GUIDANCE and COUNSELING NOTES

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UNIT ONE:
Introduction to Guidance and Counseling

Introduction to the concepts

a) Defining Guidance
This is the process of helping an individual to help himself and to develop his potentialities to the
fullest by utilizing the maximum opportunities provided by the environment.

It is an assistance given to an individual to help him, to adjust to himself, to others and to his
peculiar/unusual environment.

a) Guidance helps him to understand himself.

b) It helps him in his acquaintance with the things and the world around him.

c) It helps a person to seek harmony between his personal needs and ambitions with
peculiarities of his own environment.

In relation to education,

Guidance involves the difficult art of helping boys and girls to plan their own future wisely in the
full light of the factors that can be mastered about themselves and about the world in which they
live and work.

THE PHILOSOPHY OF GUIDANCE

Guidance is universal and the basic principles of the philosophy of guidance are common to all
countries with a slight modification to suit the locally accepted beliefs and the specific guidance
services offered. The eight principles of the philosophy of guidance are;

1. The dignity of the individual is supreme.

2. Each individual is unique. He or she is different from every other individual.

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 3. The primary concern of guidance is the individual in his own social setting. The main aim
being to help him to become a wholesome person and to gain fullest satisfaction in his
life.

4. The attitude and person perception of the individual are the bases on which he acts.

5. The individual generally acts to enhance his perceived self.

6. The individual has the innate ability to learn and can be helped to make choices that will
lead to self direction, and make him consistent with the social environment.

7. Each individual may, at times, need the information and personalized assistance best
given by competent professional personnel.

THE GOALS TO ACHIEVE IN GUIDANCE

i) Exploring self

The basic aim is to help an individual increase his understanding and acceptance of
self; his physical development, his intelligence, interest, personality traits, attitudes
and values, education capacity and others.

ii) Determining values

This helps an individual to find out the importance of values, explore different sets of
values, determine personal values and examine them in relation to the norms of the
society and their importance in planning success in life.

iii) Setting goals

Guidance also aims an individual to set goals for himself and relate these to the
values determined by him so that he recognizes the importance of long range
planning.

iv) Explore the world of work

The aim here is to help an individual to explore the world of work in relation to his
self exploration, his value system and goals that he has set for him self to achieve
success in life.
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 v) Improving efficiency

The individual is helped to learn about factors which contribute to increase

effectiveness and efficiency and to improve his study habits.

vi) Building Relationships

The aim is to help the individual to be aware of his relationship with

others and to note that it is a

reflection of his feelings about himself.

vii) Accepting responsibility for the future

The individual is helped to develop skills in social and personal forecasting, acquire
attitudes and skills necessary for mastering the future.

Defining Counseling
This is a service offered to the individual, who is undergoing a problem and needs
professional help to over come it.

It can also be seen as a helping relationship between a counsellor and a client which is
aimed at helping a client to overcome his/her challenge/problem. The counsellor can
initiate, facilitate and maintain the interactive process if he communicates feelings of
spontaneity and warmth, tolerance, respect and sincerity.

Counseling therefore is a more specialized service requiring training in personality

development and handling exceptional groups of people.

Counseling as a service is only provided to those individuals who are under serious
problem and need professional help to overcome it, while guidance is needed by all at
all time.

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 NB: Both guidance and counseling assist the individual to know about himself, to adjust
to himself, to others and the environment and thus lead the individual to become a
wholesome person.

Purpose of Counseling
During counseling, there should be a focus or purpose that governs the interaction of the
counsellor and the client. Without a goal it’s not possible to evaluate the counseling process.
The following are the general goals that may be aimed at during the sessions.

a. Enhancing coping skills

Counseling generally aims at dealing and doing away with stress, anxiety, depression
or other habitual outcomes of the problem. Whatever situation a client brings to the
counseling session, the counsellor has to try and enable the client cope better with the
particular situation than before. Sometimes, the situation is unchangeable and the goal
is to help the client accept and cope with the situation.

b. Facilitate behavior change

Many of the psychological problems that clients bring to the counseling session are a
result of dysfunctional behavior. In situations where the problem is not a result of the
above mentioned, it may elicit dysfunctional responses from the client. In both cases,
the client needs to be helped to identify and recognize the dysfunctional behavior or
response and also to move ahead and adopt more functional behavior or responses.

c. Improve interpersonal skills.

Some of the problems that clients bring to the counseling session may have their
origin from those who relate to the client. At the same time when the client is not
coping well with a particular crisis in their life, the people around the client may
suffer too.

d. To encourage individuals think about the problems and come to a greater

understanding of it and how best it can be solved.

e. To provide individuals with an option that can help in solving the problems.

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 f. To assist individuals take decisions about actions required to solve problems.

QUALITIES OF A GOOD COUNSELOR

Counsellor Personal Qualities

There are fundamental qualities that make a good counsellor. The following are some
of the important qualities a counsellor should have.

i. Good will

This refers to the willingness and ability to be sincerely concerned, interested and to
show care by working for others well being. It’s a positive attitude towards
betterment and the willingness to sacrifice one’s time, energy and emotional support
to see another better off than before.

ii. Availability

This is the ability to be present for others when they need you. Availability does not
only refer to physical presence but also involves emotional presence.

iii. Knowing own limits

This refers to the availability to do a self evaluation to accept what you can do and
what you can’t do. This enables you to discover the kinds of clients you can handle
and what problems you can’t handle.

iv. Being vulnerable

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 This refers to the willingness to be open to hurt or pain. The decisions that a counsellor
makes together with a client involves risk and sometimes options taken may backfire.
In such a case, the client may become a counsellor.

v. Self respect

This is the willingness to be a role model in both your private and public behavior.
This is very important because clients have certain expectations about the counsellor.
The counsellor usually shares important information and life expectations.

vi. Confidentiality

The counsellor has to be a person who is able to keep secrets or who does not find it
hard to keep back information concerning the client’s problems.

