Stages of Counseling

Jiya Gulati
 Counseling
It involves a professionally trained counselor
assisting a client with particular concerns.
Personal or psychological problems.
Individual, group, marriage or family counseling.
Facilitating behavior change, enhancing coping
skills, promoting decision making, and improving
relationships.
The 50-minute hour (Linder, 1954).
Subjective ‘Art’ Objective
of Counseling ‘Science’ of
Active Listening – Truly listening to Counseling
clients with empathy.
Communication of Care – Expressing Scientific tools
compassion and understanding. Use of standardized tests
Entering the Client’s World – Seeing Research methodology for evaluating
things from their perspective. efficacy
Helping Clients Discover Strengths –
Encouraging self-awareness and
personal growth.
Sensitivity to Diversity – Recognizing
cultural, gender, and spiritual
differences.
The Six Stages of the Counseling
Process
Stage 1: Relationship building
Stage 2: Assessment and diagnosis
Cormier and Hackney
Stage 3: Formulation of counseling goals (1993)
Stage 4: Intervention and problem solving
Stage 5: Termination and follow-up
Stage 6: Research and evaluation
Stage 1: Relationship Building

The counseling relationship is the heart of the counseling process.

It supplies the vitality and the support necessary for counseling to work, and
it is the critical factor associated with successful outcomes in counseling.
Counselor-offered conditions and counselor- and client-offered conditions
Counselor-offered conditions

Counselor-offered conditions relate to how the counselor influences the

counseling process.
Core conditions for
effective counseling
Carl Rogers (1957)
Necessary and sufficient for
constructive personality change
to occur
Carkhuff (1969, 1971) expanded
the core conditions to include
respect, immediacy,
confrontation, concreteness,
and self-disclosure.
Carkhuff also pioneered the
development of listening skills
that could be used to promote
these core conditions
Empathy

It is an active, immediate, and ongoing process in which the counselor

becomes aware of the client’s feelings, experiences those feelings, and
creates a mirror through which clients can explore and discover deeper
meanings associated with their feelings. (Raskin and Rogers)
 Empathy (Egan’s views)
Egan (2002) described empathic understanding as a process that involves
listening, understanding, and communicating that understanding to the client.

