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Counselling - Definition An interactive process characterized by a
unique relationship between the counselor and client that leads to change in one or more of the following areas:
Behavior Beliefs or emotional concerns relating to
perceptions Level of emotional distress
Counseling Process Structure
1. Rapport and Relationship Building
2. Assessment / Problem Definition
3. Goal-setting4. Initiating Interventions5. Termination
Rapport and Relationship Psychological climate resulting from the
interpersonal contact of client and counselor.
Living and evolving condition. Relationship includes respect, trust, and
relative psychological comfort.Impacted by Counselor’s personal and professional
qualifications. Client’s-interpersonal history,
– anxiety state,– interrelation skills, and– previous ability to share,
Clinical Assessment
Involves specific skills Observation Inquiry Associating facts Recording information Forming hypotheses (clinical
“hunches”)
Observation1. Take notice of the client’s general
state of anxiety.2. Establish sense of client’s cultural
context.3. Note gestures / movements that
denote emotional / physical dysfunctions.
4. Hear how the client frames his / her problems.
5. Note verbal and non-verbal patterns.
FocusPresenting problem and context
Basic Questions What concerns brought you
here? Why now? Has this happened before? How is it impacting your daily
life?
Detailed Inquiry Clarify stressors Elicit
– coping skills,– social support, – and resources
Clarify life function– work– family– health– intimacy
Focus Mental status
Basic Questions How do you feel now? How is your mood affected? Had any unusual
experiences? How is your memory? Do you think that life isn’t
worth living?
Detailed Inquiry Note
– age & mannerisms– dress & grooming– orientation
Probe– anxiety symptoms– form, content, thought.– suicidal ideation– violent impulses
FocusDevelopmental history and dynamics
Basic Questions How would you
describe yourself as a person?
Shift to the past, how were things when you were growing up?
Detailed Inquiry Clarify
– current self-view– level of self-esteem– personality style
Note– developmental
milestones– experience in school– best friends– educational level
FocusSocial history and cultural dynamics
Basic Questions What is your current
living situation? What is your ethnic
background?
Detailed Inquiry Elicit
– job or military– legal problems– social support system– race, age, gender– sexual orientation– religion– language– dietary influences– education
FocusHealth history and behaviors
Basic Questions Tell me about your
health? Health habits?
Detailed Inquiry Identify
– prescriptions– substance usage– health status– health habits
FocusClient resources
Basic Questions How have you tried to
make things better? Results?
How do you explain your symptoms?
What is your / my role in your treatment?
When will things change / get better?
Detailed Inquiry Probe
– Efforts to change– Efforts vs. successes
Clarify client explanatory model
Identify treatment expectations
Specify readiness for change
FocusWind down and close
Basic Questions What else would be
important for me to know?
Do you have any questions for me?
Detailed Inquiry Use an open-ended
query – Allows the client to
add information.– Creates sense of
reciprocal and collaborative relationship.
Conceptualizing Problems
Recognize a client need. Understand that need. Meet that need.1. Beliefs may
• Contribute to the problem.• Impede the solution.• Become the problem.
2. Feelings / responses often• Exaggerate the problem.• Impede comprehension of the problem.• Become the problem.
3. Behavior / responses may• Be inappropriate.• Contribute to the problem.• Complicate the problem.
4. Interaction patterns include• Miscommunication channels,• Expectations,• Self-fulfilling prophesies.• Coping styles.
5. Contextual factors• Time• Place• Cultural and socio-political issues.
Goal Setting
1. Indicates how well counseling is working.2. Indicates when counseling should be concluded.3. Prevents dependent relationships.4. Determines the selection of interventions.5. Mutually defined by the client and counselor. Counselor Greater objectivity Training in
Normal andAbnormal behavior
Process experience
Client Experience with the
problem History of the problem Potential insights Awareness of personal
investment in change
Process goals Related to establishing
therapeutic conditions for client change.
Includes:Establishing rapport, Providing a non-
threatening setting, and
Possessing and communicating accurate empathy and unconditional regard.
Outcome goals Are different for
each client and directly related to clients’ changes.
Always subject to modification and refinement.
To begin, formulate tentative outcome goals.
Modify goals as needed to support effective change.
Interventions
Objective -- initiate and facilitate client change.
After assessment and goals setting, answers the question, “How shall we accomplish these goal?”
Must be related to the problem. Selecting an intervention may become an
adaptive process. Skills to initiate include
1.Competency with the intervention;2.Knowledge of appropriate uses;3.Knowledge of typical client responses;4.Observation skills to note client responses.
No clear cut ending, but no need to continue beyond usefulness.