Counsellor Interpersonal Skills

i. Social Intelligence

This refers to a good common sense, power of judgment and prediction. The
counsellor has to be quick to assess what has to be done in a particular
situation. He or she has to be able to imagine and predict what is likely to
happen when a session takes a particular direction. When a counsellor is
working with more than one person, the counsellor has to be intelligent enough
to steer the session while minimizing the conflicts that may come up between
the parties in the session.

ii. Good communication skills

This is the ability to listen and show interest and also sensitivity towards the
clients’ communication. Communication is also the ability to respond to what

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 the client has said accurately. Although the primary work of the counsellor is to
listen, it does not mean that a counsellor remains silent throughout the session.

iii. Patience

Sometimes patients move in circles and the counsellor has to be patient not to
give up on such a client. The counsellor has to be competent in enabling the
client explore his world of experience, his feelings and behavior.

iv. Action oriented

The counsellor has to be action oriented and this requires developing a

complete plan of action in relationship to the client. The plan has to be
reviewed from time to time and assessment has to be made as to how the client
has gone on terms of solving or implementing the plan of action.

v. Concentrative

The counsellor should be able to work on a single individual or group. The

counsellor should be a person who is capable of working with individual
persons or groups of people. In addition the counsellor should not be a person
who becomes tense of meeting a client/meeting a group of people.

Counsellor Attending Skills

These refer to what a counsellor is supposed to do in attending to the client during a

session. It’s important for the counsellor to know the state in which the client has
come into the counseling relationship. This can be easily answered when the

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 counsellor simply asks what the client would like the counsellor to do for him/her.
What the client expects from the counselor.

This gives the counsellor the opportunity to clarify on some of the misconceptions that
a client may have about what the counsellor is supposed to do for him/her. E.g. some
clients come discouraged, thinking that it’s not proper for them to receive help for
their problems.

For all these elements to be gratified in the counseling session, the counsellor is
expected to have attending skills as summarized:

S----Squarely facing the client (position that indicates that you’re available and
attentive to what the client is saying).

O----Open Posture (Having your hands open out and not closed up/rapped across the
chest. Being open communicates to the client that you’re available and ready to
receive the client and the client’s communication).

L---Leaning forward (A posture that communicates involvement and interest).

E---Eye contact (An act that encourages the client to open up).

R---Being relaxed and settling down.

Challenges facing the counselling profession

1. Inadequate Training and application. Actual counselling settings are not adequate to
expose trainees to practical counselling.
2. Limited awareness and understanding of the counselling process in many settings. There
are many people who do not see the relevance of counselling as a service hence not going
for the service.

3. Recognition of counselling as a profession in some countries is still lacking.

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 4. Stress and burnout. Overload of work causes stress to counsellors especially in settings
with limited service providers like in the developing countries. Usually client issues lead
to emotional exhaustion in the counsellor.

5. Low payment/Salary. In many settings counsellors are paid low salaries because they
believe that counselling only involves taking and listening.

6. Balancing ethical issues in a counselling session is a challenge. In critical cases like

suicide, deciding how much information to share with the family is always difficult.
Sometimes conflict of interest may affect the quality of a counselling session. Playing
roles like that of a parent or school teacher instead of being a counsellor.

7. Weakness of the licensing body for counsellors. UCA still not effective in its roles.

8. Professional development of counsellors still low in many settings as there is not clear
supervision for counsellors to evaluate performance.

9. Balancing between personal and professional conduct. We are humans before we become
counsellors. Therefore it is difficult to maintain a neutral position while providing the
counselling service.

Counseling Theories and Approaches

Psychotherapy theories provide a framework for therapists and counselors to interpret a
client’s behavior, thoughts, and feelings and help them navigate a client’s journey from
diagnosis to post-treatment. Theoretical approaches are an understandably integral part of

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 the therapeutic process. But with so many different methods out there, how do you know
which counseling approach works best for you?

Psychoanalysis/Psychodynamic Theory

Psychoanalysis or psychodynamic theory, also known as the “historical perspective,”

has its roots with Sigmund Freud, who believed there were unconscious forces that drive
behavior. The techniques he developed, such as free association (freely talking to the
therapist about whatever comes up without censoring), dream analysis (examining
dreams for important information about the unconscious), and transference (redirecting
feelings about certain people in one’s life onto the therapist) are still used by
psychoanalysts today.

In general, psychotherapists and counselors who use this approach direct much of their
focus and energy on analyzing past relationships and, in particular, traumatic childhood
experiences in relation to an individual’s current life. The belief is that by revealing and
bringing these issues to the surface, treatment and healing can occur. This theory is
highly researched, and as the field of neuroscience advances, counselors are finding how
psychodynamic theory can actually positively affect a client’s brain. Psychodynamic
theory can be more time intensive in comparison to some short-term theories because it
involves changing deeply ingrained behaviors and requires significant work on
understanding one’s self.

Freud distinguished three states of mind, which were the conscious, which is what we
are aware of in the here and now, the preconscious, which consists of things we can
bring back easily into consciousness from our memory, and the unconscious, which
stores all the thoughts, feelings and ideas we have during our life. These thoughts
cannot be brought easily into consciousness and they can have a major influence on our
feelings and our behaviour in the here and now.

Freud was particularly interested in the unconscious part of the mind and through his
approach he tried to reach the repressed thoughts and memories and bring them into
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 consciousness. This was so as his clients could have an insight into their problems and
try to overcome them with psychoanalytical support and to bring them to a better state
of mental health.

Through his work, Freud discovered that the mind consists of three interrelated
systems, which for Freud, was a useful way of thinking about how personalities develop.
These three systems are; the id, which is a mass of powerful pleasure-seeking instincts,
the ego, which acts according to the reality principle and has to find safe and acceptable
ways to satisfy the id’s basic demands, and the super ego, which is like our conscious. It
is concerned with right and wrong, and it incorporates the moral values which a person
learns initially from their parents. These three systems are constantly in tension with
each other, for example the id and the super ego are usually in direct conflict, while the
ego acts as a neutral and therefore it makes an individual balanced.

Behavioral Theory

Behavioral theory is based on the belief that behavior is learned. Classic conditioning is
one type of behavioral therapy that stems from early theorist Ivan Pavlov’s research.
Pavlov executed a famous study using dogs, which focused on the effects of a learned
response (e.g., a dog salivating when hearing a bell) through a stimulus (e.g., pairing the
sound of a bell with food).

