INTRODUCTION
Is there anybody here today who has been employed and never suffered from occupational stress? Of course, at this conference we all probably realise that the subject of 'occupational stress' is not straight forward. Too often we may counsel staff who believe that they are suffering from 'occupational stress' when, in fact, most of the stress is caused by their own internal perfectionist demands and the external demand, such as a project, is only a small activating trigger. All the relaxation exercises in the world will probably be unable to help people with these internal 'I MUST perform well' demands.
This brings me to some of the issues I wish to share with you today: my experiences as a counselling psychologist undertaking stress management interventions in industry. Before I share a number of my experiences, I would like to spend a few minutes discussing my general approach to industrial interventions, to try and help you understand the client-centred approach I and others have developed and then share my experiences. This may help to put the interventions into some kind of context.

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CLIENT-CENTRED INTERVENTIONS
The client-centred approach applied to the field of stress management has been well documented (e.g. Evans and Reynolds, 1993; Palmer, 1992).
A number of slightly different models have evolved, however, essentially they are the same. I will briefly describe what I do at each stage of a client centred intervention when I am employed as an external consultant. This approach can be adapted if the counselling psychologist is directly employed by the organisation.

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Stage 1: The making contact and building a relationship stage.
Obviously, this is when you get to know the client if you have not previously worked together. It is important to establish a working relationship underpinned by mutual trust and respect. If it is a new client, even before our first meeting I ask to see general background information about the organisation and often this can be found in in-house journals, newsletters, company annual reports and accounts. This information allows me to get some kind of picture about the organisation and often allows me to ask relevant and pertinent questions at the first meeting.

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Stage 2: Contracting.
This is where the ground rules for the assignment are discussed and agreed. As a client-centred intervention is being undertaken it is important that the client realises that they own the problem and are responsible for implementing the programme whereas the consultant facilitates the intervention.

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Stage 3: Data collection
Data collection is an important stage as money spent on interventions not focused on the needs of the organisation and its members is wasteful of resources and could be potentially harmful especially if undertaken by unskilled consultants. At this stage questionnaires completed by staff or key personnel can provide useful information. I have found the Occupational Stress Indicator (OSI), (Cooper et al., 1988) very useful. It evaluates occupational stress by analysing five key factors:

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Sources of pressure:
Factors intrinsic to the job itself
The managerial role
Relationships with other people
Career and achievement
Organisational structure and climate
Home/work interface

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Individual characteristics (Type A):
Attitude to living
Style of behaviour
Ambition
Total type A

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Locus of control:
Organisational forces
Management processes
Individual influence
Total control

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How the individual copes with the stress experienced:
Involvement
Time
Home and work relationships
Logic
Task strategies
Social support

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The effects of stress:
Personal relationships
Organisational processes
Organisational design and structure
The job itself
Achievement, value and growth
Total job satisfaction
Mental health
Physical health

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This provides a wealth of information about how the staff perceive the organisation and the effects of stress upon them. During stage 3 interviewing staff also provides useful information.

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Stage 4: Making sense of the data and diagnosing the problem.
This stage is not always straight forward. Sometimes insufficient data has been collected and more is necessary. Other times there is so much data it becomes difficult to see 'the wood for the trees'. The client may misinterpret the data and decide that the high rates of absenteeism in her/his division is due to 'their basic lazy attitude towards work' whereas the consultant can clearly see that the client's own attitude and subsequent behaviour may be a major cause of the problem. These issues usually need further exploration. The OSI produces a useful group profile which can help to diagnose problems.

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Stage 5: Generating options, making decisions and action planning.
The consultant helps the client to generate options and choose the most helpful one. However, the client may not choose the best option and the consultant may need to help the client to reconsider the decision. If the client goes ahead with a less than desirable intervention then this can become a useful process of learning for the organisation. I will normally predict the possible outcomes of each option based on my experience and any relevant research. The client may not wish to tackle the underlying causes of the stress and opt for stress symptom management such as stress management training, time management training or stress counselling. These three solutions firmly place the burden of stress and its management upon the individual and do not necessarily focus on the actual causes of the stress e.g. work overload. This issue needs to be discussed.
Once a particular option has been chosen an action plan is developed which highlights the different stages involved and when they will be undertaken. Action planning then leads onto the next stage.