Primary and Advanced Empathy

Egan described primary empathy as a Advanced empathy involves employing
process that involves the counselor the process of primary empathy as
attending, listening, and communicating well as utilizing the skills of self-
accurate perceptions of the client’s disclosure, directives, or
messages. interpretations.
Gladstein identified the following
stages of empathy:
the counselor has an emotional reaction to the client’s situation,
the counselor attempts to understand the client’s situation from the client’s
perspective,
the counselor communicates empathy to the client,
and the client feels a sense of caring and understanding from the counselor.
Unconditional positive regard
Unconditional positive regard involves the counselor communicating to
clients that they are of value and worthy as individuals.
This concept has been referred to by several other terms, including
nonpossessive warmth, acceptance, prizing, respect , and regard.
According to Martin, unconditional positive regard does not imply that the
counselor reacts permissively, accepting all the client’s behavior. Instead, it
means that the counselor accepts the client while setting limits on certain
behaviors.
Congruence
Congruence involves counselors behaving in a manner consistent with how
they think and feel. This condition has also been referred to as genuineness.
Respect
It focuses on the positive attributes of the client.
Counselors can communicate respect by making positive statements about
the client and openly and honestly acknowledging, appreciating, and
tolerating individual differences.
Immediacy
Immediacy involves communication between the counselor and client that
focuses on the here-and-now.
It allows the counselor to directly address issues of importance to the
counseling relationship.
Immediacy can involve counselors describing how they feel in relation to the
client in the moment.
Similar to Ivey’s (1971) notion of direct, mutual communication.
Confrontation
The core condition of confrontation involves the counselor pointing out
discrepancies in what a client is saying.
There can be discrepancies between what the client is saying and doing,
between statements and nonverbal behavior, and between how clients see
themselves and how the counselor sees them.
Confrontation is a difficult and risky counseling technique that is used most
effectively by high-functioning counselors.
A negative effect on the counseling process can occur when, for example, a
client misreads the confrontation and feels attacked or rejected by the
counselor.
Concreteness
Concreteness refers to the counselor helping clients discuss their concerns
in specific terms.
Clients can feel overwhelmed by their problems and have difficulty putting
things into perspective.
When this occurs, concreteness can help the counselor create a focus for the
client in the counseling process.
Self-Disclosure
Jourard (1958) developed the concept of self-disclosure, which involves
making the self known to another.
Danish, D’Augelli, and Brock (1976) differentiated two types of self-disclosure
statements:
self-disclosing and self-involving.
In self-disclosing statements, counselors disclose factual information about
themselves.
In self involving statements, counselors describe what they are experiencing
in relation to the client in the counseling process.
Strong’s Social Influence Model (1968)
Strong’s (1968) social influence model also emphasizes the importance of
counselor-offered conditions in the counseling process.
The model has two stages, representing an integration of social psychology
into counseling theory.
During the first stage, the counselor attempts to be perceived by the client as
expert, attractive, and trustworthy.
When this occurs, the counselor establishes a power base.
In the second stage of Strong’s model, the counselor uses the power base to
exert positive influence on the client within the counseling process.
Stage 1
During the first stage, the counselor attempts to be perceived by the client as
expert, attractive, and trustworthy.
Counselors are perceived as experts when they have objective evidence of
training, use prestigious cues, use frequent, consistent, and responsive
nonverbal behavior (e.g., touch, smiling, body leans), and employ narrative
analogies and empathic responses.
They are seen as attractive when they have objective evidence of training,
status, and engage in self-disclosure.
Trustworthiness is enhanced through credible introductions, reputational
cues, responsive nonverbal behavior, and verbal and nonverbal cues
associated with confidentiality.
Stage 2
The second stage of Strong’s model suggests that once counselors establish
a power base by appearing expert, attractive, and trustworthy, they can exert
a positive influence on the client.
Expertness, attractiveness, and trustworthiness are related to client
satisfaction, changes in the client’s self-concept, favorable counseling
outcomes, and less-premature terminators.
Counselor- and client-offered
conditions
The concept of a working alliance is another way to describe the counseling
relationship.
Bordin suggested that the working alliance is composed of three parts:
agreement between the counselor and client about the goals of counseling,
agreement between the counselor and client about the tasks of counseling,
and the emotional bond between the counselor and client.
Al-Darmaki & Kivlighan (1993) suggested that the working alliance is
dependent on four factors:
client precounseling characteristics such as motivation and interpersonal
skills,
the counselor’s personal characteristics,
the counselor’s skills,
and the match between the client’s needs and the counselor’s skills and
resources.
With respect to the fourth factor (the importance of the counselor-client fit),
Gelso and Fretz (2001) suggested that the strength of the working alliance
depends on
the degree of agreement relating to the goals and tasks of counseling
and the level of emotional attachment between the counselor and client.
Lazarus (1993) went on to note that the counseling relationship should be
characterized by counselors functioning like “authentic chameleons,”
adjusting their therapeutic style to the unique and emerging needs of clients.
Stage 2: Assessment and
Diagnosis
They can help a counselor develop an in-depth understanding of a client and
identify mental disorders that require attention.
This understanding can facilitate goal setting and suggest types of
intervention strategies.
Assessment
Assessment procedures can be divided into standardized and
nonstandardized measures.
Standardized measures include psychological tests that have a standardized
norm group.
Nonstandardized measures do not have a standardized norm group and