B. F. Skinner developed another behavioral therapy approach, called operant

conditioning. He believed in the power of rewards to increase the likelihood of a behavior
and punishments to decrease the occurrence of a behavior. Behavioral therapists work on
changing unwanted and destructive behaviors through behavior modification techniques
such as positive or negative reinforcement.

Behaviourism is focused towards the external factors in a person’s environment that

would affect how they behave. The behaviourist approach began with John Watson who

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 believed that psychology should be studied by observing a person’s behaviour because
he was interested in what people did rather than what they thought of.

Ivan Pavlov accidentally discovered the conditioned reflexes while studying a dog’s
digestive process. Pavlov then developed laws of conditioning to establish classical
conditioning. Pavlov stated that the process of classical conditioning was able to explain
all of the aspects of human psychology, which was everything from speech to emotional
responses that were patterns of stimulus and response.

Cognitive Theory

In the 1960s, psychotherapist Aaron Beck developed cognitive theory External link. This
counseling theory focuses on how people’s thinking can change feelings and behaviors.
Unlike psychodynamic theory, therapy based on cognitive theory is brief in nature and
oriented toward problem solving. Cognitive therapists focus more on their client’s
present situation and distorted thinking than on their past. Cognitive and behavioral
therapy are often combined as one form of theory practiced by counselors and therapists.
Cognitive behavioral therapy, or CBT, has been found in research External link to help
with a number of mental illnesses including anxiety, personality, eating, and substance
abuse disorders.

Cognitive approach analyses behaviour in terms of the Activating events, Beliefs and the
emotional or behavioural Consequences (ABC). Two Americans, Albert Ellis and Aaron
Beck came to the same conclusion and so they developed the cognitive approach to
understanding problem behaviour. It was called cognitive because it focuses on
thinking.

The cognitive approach says that thinking and feeling come between the stimulus and
the response and in order to help people who have problems with their behaviour,
counselors need to help them examine what they think and feel.

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 The cognitive approach assumes that what people think and what they believe are quite
rational, but sometimes their thinking is distorted and this can lead to social, emotional
and behaviour difficulties.

Humanistic Approach/ Client Centered Counseling

Humanistic therapists care most about the present and helping their clients achieve their
highest potential. Instead of energy spent on the past or on negative behaviors, humanists
believe in the goodness of all people and emphasize a person’s self-growth and self-
actualization.

Humanistic theories include client-centered, gestalt, and existential therapies. Carl Rogers
developed client-centered therapy, which focuses on the belief that clients control their
own destinies. He believed that all therapists need to do is show their genuine care and
interest. Gestalt therapists’ work focuses more on what’s going on in the moment
versus what is being said in therapy. Existential therapists help clients find meaning in
their lives by focusing on free will, self-determination, and responsibility.

The humanistic approach, which is also known as the person-centered approach,

focuses on the individual person’s thoughts, feelings, and experiences. It is based on
the idea that a person has a natural tendency to grow and develop as a person in a
psychological sense.

Two key figures within the humanistic approach are Abraham Maslow and Carl Rogers.
Maslow is best known for his hierarchy of needs and this describes the needs which
have to be met in order of priority for a person to become fully complete as a person.
There are six levels of needs, which are; Physiological needs, which are a person’s most
basic needs like food, air and water, Safety needs, which is to avoid pain and harm,
Belongingness which is a person’s need to belong and feel secure, Love needs, which is
to love and be loved in return, Self-esteem needs, which is the need to feel that a

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 person is worthwhile, and finally Self-actualization needs, which is at the very top and it
is the need to become a whole and intergraded person.

“The Humanistic Approach began in response to concerns by therapists against

perceived limitations of Psychodynamic theories, especially psychoanalysis. Individuals
like Carl Rogers and Abraham Maslow felt existing (psychodynamic) theories failed to
adequately address issues like the meaning of behaviour, and the nature of healthy
growth. However, the result was not simply new variations on psychodynamic theory,
but rather a fundamentally new approach.” (The Humanistic Approach)

Humanists believe that it is necessary to study the person as a whole, especially as an

individual grows and develops over the lifespan. The study of the self, motivation, and
goal-setting are also areas of special interest.

Existential Therapy

This is a form of psychotherapy that looks to explore difficulties from a philosophical

perspective. It focuses on the human condition as a whole and it highlights our
capacities and encourages us to take responsibility for our successes.

This therapy also focuses on concepts that are universally applicable to human existence
including death, freedom, responsibility and meaning of life.

Existential Therapy focuses on free will, self-determination, and a search for meaning
often centering on you rather that on the symptom. The approach emphasizes your
capacity to make rational choices and to develop to your maximum potential. This
approach stresses that;

a) All people have the capacity for self-awareness

b) Each person has a unique identity that can be known only through relationships with
others.

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 c) People must continually re-create themselves because life’s meaning constantly
changes.

d) Anxiety is part of human condition.

Mindfulness-Based counselling

Mindfulness-based cognitive therapy (MCBT) is a type of psychotherapy that involves a

combination of cognitive therapy, meditation, and the cultivation of a present-oriented,
non-judgmental attitude called mindfulness.

This therapy is a modified form of cognitive therapy that incorporates mindfulness

practices such as meditation and breathing exercises. Using these tools, therapists teach
clients how to break away from negative thought patterns that can cause a downward
spiral into a depressed state so they will be able to fight off depression before it takes
fold.

This approach was developed for people with recurring episodes of depression or
unhappiness, to prevent relapse. It has been proven effective in patients with major
depressive disorder who have experienced at least three episodes of depression.

More so this is an approach to psychotherapy that uses Cognitive behavioral therapy

(CBT) methods in collaboration with mindfulness meditative practices and similar
psychological strategies. This approach was originally created to be a relapse preventive
treatment for individuals with major depressive disorder.

Rational Emotive Therapy

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 Rational Emotional Behavioral Therapy (REBT) is a type of therapy introduced by Albert
Ellis. It’s an approach that helps you to identify irrational beliefs and negative thought
patterns that may lead to emotional or behavioral issues.