Awareness by the counselor and the client that the work is accomplished.
May take the same number of sessions as rapport building.
Types of Termination1. Suggested termination, with client
agreement2. Imposed termination
• Continuing is against client best interest• Client is deteriorating, not progressing• Incompatibility with the therapist• Client using therapy in place of life
Termination
3. Situational termination• Client moves• Employment changes4. Early termination, clients just don’t
return.
Methods Gradual tapering off of sessions. Therapeutic vacations, taking a break
without breaking the connection. Direct (imposed) termination.
Basic skills of Counselling Listening is not passive. It is
important to indicate that the person is being heard
Good counselling skills means listening before acting to solve problems
Verbal listening skills Show interest Gather information Encourage speaker to develop ideas Communicate our understanding of ideas Request clarification of understanding Build the therapeutic alliance
Listening Skills Using good verbal listening skills, you
increase the chances that: You will understand what the other
is saying and they will understand you You will create a situation where
you will be able to develop a helping relationship
Non verbal attending and observation
1. Take notice of the client’s general state of anxiety.
2. Establish sense of client’s cultural context.3. Note gestures , movements that denote
emotional / physical dysfunctions. Non verbal behavior include eye contacts, head nods, facial discrimination, body posture and physical distance between counselor and client
4. Hear how the client frames his / her problems.
5. Note verbal and non-verbal patterns.
A Good Listener
Maintains eye contact Makes few distracting movements Leans forward, faces speaker Has an open posture Allows few interruptions Signals interest with encouragers and
facial expressions
Bad listening Makes little eye contact Makes distracting movements Faces away from speaker Has a closed posture (eg:arms crossed) Interrupts speaker Does too many other things while
listening Has a flat affect, speaks in a monotone,
gives few signals of interest
Responding
Ask open and closed questions
Use “encouragers” Paraphrase what
you have heardReflect on feeling Summarize
Asking questions Open Questions
Open questions Generally start with “what”, “how”,
“why” or “could “ Questions serve to:
Gather lots of general information Encourage discussion
Eg: Nurse: “How has the baby been eating?” Nurse: “What is the bedtime routine?” Nurse: “Could you tell me about giving the
baby medicine in the morning?”
Closed Questions Generally start with “is”, “are”, or “do” Serve to:
Gather lots of specific information quickly
Tend to close down discussion Eg:
Nurse: “Are you giving the medicine every day?”
Nurse: “Is the baby able to tolerate the medicine in the morning?”
Encouragers
There is a category of responses that fall between non verbal attending and actual responses ,termed by Ivey & Ivey(1999) as minimal encouragers.
Eg: “Yes, I understand” or repeat a word or two of what was said, “uh-huh”, “hmn hmn””and…?”and “then..?”
Serves to: Encourage further discussion
Reflection of Feelings Focus on feelings (stated and unstated) Serves to:
Communicate understanding of emotions When combined with a paraphrase,
confirms the accuracy of understanding (“Check out” the the other person)
Encourages discussion of feelings
Paraphrasing Briefly summarize the content of the
discussion Reflective listening
Check your understanding Show that you heard what was said
Acknowledge and accept feelings without judging
Eg: Patient: “I am worried that the medicine is
making my baby sick” Nurse: “It sounds like you are worried about
how the baby is reacting to the medicine.”
Summarizations
Finally pull together ideas from the interview
Serves to Organize the structure of the
interview Check the accuracy of
understanding
Influencing or Changing Behavior
Directives Reframes and interpretations Advice Feedback Logical consequences
Directives Requests to clients to perform some actions. Counselors might give home assignments to
keep track of times when clients felt on the verge of losing control or to note what conditions seemed to lead to a greater sense of productivity at work.
Works best if clear and concrete Serves to:
Move a person to take a specific act
Reframing and Interpretations
Attempts to replace an old, maladaptive response with a newer, more useful (usually positive) one
Serves to Increase insight and
understanding Shift emotional or intellectual
response
Advice Provides information to help client make
a decision. Can be very directive or less so
Serves to: Share information that would be
relevant for a person’s decisions, actions, or understanding
Disadvantages of advice It’s often disempowering (You can’t
solve this on your own) People may say (but not really mean)
that they want advice
Feedback Gives information about how the person
is experienced by others Serves to:
Help client see self more objectively (as others see him or her)
Feedback works best when It is requested or desired It is concrete It is positive If negative, it addresses something
changeable or controllable
Logical Consequences
Focuses on the logical consequences of a person’s behavior, actions, thoughts, or feelings
Serves to: Increase awareness of consequences
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