include strategies such as the clinical interview and assessment of life
history.
Diagnosis
Diagnosis is a medical term that means “identification of the disease-causing
pathogens responsible for a physical illness”.
Rosenhan and Seligman (1995) identified four reasons for making a
diagnosis:
facilitating communication shorthand,
indicating possible treatment strategies,
communicating etiology,
and aiding in scientific investigation.
Stage 3: Formulation of
Counseling Goals
Goals serve three functions in the counseling process (Cormier & Hackney,
1993): motivational, educational, and evaluative.
Motivational function
First, goals can have a motivational function, especially when clients are
involved in establishing the goals.
Clients appear to work harder on goals they help create.
They may also be more motivated when they have specific, concrete goals to
work toward, which can help clients focus their energy on specific issues.
It is also important for counselors to encourage clients to make a verbal
commitment to work on a specific counseling goal.
Clients tend to be more motivated to work when they have made a
commitment to do so.
Educational function
From this perspective, clients can learn new skills and behaviors that they
can use to enhance their functioning.
For example, a counseling goal might be to become more assertive. During
assertiveness training, clients can learn skills to enhance their functioning in
interpersonal situations.
Evaluative function
Clear goals give the counselor and client an opportunity to evaluate progress.
Goals can also be useful in implementing research strategies, and they
provide a means to assess counselor accountability.
 Process and Outcome goals
(Cormier & Hackney, 1993)
Process goals establish the Outcome goals specify what the
conditions necessary to make the client hopes to accomplish in
counseling process work. counseling.
These goals relate to the issues of The counselor and client should
formulating a positive relationship by agree on these goals and modify
promoting the core conditions. them as necessary.
Process goals are primarily the
counselor’s responsibility.
George and Cristiani (1995) identified five
types of outcome goals:
Facilitating behavior change.
Some form of behavior change is usually necessary for clients to resolve their
concerns.
The amount of change necessary varies from client to client.
For example, one client might need counseling to learn how to deal effectively with a
child, whereas another might require psychotherapy to change an unhealthy, stressful
lifestyle.
Enhancing coping skills.
Erikson (1968) identified several developmental tasks and associated coping
mechanisms unique to the various stages of development.
Blocher (1974) later created a developmental counseling approach that identified
coping skills necessary to proceed through the life span.
For example, intimacy and commitment are developmental tasks of young adulthood.
Coping behaviors necessary to meet these developmental tasks include appropriate
sexual behavior, risk-taking behavior, and value-consistent behavior such as giving
and helping.
In more general terms, many clients may require help coping with life.
They may have problems dealing with stress, anxiety, or a dysfunctional lifestyle.
In these situations, clients may benefit from a stress management program that
includes relaxation, meditation, and exercise.
Promoting decision making.
Some clients have difficulty making decisions. They may feel that no matter what
they decide, it will be wrong. They may even think they are “going crazy.”
Difficulty making decisions is often a normal reaction to a stressful life situation
such as a recent divorce.
In these situations, the counselor may want to reassure clients that they are not going
crazy. Helping clients feel normal can encourage them and alleviate unnecessary
worry.
For clients who need help developing decision-making skills, the counselor may wish
to take a more active role.
It may be appropriate to involve family members if the client is suffering from a
serious mental disorder, such as an organic brain syndrome.
Improving relationships.
Adler (1930/1964) once suggested that the barometer of mental health is social
interest. He believed that a person who did not have a close relationship with anyone
was at risk for mental problems.
Glasser (1965) noted that all people need one or more reciprocal relationships in
which they feel loved and understood and experience a sense of caring.
Counselors can use a variety of counseling strategies to help clients improve their
interpersonal relations.
These strategies include social-skill training programs, group counseling that focuses
on interpersonal relations, couples therapy, and marital therapy.
Facilitating the client’s potential.
Goals in this category are more abstract and relate to the concepts of self-realization
and self-actualization.
Self-realization implies helping clients become all they can be as they maximize their
creative potential. Roadblocks to self-realization require the counselor’s attention. For
example, clients may become discouraged and want to quit at the first sign of failure.
In these instances, the counselor can help clients gain a more realistic understanding
of what is required to be successful.
Self-actualization, a concept developed by Abraham Maslow (1968), relates to the
need to fulfill one’s potential. He believed that as people’s basic needs are met, they
will move toward self actualization.
Rogers (1981) incorporated the concept of self-actualization into his person-centered
counseling approach. He believed that if the counselor establishes certain conditions,
such as communicating nonpossessive warmth, unconditional positive regard, and
empathy, then the client can move toward self-actualization and become a healthy,
integrated person.
Stage 4: Intervention and Problem-
Solving
Once the counselor and client have formulated a counseling goal, they can
determine what intervention strategy to implement.
They may choose from a variety of interventions, including individual, group,
couples, and family counseling.
It may be best to begin with individual counseling for clients with problems of
an intrapersonal nature.
As clients become more secure, they may be able to benefit from the open
dialogue that often characterizes group counseling.
Couples or family counseling may be more appropriate for clients with
difficulties of an interpersonal nature, as in a marital or parent-child conflict.
Selecting an intervention strategy
Involving clients in the process of selecting intervention strategies has some
advantages.
This approach can help counselors avoid using strategies that a client has
already tried without apparent success. Instead, the counselor and client