Once you have identified these patterns, a therapist will help you develop strategies to
replace them with more rational thought patterns. This therapy is particularly helpful for
people living with a variety of issues, including;

a) Depression
b) Anxiety

c) Addictive behavior

d) Phobia

e) Overwhelming feeling of anger, guilt or rage

f) Procrastination

g) Disordered eating habits

h) Sleep disorders

Reality Therapy

This is a form of counselling that views behaviors as choices. It states that psychological
symptoms occur not because of mental illness but due to people irresponsibly choosing
behaviors to fulfil their needs.

It is a client centered form of cognitive psychotherapy that focuses on improving

present relationships and circumstances while avoiding discussion of past events. This
approach to counselling and problem solving focusses on the here and now actions of
the client and the ability to create and choose a better future
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Integrative Therapy

Holistic and integrative therapy involves integrating various elements of different

theories to the practice. In addition to traditional talk therapy, holistic therapy may
include nontraditional therapies such as hypnotherapy or guided imagery. The key is to
use the techniques and psychotherapy tools best suited for a particular client and problem.

UNIT TWO

Communication in Counseling

Defining communication

Communication is a process of exchanging information, ideas, thoughts, feelings and emotions

through speech, signals, writing, or behavior.

The Communication Process

The Communication process is the guide toward realizing effective communication. It is through
the communication that sharing of a common meaning between the sender and the receiver takes
place. Individuals that follow the communication process will have the opportunity to become
more productive in every aspect of their profession.

The communication process is made up of four key components. These include encoding,
medium of transmission, decoding and feedback. The communication process begins with the
sender and ends with the receiver. It is as shown below:
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The sender/ Source

This is the person who conceives an idea and wants to share it. To communicate it, he must first
think along these lines;

Encoding

This is a process of transforming the idea/ thought into a message that the receiver will
understand. The sender has to decide the specific outcomes he wants from communication. This
will help him decide on the appropriate form of language and tone.

Channel/ Medium

This is a means by which a message is sent. It’s the physical transmission of the message to the
receiver.

Decoding

This is where the receiver converts the message into thought. The receiver must understand the
language of the sender and he also makes sure that he uncovers the hidden meaning, feelings or

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 attitudes which the sender has conveyed in the message. The decoded message is stored in the
receiver’s mind.

Receiver

This is the person for whom the message is meant. He is responsible for decoding and
interpreting the message sent.

Feedback

The communication process cannot be successful without appropriate feedback. The receiver
reacts to the sender by giving a feedback. Feedback is the receiver’s response to the message of
the sender and the final link in the communication process. It’s the stage at which the sender
evaluates the effectiveness of the communication process.

Communication can best be summarized as the transmission of a message from a sender

to a receiver in an understandable manner.

The communication process is the guide toward realizing effective communication. It is

through the communication process that the sharing of a common meaning between the
sender and the receiver takes place. Individuals that follow the communication process
will have the opportunity to become more productive in every aspect of their profession.
Effective communication leads to understanding.

Noise is also another common barrier. Noise can occur during any stage of the process. Noise
essentially is anything that distorts a message by interfering with the communication process.
Noise can take many forms, including a radio playing in the background, another person trying
to enter your conversation, and any other distractions that prevent the receiver from paying
attention.

IMPORTANCE OF FEEDBACK:

a) Information obtained from feedback can be used in decision making.

b) Completes the communication cycle.

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 c) Confirmation that the message was received.

d) Used as a tool to assess whether the communication was successful.

e) A measure of performance.

BARRIERS TO EFFECTIVE COMMUNICATION

1. Noise
This is the physical sound or mental disturbance that disrupts the flow of communication on
either the sender or receiver’s sides. It can be physical noise that is sound coming from the
surrounding environment or psychological noise (mental disturbance) e.g. preoccupation,
tiredness, anxiety, stress etc.

2. Prejudices
This is bias and prejudging the receiver conditioned by what we already know and our
background knowledge and experience. Sometimes people under look one another because of
status, origin etc (we often want to hear what we want to hear or what we think we have
heard instead of what has actually been said.

3. Inattentive listening
Listening is a skill and careful concentration is demanded if communication is to be
understood. Success at gaining attention depends on the words used, the way the
communication is expressed, our interest in the speaker, in the communication and other
factors.

4. Language barrier
In effective communication, the choice of words is very vital. Many words or gestures have
different meanings. Foreign language, dialects, regional accents and the use of technical or
specialist language should be considered.

5. Emotional responses

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 Communication cannot succeed if a person is highly emotional about the topic concerned.
Problems may arise from insecurity, resentment, anger, fear etc, this makes a person
preoccupied with emotions to receive and send the intended message. If emotions are high on
the part of the sender or the receiver/recipient, it is better to wait for a while before trying to
put the message across.

6. Information over load and under load

If you receive a message with too much or too little information you may tend to put up a
barrier because the amount of information is coming so fast or so slow that you may have
difficulty in interpreting the information. Excess information may confuse the receiver as he
has to figure out the exact importance of the message and scanty information would make
him grope for the actual intent of the message.

7. Differing perceptions
Our minds organize this stream of sensation into a mental map that represents our
perception or reality. In no case is the perception of a certain person the same as the world
itself and no two maps are identical. Because your perceptions are unique, the ideas you want
to express differ from other people. As senders, we choose the details that seem important
and focus our attention on the most relevant and general that is selective perception. As
receivers, we try to fit new details in our existing pattern thus distorting the information.

8. Differing backgrounds
Age, education, gender, social status, economic position, religion, political beliefs e.t.c can
all separate one person from another and make understanding difficult.

9. Poor planning

10. Lack of feedback rendering the communication process incomplete

FACTORS THAT INFLUENCE COMMUNICATION.

a) The method chosen when communicating is very crucial.

