positive symptoms of psychosis.