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Stage 6: Implementation.
The consultant helps the client to implement the plan but refrains from making a 'take-over' bid! Even if the client agrees to undertake the intervention, it is important for the consultant NOT to assume that the intervention will occur in his/her absence. The consultant needs to help the client through this often difficult stage by giving support and encouragement. A tentative approach is recommended as any intervention can lead to slight organisational or 'cultural' changes which can be inherently stressful.

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Stage 7: Follow-up or Disengagement
The consultant either arranges a follow-up or completely disengages depending upon the needs of the organisation. For example, if the intervention was a training workshop, this can be evaluated and later modified as the consulting cycle is revisited. Sometimes it will be necessary to start at the contracting stage again especially if contractual difficulties had been experienced.

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MY EXPERIENCES IN INDUSTRY
Using the client centred approach I have been involved in a diverse range of interventions. It is worth noting that organisational interventions can be made at three different levels (Cox, et. al. 1990):

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Primary:
Remove hazard or reduce employees' exposure to it, or its impact on them.

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Secondary:
Improve the organisation's ability to recognise and deal with stress related problems as they occur.

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Tertiary:
Help employees cope with and recover from work related problems
 

I suggest that the most effective stress management interventions are those that include all three levels. However, this is not usually possible due to a variety of reasons. I will now briefly describe a number of assignments I have undertaken.
In one police force it was decided that peer counselling would be the most effective and acceptable intervention with back-up external counsellors if necessary. Peer counsellors received on-going training and supervision.

Banks have chosen a number of different options:

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health related seminars
'stress management' workshops
'managing pressure to increase performance' workshops.
'Managing pressure to increase performance' workshops help staff to overcome fears they may have of being seen attending or sent to stress workshops.

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It is important to adapt an intervention to the culture of the organisation. This is particularly the case with 'macho' cultures.

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A supermarket chain chose stress management or managing pressure training depending upon the region. The programme started initially with store managers and at the follow-up stage the programme adjusted as we moved back around the consulting cycle after collecting new data. The programme has included training senior managers. As each workshop participant receives a personal Occupational Stress Report (Cooper et. al., 1988) during the course of the workshop it is important that all participants understand issues such as Type A behaviour, locus of control and coping strategies before reading their report. In addition time is set aside to see participants individually to answer any queries that may have arisen from the workshop or the OSI report. Otherwise, I believe that it would be unethical use of the OSI report. Although a 'top-down' intervention in industry is preferable this is not always possible due to the key staff involved in the process having limited influence at board level. In this example the 'middle-up' and 'middle-down' intervention appears to be gradually interesting staff at both ends of the organisation .

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One trade union decided to train the health and safety officers in stress management skills. More latterly, lectures on stress and trauma have been given at their national conferences which helps to educate many trade union representatives. This trade union has produced relevant information and stress questionnaires for its members on stress and its management so that they are able to confront stress related issues as they arise in their own particular organisation.

One government body experiencing closure decided that the out-placement counselling agency was having little success in helping staff to find new jobs. The next best option was to assist staff in dealing with the stresses of being unemployed. This involved a series of seminars based on rational emotive behaviour thinking skills to prevent or reduce unhelpful anger, depression, anxiety and shame (see Neenan, 1993).