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 b) Recipient-who is receiving the message, appropriate language, the situation at hand,
relationship between the sender and the receiver.
c) Distance-is it within or far away.
d) Time –when communicating overseas.
e) Urgency-is it so urgent that you need feedback immediately.
f) Written record-written communications carry more authority and a proof of a transaction.
g) Cost-affordability, how much will the communication cost.
h) Confidentiality-e-mail or fax may not be appropriate; a telephone call could be overheard.
i) Safety and security

Forms/Types of Communication

People communicate with each other in a number of ways that depend upon the message and its
context in which it is being sent. Choice of communication channel and your style of
communicating also affect communication. So the forms of communication include;

1. Verbal Communication
2. Nonverbal Communication

Verbal Communication

Verbal communication refers to the form of communication in which message is transmitted

verbally; communication is done by word of mouth and a piece of writing. Objective of every
communication is to have people understand what we are trying to convey. In verbal
communication remember the acronym KISS (keep it short and simple).

Verbal Communication is further divided into:

a) Oral Communication
b) Written Communication

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Oral Communication

In oral communication, Spoken words are used. It includes face-to-face conversations, speech,
telephonic conversation, video, radio, television, voice over internet. In oral communication,
communication is influence by pitch, volume, speed and clarity of speaking.

Written Communication

In written communication, written signs or symbols are used to communicate. A written message
may be printed or hand written. In written communication message can be transmitted via email,
letter, report, memo etc. Message, in written communication, is influenced by the vocabulary &
grammar used, writing style, precision and clarity of the language used.

Nonverbal Communication

Nonverbal communication is the sending or receiving of wordless messages. We can say that
communication other than oral and written, such as gesture, body language, posture, tone of
voice or facial expressions, is called nonverbal communication. Nonverbal communication is all
about the body language of speaker.

Key Communication Skills in Counseling that every Counselor should have

1. Listening Skills
2. Attending Skills

3. Providing basic empathy

4. Ability to summarize

5. Paraphrase

6. Probing skills

7. Ability to integrate other communication skills

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 8. Asking questions

EFFECTIVE COMMUNICATION IN COUNSELING

LISTENING AS A COMPONENT IN COUNSELING

Listening is the absorption of the meanings of words and sentences by the brain.

Listening leads to understanding of ideas and facts. It takes attention or sticking to the task in spite of
distractions. Listening is half of oral communication. In other words, if someone communicates and there
is no one to listen, then communication becomes incomplete.

NOTE: The difference between listening and hearing is that, hearing is physical. Listening involves
following and understanding the sound- it is hearing with a purpose.

TECHNIQUES FOR EFFECTIVE LISTENING

What is effective listening?

This is actively absorbing the information given to you by the speaker, showing that you are listening and
interested, and providing feedback to the speaker so that he or she knows the message was received.
Effective listeners show speakers that the listeners have heard and understood the message being
communicated.

Process of listening

For listening to be effective, the following stages must be considered;

(i) sensing ;This involves physical hearing of the message and one takes note of it .The
efficiency of this stage will be affected by various external factors like noise, poor hearing
and lack of attention.
(ii) Interpreting; this involves perceiving the speaker’s message basing on your own experiences
expectations, your own values, beliefs and needs.

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 (iii) Evaluating: It is important to consider the points mentioned and assess their importance; one
should separate facts from opinions and assess the quality of these facts provided by the
speaker.
(iv) Remembering; this involves storing the message for future reference .One may take notes as
he/she is listening or make a mental note of key points.
(v) Responding: When you are given chance to evaluate the speaker’s message, it is important
to give verbal feedback, nods or sounds of agreement.

TYPES OF LISTENING

1- Competitive listening; this happens when we are more interested in promoting our own point of view
than in understanding or exploring someone’s view. We either listen for opening to take the floor or for
flaws or weak points we can attack. As we pretend to pay attention we are impatiently waiting for an
opening or internally formulating our plan to devastate their arguments and make us the victor.

2- Active listening ;this is the most useful and important listening skill in active listening we are also
genuinely interested in understanding what the other person is thinking, feeling, wanting, or what the
message means. It involves understanding and reflecting on the message in order to send feedback.

GOOD LISTENING SKILLS

1. Establish eye contact with the speaker.

 Studies show that listening has a positive relationship with eye contact while the speaker is
speaking. This interrupts your brain and adds distraction to the speaker.
 Focus on the visual aid only when it is an asset to the point being discussed.
 Don’t get so involved in taking notice that you fail to often look at the speaker. The speaker’s
gestures, movements and facial expression are often an important part of the message. Etc.

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2. Want to listen
This suggestion simply says that, you must have an intent to listen. We can recall having been forced to
listen to a speech or briefing that we didn’t want to listen to. This listening seldom results in
understanding or enjoyment. Therefore, we should always clear our mind and prepare to listen.

3. Avoid pre-judgment/ Don’t be biased

Never pre- judge the speaker because of appearance, occupation and do not make any conclusions
before hearing what is said. Remember you cannot evaluate the importance of the message from the
speaker until you have heard it.

4. Give positive feedback

It is always important to give positive feedback non-verbally. You can give feedback by:-

Looking and acting interested. Positive head nods, alertness and smiles all offer encouragement to the
speaker. Share information with the speaker- we tend to tell things to those who tell us things.

5. Judge content not delivery

You must appraise the content and not the speaker. Weigh the merits of what the speaker is saying. Focus
on the main issues to see whether they have some sense in them.

6. Extract key points

You can pick out and repeat to yourself key words and phrases to help you fix in your mind what is
being said. Take notes effectively- Don’t attempt to write everything down.

7. Follow the golden rule

Do to others what you would have them do unto you. The effective listener is always other directed,
focused on the other person. In other words, be the kind of listener you want others to be when you are
talking. Ask “How would I want others to listen to me?” That’s how to be an effective listener.

8. Block out distractions

Fight distractions and other competing thoughts if you are to be a good listener. Everyone has
mannerisms.

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BARRIERS TO EFFECTIVE LISTENING IN A COUNSELLING SESSION

If you are to become a good listener, it is important to be familiar with and conquer a number of physical
and mental obstacles.