together can select a strategy that seems realistic in terms of its strengths
and weaknesses.
Guidelines by Cormier and Cormier:
The counselor should provide an overview of the different treatment
approaches available,
describe the role of the counselor and client for each procedure,
identify possible risks and benefits that may result,
and estimate the time and cost of each procedure.
In addition, it is important for the counselor to be sensitive to client
characteristics, such as values, beliefs, and multicultural issues, when
selecting an intervention strategy (Cormier & Hackney, 1993).
Counselors should also be aware of a client’s personal strengths and
weaknesses in selecting a counseling approach.
For example, counselors should determine whether a client has the
necessary self-control or ego strength to utilize a counseling strategy
(Cormier & Hackney, 1993).
Smith’s (2006) strengths-based counseling model suggests that instilling
hope and optimism is believed to be a vital aspect of the counseling process
as these attitudes can act as a buffer to mental illness.
In addition, counselors can promote strengths by fostering resilience,
encouragement, and empowerment.
Problem-Solving Strategies
Kanfer and Busemeyer’s six-stage model includes
problem detection,
problem definition,
identification of alternative solutions,
decision making,
execution,
and verification.
This model is a behaviorally oriented approach that involves describing a
particular problem in behavioral terms, identifying possible solutions
associated with the problem, deciding on a course of action relative to the
various alternative solutions, implementing the decision, and verifying
whether the outcome is consistent with the expected outcome.
Heppner, Witty, and Dixon (2004) have identified the following variables
associated with problem solving and adjustment:
Effective counseling is associated with resolving clients’ problems and
enhancing problem-solving abilities (e.g., the number of alternatives
generated in problem solving is positively associated with adjustment).
Effective problem solvers are flexible and adaptive and can handle stress.
They can also develop strategies to reach their goals and satisfy their needs.
Ineffective problem solvers have difficulty solving problems and coping with
environmental stressors.
Problem-solving appraisal is related to how well clients are able to address a
wide array of life’s challenges.
Problem Solving Inventory (PSI)
Heppner and Petersen (1982) developed the Problem Solving Inventory (PSI)
as a means of investigating the role of appraisal in problem solving. In a
review of more than 120 studies that investigated problem-solving appraisal
and human adjustment, Heppner et al. (2004) concluded that the PSI is a
robust instrument useful in investigating a wide variety of areas, such as
mental and physical health, coping with stress, and educational and
vocational issues.
Problem-solving strategies can also be used in conjunction with counseling
theories.
Nystul (1995, 1999), for example, developed a four-step problem-solving
model based on Adler’s and Glasser’s theories.
This model can be used with children, adolescents, or adults and has a built-
in mechanism to enhance clients’ involvement in counseling and to minimize
client resistance.
The model can be especially useful in brief-counseling approaches.
Step 1 – Awareness of Behavior (Glasser’s Theory):
The counselor helps the client recognize problematic behaviors by adding “-
ing” (e.g., “angering”) to emphasize personal control over those actions.
Step 2 – Understanding the Purpose (Adlerian Psychology):
The client explores the psychological purpose behind the behavior, including
its origins and how it served their needs. Maslow’s hierarchy of needs is used
to identify which needs were being met. This step respects the client’s past
coping mechanisms and is key to reducing resistance to change.
Step 3 – Realizing the Cost (Homans’s Social Exchange Theory):
Clients are guided to see how their behavior, once useful in childhood, now
has more costs than benefits in adulthood. This shift in awareness increases
motivation for change.
Step 4 – Developing a New Approach:
Clients work with the counselor to create healthier strategies that meet the
same needs identified earlier but without the negative consequences, often
by learning new coping skills.
Stage 5: Termination and Follow-Up
Perhaps the ultimate goal in counseling is counselors becoming obsolete or
unnecessary to their clients, which can occur when clients have worked
through their concerns and are able to move forward in their lives without the
counselor’s assistance.
At this point, counseling can be terminated.
It is usually best for the counselor and client to agree on a termination date,
reducing the chance of premature termination or feelings of ambivalence.
Four components of termination that are
associated with positive outcomes in the
counseling process
discussion of the end of counseling,
review of the course of counseling,
closure of the counselor-client relationship,
and discussion of the client’s future postcounseling plans.
Clients can explore what they have learned in counseling and identify how
they will apply that knowledge to enhance their psychological functioning.
Clients and counselors can process their feelings regarding the counseling
relationship and work toward closure regarding potential affective issues.
Counselors can also arrange a brief follow-up counseling session (e.g.,
several weeks after the last formal session) to see how the client is doing
and provide additional counseling services as necessary
George and Cristiani (1995) identified five
types of outcome goals.
discussion of the end of counseling,
review of the course of counseling,
closure of the counselor-client relationship,
and discussion of the client’s future postcounseling plans.
Stage 6: Research and Evaluation
Research and evaluation can occur at any time during the counseling process
or after termination.
Some behavioral approaches utilize single-case or small-group research
designs that require counselors to evaluate counseling whenever they
implement an intervention strategy.
These research procedures involve face-to-face interaction between the
counselor and client.
Other research procedures, which may or may not involve direct interaction
between counselor and client, are empirical research involving hypothesis
testing and alternative methodologies, such as the discovery approach.
Research and evaluation are an integral part of the counseling process.
They contribute to the science dimension of counseling by promoting an
objective understanding of what is occurring.
Counselors can also use research and evaluation to communicate
accountability.