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Workshop Contents
In my experience, 1-day stress management workshops based on multimodal, rational-emotive, cognitive-behavioural interventions are too short to discuss relevant work-related issues, what is stress and how to reduce it. Two day workshops with a half-day follow-up are preferable. The 'managing pressure' or 'stress management' workshops I run tend to share similar themes depending upon the needs of the group (adapted Palmer and Dryden, 1995; abridged Clarke and Palmer, 1994) :

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Discussion of ground rules
Ask what they hope to learn and achieve over the next 2 days (This confirms their requirements they sent in prior to the course.)
Participants share their 'Stress Diaries'.
Discussion of simple definition of stress.
Small group work to consider symptoms of stress.
Debrief & discuss psychophysiology of stress. (use video)
Use of biodots (temperature sensitive biofeedback).
Thinking skills or twisted thinking-small group work (in pm of first day & am of second day).
Multimodal Relaxation Method (Palmer, 1993).
Then GSR biofeedback to discover what technique helps them.
GSR to illustrate thoughts & images can cause stress.
Imagery techniques e.g. coping and time projection imagery
Occupational/organisational stress discussed and interventions developed in small groups. Stress mapping may be used (Palmer, 1990; Palmer and Dryden, 1995)
Type A, Locus of Control, and workplace coping strategies discussed & assessed. What can be improved.
Occupational Stress Reports given out.
Additional coping strategies e.g. assertion, stability zones, time management etc.
Lifestyle interventions e.g. diet, weight, exercise, stop smoking.
Stress management action plan devised for group.
Individual stress management plans developed.
Discussion of 'where to go from here'
Possibility of follow-up day discussed.
Feedback & evaluation.

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CONCLUSION & PERSONAL CONCERNS
A client-centred approach throws up a wide range possible interventions in which the consultant needs competency in a variety of different areas to undertake effective assignments (adapted Palmer and Dryden, 1994 pp. 11):
 

Recognised competency in:

cognitive-behavioural techniques
rational emotive behavioural techniques
counselling and listening skills
group-facilitation skills
teaching related key topics
problem-solving skills/training
knowledge of relevant research
knowledge of lifestyle options, e.g. diet, exercise etc.
understanding of occupational, organisational, change management, family, social, and cultural issues.

If consultants have not grasped these basic skills and issues then they may be 'short-changing' their clients. Inevitably clients tend to resist organisationally-orientated interventions and this probably accounts for the lack of published research in this area. However, if the consultants are trainers, do they only offer stress management training as the panacea? I wonder how often consultants inform their clients or even know that the existing research on stress management training for non-clinical populations only suggests that limited improvements in self-reported symptoms and psychophysiological indices of strain are attained. In addition, the studies have seldom reassessed the target groups at long-term follow-up. I suspect that the consultants rarely inform their clients that stress management interventions can sometimes lead to increased rates of absenteeism! In essence, the profession needs more solid research to back-up the 'intuition' of practitioners and the latter need to concentrate on applying the theory to practice.

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REFERENCES
Clarke, D. and Palmer, S. (1994). Stress Management. Cambridge: National Extension College.
Cooper, C. L., Sloan, S. J., and Williams, S. (1988). Occupational Stress Indicator. Windsor: ASE.
Cox, T., Leather, P., and Cox, S. (1990). Stress, health and organisations. Occupational Health Review, 23, 13-18.
Evans, B. and Reynolds, P. (1993). Stress consulting: A client-centred approach. Stress News, 5, 1, 2-6.
Neenan, M. (1993). Rational-emotive therapy at work. Stress News, 5, 1, 7-10.
Palmer, S. (1990). Stress Mapping: a visual technique to aid counselling or training. Employee Counselling Today, 2, 2, 9-12.
Palmer, S. (1992). Stress management interventions. Counselling News, 7, 12-15.
Palmer, S. (1993). Multimodal techniques: relaxation and hypnosis. London: Centre for Stress Management.
Palmer, S. and Dryden, W. (1991). A multimodal approach to stress management. Stress News, 3, 1,
Palmer, S. and Dryden, W. (1994). Stress management: approaches and interventions. British Journal of Guidance and Counselling, 22, 1, 5-12.
Palmer, S. and Dryden, W. (1995). Counselling for Stress Problems. London: Sage.
Copyright S. Palmer, 1995.
(**Article based on a paper presented at the International Stress Management Association (UK) 'Cost and Benefit' Conference at the University of York, 1 July 1994. Published in conference proceedings.) This version was published in Counselling Psychology Review, 1995, 10, 1, 17-21.