 Pre-judgment ;most people function in life through some basic principles and assumptions ,so
some listeners jump to conclusions or close their mind to new information on anything that does
not agree with their beliefs.
 Selfishness; some people prefer not to listen but to take control of conversations. It doesn’t
matter what the subject is, the selfish listener believes he/she knows more than the speaker and
they set about to prove it by relating their own experiences and their own problems and belittling
the speaker’s comments (they are supercilious).
 Selective listening: selective listeners let their minds drift around all over the place perhaps
wondering whether they will go for lunch or what they will do after work. They tune out until
they hear something that attract their attention and then they turn back in again temporarily
 Criticizing the communicator. Do not be destructed by critical evaluation of the speaker. Focus
on what they are saying –the message rather than the speaker.
 Understanding speech rate vs. thought rate .Speech rate (125words per minute ) is usually much
slower than the rate at which we think (600-800words per minute) you may need to focus on
using that extra mental time to clarify and organize in your mind what the speaker is going to say.
 Experiencing information overload; too much stimulation or information can make it very
difficult to listen with full attention Try to focus on relevant information and central points that
are being conveyed.
 Hearing external noise: audible noise may be extremely destructing.
 Experiencing physical difficulty; feeling physically unwell or experiencing pain can make it very
difficult to listen effectively. You may to wish to communicate that this is not a good time and
reschedule the discussion.
 Language difference or accent

BUILDING COUNSELLOR/ --CLIENT RELATIONSHIP

Effective Counselor - Client Communications

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Limited appointment time, the ability of clients/patients to do their own research which then
needs to be discussed with practitioners/counselor, and the general behavior of the client; these
challenges and others make effective communications between clients/patients and their
practitioners more important than ever. Good communications really boils down to two things:
respect for each other, and the ability to manage expectations.

How to encourage a client to talk in a counselling Session

1. Ask focused questions during a counselling session. From the start of the first session,
you have to always ask the right questions during therapy.

2. Be welcoming. Create a safe environment for the client. Provide some comfort to the
client.

3. Build a strong relationship. A robust bond between the therapist and a client determines
the success of a counselling session for example emotional bonding and agreement with
the client and the therapist goals.

4. Do an exit interview. These interviews reveal what is valuable and provide feedback on
areas of improvement. For example find out if the client feels comfortable with you or
ask a client if you are setting the right tone for the client.

5. Listen actively well to your clients

6. Stay in touch or follow up with your client.

How to Improve Counselor—Client Communication

1. Educate yourself to help your client in a realistic way

2. Prepare for your counselling appointment.

3. Think about how you speak to the client / selection of the words and language

4. Have realistic expectations for your client

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5. Listen to your client

Importance of Feedback in Counselling

1. It helps to understand a clients’ subjective experiences

2. Helps to activate a quality relationship

3. Feedback acts as a confirmation that the message was received.

4. It allows or supports clients’ abilities to choose their goals and how to meet them

5. It makes it clear what is needed, how they are doing and how they can improve.

6. Feedback also instills a feeling of support and recognition.

7. It supports easy resolving of conflicts

8. Feedback in counselling acts as a motivation tool in a counselling session

9. Information gained from feedback can be a basis for decision making in resolving the
problem of a client.

Measures to overcome the barriers of communication in counselling

1. Clarify ideas before communicating them to the client

2. Communicate according to the needs of your client.

3. Consult with others before you can communicate

4. Be aware of the language you are using, tone and content of the message

5. Convey information that is of help and value to your client.

6. Consistency in the message

7. Follow up your communication

8. Be a good listener.

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Effective communication channels
1. Face to face communication. This is the most common and the most effective way of
ensuring effective communication.

2. Video conferencing

3. Use of phone calls

4. Use emails

5. Online messaging platforms

6. Use of social media

7. Focus group discussions

8. Through use of text messages

Summary of effective counselling skills

1. Communication skills : Every counsellor needs excellent communication skills to
effectively talk to a range of different people.

2. Interpersonal Skills : This is the ability to build relationships with the different people
that come for the counselling service.

3. Ability to understand ethics surrounding the profession. This may for example involve
ensuring confidentiality that ensures the clients’ safety and well-being.

4. Patience when working with the clients. You must know that sometimes counselling
results take long to be achieved. So you have to be patient.

5. Counsellors should have compassion. This is the ability to help others and to empathize
with them.

6. Emotional stability. You should have a strong emotional feeling and the ability to handle
the stress and emotional turmoil caused by people who are distressed.

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 7. Knowledge of laws and regulations.

8. Trustworthiness. You must be trustworthy and be able to inspire your clients to confide in
you and with their problems otherwise they wont improve or return to you.

9. Research skills. You must know how and where to find the information you need and
evaluate it effectively. This applies where you are trying to help a client by seeing what
other solutions have been tested.

10. Problem solving skills: you need to be able to solve problems as they arise. You must
have alternative strategies available and be able to implement them fast to ensure your
client can move forward.

11. Observations skills: you must be able to observe a person’s facial expressions, body
language and social interactions during the counselling session to determine clients’
attitude and behavior.

12. Reasoning skills: you need reasoning skills so you can see subtle connections between
problems that don’t seem related. This means you must be able to take a broader view of
human behaviors and find similarities or general principalities at play instead of focusing
on the individual details of a case.

13. Genuine interest in others.

14. Self -reflection

15. Ability to listen

16. Flexibility.

UNIT THREE

The Counseling Process

Introduction

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 There is a natural progression that takes place within the context of the helping
relationship (counselling). This process enables you and the person you are working with
to build a relationship, assess the situation, set goals and come up with a plan to bring
about your desired results. This progression is known as the counseling process.

Often, the progression of counselling depends on the method used by the counsellor and
the goals of the client; however there are standard steps that are acknowledged by all
practitioners.

There are four stages of the counseling process, these are: developing a relationship,
making an informed assessment, establishing mutually agreed upon goals and objectives
and developing an implementation plan.

Phase 1: Developing A Relationship

Every counsellor begins with developing a positive helping relationships with his/her
client; you’ve got to be able to connect with them. This can only happen when clients
are made to feel like you genuinely care about their well-being and that you understand
where they are coming from. It’s about behaving in a way that demonstrates the core
conditions of genuineness, respect and empathy.

To develop solid relationships with clients, you need to create a safe environment where
people will feel comfortable enough to open up to you and talk to you about anything that
is on their minds.

You also need to help clients see that despite their circumstances they have strengths. In
short, you should start things off from a strengths-based perspective.

Questions to Consider When Trying to Develop A Relationship

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  In what ways can you build better relationships with the client(s)?

 If there are clients who are not actively engaged, what can you do differently to
engage them?

 If a client is resistant, what steps can you take to reduce resistance?

 How do you know when you’ve built a solid relationship with a client? Could you
use these indicators to strengthen your relationships with other client?

Phase 2. Making an Informed Assessment

An informed assessment happens when both you and the client gather information in
order to figure out what’s “really” going on so that you can assess what needs to
happen next in order to change the situation for the better or build up the client’s coping
skills to better deal with a problematic situation.

The first step in making an assessment is to find out if change is necessary, and if it is,
what needs to happen for change to take place?

If you have determined that change is necessary, then the next step is to figure out what
needs to change. Is it a behavior? An attitude? A situation?

A good assessment can provide an opportunity for a person to see how his/her behavior
or attitude might be contributing to an undesirable or unhealthy situation. Assessment is
an ongoing process. You need to regularly check in with your client to see how things are
going. Reassessments enable you to ensure that you and the client are on the right track.

How do you gather information in order to make an informed assessment? You can
gather information in a number of ways:

a) Talking with client,

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 b) Observing the client’s behavior and interactions,

c) Discussions with other people who are involved in the person’s life (client), and

d) Reading any documented information on the person. Keep in mind that when
utilizing someone else’s verbal or written report as a source of background
information, you run the risk of subjecting yourself to their biases and
assumptions.

Points to Keep In Mind When Making An Assessment

 Be aware of your biases and how they impact on the assessments you make.

 Involve client in the assessment process.

 Don’t rely on one single source to make an assessment, gather as much information
as you can from a variety of sources.

 Don’t automatically label a behavior as dysfunctional because you don’t understand

it, or it is not germane/connected to your culture.

 Make sure to point out a client /person’s strengths even when addressing
problematic behavior.

Phase 3. Establishing Mutually Agreed Upon Goals and Objectives

Why is it important to establish “mutually agreed” upon goals and objectives? Because
if a person is in agreement with the goals, then he/she is more likely to follow through on
them.

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When a client is actively involved in the goal setting process and is in agreement with the
goals, then he/she is more inclined to take ownership of the goals.

What are goals? Goals are broad statements that identify what you want to accomplish.
Think of goals as the end result that you are trying to achieve.

While goals are broad statements that identify what you want to accomplish overall,
objectives are the measurable steps that you take to achieve your goals. For example if
you have a goal that states, “Client will be better able to manage her anger.” One of
your objectives might be, “client will recognize emotional triggers that lead to angry
outbursts and use positive, self-talk to calm herself down.”

Your objectives should always be concrete and measurable. They should also be derived
from the overall goal.

Questions to consider when developing goals and objectives

 What do you and the client want to achieve?

 How are you going to achieve it?

 When do you want to achieve your stated goal?

 What obstacles do you anticipate?

 How will you address these obstacles?

 How will you use to measure and monitor progress?

 Are your goals realistic?

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Phase 4. Implementation Plan

The implementation plan is a plan that you and the client work on together. It is designed
to prevent, intervene, or address unhealthy behaviors and practices.

The implementation plan identifies who will perform the activities, where the activities
will occur, how frequently they will occur, how they will be carried out and when they
will be carried out.

Implementation activities are designed to help individuals re-think risky behavior, work
through problematic issues, address unhealthy lifestyles practices, learn new skills and
build strengths. Implementation activities can include: counseling, crisis intervention,
training and education, supportive services, concrete services and constructive use of free
time.

Note:

As you can see, each stage of the counseling process builds upon the former. As you
move through each stage, you will come to realize that it takes patience and practice to
counsel client effectively, but if you are committed to the goal you’ll do just fine. You
may not feel completely confident in your ability as a counselor, but as you expand your
knowledge base, gain more experience and strengthen your helping skills, you will
become a more effective counselor.

Termination of the counseling relationship

Ideally, termination occurs when the goals that are mutually agreed upon by the
counselor and client have been achieved, or the problem for which a client has entered
into counseling has become more manageable or is resolved.

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Termination is the final stage of the counseling process but is not something that should
be broached during your last (or next to last) session with a client. Doing so does not
allow for the proper amount of time for counselor and client to process what termination
means, how the client will handle the conclusion of the counseling relationship, and what
follow-up contact or transitioning needs to happen for the client. Termination should be
among the first topics that you and your client discuss.

Kramer (1990) clearly articulates this when he writes: “The therapist must be clear from
the first contact, unless there are mitigating circumstances that the intent of treatment is
to help the (client) function without the therapist.”

As a counselor, you are ethically bound to communicate to your client how long you will
be available to counsel them, to discuss openly the timeline of your relationship, and to
make appropriate referrals or recommendations at the conclusion of your relationship.

It is a stage of counseling that clients need to be prepared for and counselors need to
address early on in the counseling process to avoid abandonment.

Guidelines in terminating a counseling session

a) Remind clients of the approaching ending of the sessions with you. This should be
done at least 2-3 sessions prior to the final one (5minutes before the session if
meeting once). This provides you an opportunity to ask clients to talk about
relationships that have ended in their past, how they have ended, and how that might
affect the end of this counseling relationship (Recap).

You can also ask clients what they would like to focus on during their remaining time
with you. A question to ask prior to the final one, which may help to prepare clients
for the reality of the end, is "If this were our last meeting, how would that be for
you?"

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b) Review the progress that you and the client have made during your sessions. Very
often, clients will forget the advances they have made, or neglect to give themselves
credit for their accomplishments. Doing this with them can instill confidence and
provide them with a positive perspective on what counseling helped them to do.
c) Allow clients to talk about their feelings surrounding termination. They will likely
have many emotions to work through and time should be spent acknowledging and
processing them.

d) Be aware of your own feelings surrounding the termination process. It is normal to

feel many emotions when ending a relationship with your clients. Acknowledge your
feelings, your ambivalence about termination, etc. Always keep in mind that your
ultimate goal as a counselor is to "put yourself out of business."

e) If possible, have an open-door policy. Once termination has ended, clients may want
to return a few months or years later to refocus or to "check-in". This is often
impossible in the training setting, but something to keep in mind for your professional
career.

f) Review the tools and skills that clients have acquired through the counseling process.
These tools will be critical in helping clients be self-sufficient in handling problems
that might have previously brought them to counseling. If there are additional
resources that you feel your client would benefit from for continued personal growth,
make appropriate referrals and make your client aware of them.

When to terminate a counseling session

 After the client has gained insight into his problem and has been able to cope with it
or resolve it and the counselor sees clearly that the client is using the relationship for
dependency.

 When client proves uncooperative, for example if the client is transferred to another
counselor or refereed to another without knowledge of the initial counselor.

39
  If the problem is beyond the competence of the counselor, he/she should refer client
to another specialist.

 If you have got a suitable referral for your client in case he needs more support.

 If a client becomes hostile in the counselling session.

Referral in Counseling

As you continue to listen to people’s problems you realize that they need help from
qualified professionals. By taking this action you are being responsible and are likely to
be trusted and respected because you are able to recognize your limitations and ensure
that the person gets the most appropriate help.

The question of referral is not quite as simple as it appears. The counselor has to consider
several important and very closely related aspects, such as;

1. Why a person is referred

2. Who makes the referral

3. How the referral is structured

4. How the client perceives the referral in his own way.

Continuation of Communication Skills in Counselling

Communication is a two way process between the sender and receiver. In counselling
the major role of the counsellor is to listen while to the client it’s to communicate.
Counselling skills require that the counsellor uses minimal responses. I.e. short verbal
40
 and non-verbal responses or expressions and brief statements that help reaffirm that the
counsellor is listening to the client. For example; nodding the head, using verbal
expressions like yes, right, go on, okay, sure, etc.

Any counsellor has to be a good listener but this doesn’t mean that the counsellor sits
quietly throughout the session. The client’s talk has to be punctuated with non-verbal
and verbal behavior from the counselor. The aim of such a response from the
counsellor is to encourage the client to talk and to give as much information as
possible. The use of minimal response has to be done with understanding that the client
has come to talk with the counsellor and not to listen to the counselor. Such an
understanding gives the counsellor an idea of what to do for instance not to talk too
much. The counsellor should listen patiently to the client to sort out his/her emotions
and to get clear sense of direction. In some cases just listening to the client is
therapeutic enough to bring emotional healing.

On the other hand for clients who are emotionally charged, or confused and
uncoordinated, listening to them without interruption helps them sort out their
confusion, explore their dilemma and pay more attention to the important details,
therefore using minimal responses allows the client to focus on the story without
interruption from the counsellor. Minimal responses encourage the client to go on
talking knowing that the counsellor is paying attention and cuts down on the need of
asking to prompt the client to talk.

When using minimal responses (Encouragers)

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 There are some important things that a counsellor has to bare in mind when using
minimal responses. These include;

i. Minimal responses have to come at regular intervals and should be spaced in such a
ways that they don’t become intrusive or destructive.

ii. Minimal responses have to match the speed and pace of the client for example- an
agitated client demands the same pace from the counsellor. The tone of the counsellor
has to be matched with the client in terms of tone and pace before trying to speed up or
slowdown the client.

iii. The body language of the counsellor is very important. The counsellor should not get
too occupied with the use of minimal responses and forget to check his/her body
language. The counsellor has to try to be simple and natural in both facial expressions
and body posture. The counsellor has to control destructing expressions such as staring
away or at the client, swinging around or over dressing.

iv. The counsellor can use longer statements to break the monotony of the brief
statements. For example; the counsellor could occasionally say “I hear what you’re
saying”, “I understand, tell me more about that.”

v. The counsellor has to maintain good eye contact especially when building rapport. Eye
contact should be natural and if the counsellor looks away from the client, it has to be
at objects within short range. Looking far away means the counsellor is no longer
interested in what the client is saying.

vi. Allow silence. The counsellor shouldn’t strive to cover every silence with a minimal
response neither should he/she get pre-occupied with what to answer while the client is
speaking. Silence allows the client to think about what he/she just said and to focus on
what to say next. Sometimes whatever the client has to say is very painful or
important. In such a case, the client may pause and has to be allowed time to think
through and gather the strength to say what he/she has to say.

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vii. Allow the client to cry if he/she wants to cry. The counsellor should not stop the client
from crying by prompting with minimal.

ACTIVE LISTENING

This refers to listening and interpreting the client’s verbal and non-verbal expressions
in messages. This requires the counselor to make good use of the eyes, ears and all
other senses. The counselor has to interpret the information that he/she receives
through these senses.

Listening to the verbal expression means listening to the client’s expressions, feelings
and behavior. Experience is what the client says that happened to him or her.
Experience may be about what other people have done to the client, what the client has
done or failed to do. The client talks of what happened to him/her, how, when, and
why it happened.

The client will also talk about feelings and this is what the client feels as a result of
what happened to him/her. As a result of his/her reactive behavior, when the client
talks about feelings, they describe the emotional outcome of their experiences. They
talk about how they feel about what happened or the way they feel about what they did
because of their experiences.

The client will also talk about behavior and this is what the client says or does in
response to what has happened to him or her because of the way they feel. Behavior
may also be stated as a client’s practical reaction to a given experience. Behavior may
be overt; i.e. behavior that can be witnessed by others or it can be behavior which
cannot be observed e.g. day dreaming or fantasizing. When listening to a client, it’s
the responsibility of the counselor to try and figure out how the client is affected in the
three areas. While talking, the client will not specify their feelings, experience and
behavior. It’s the counselor who sorts out the clients talk into these three categories.
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The counselor who listens actively will be able to distinguish the client’s experience,
behavior and feelings and to reflect back this information to the client.

The non-verbal behavior of the client is very important and it can be displayed through
the posture, the movements, facial expressions, tone and the pitch of their talk.

The nonverbal behavior normally gives a more accurate message and may give away a
person when he/she is trying to hide some information. This is because nonverbal
information/behavior is very difficult to control; therefore at moments when the
nonverbal behavior doesn’t respond to the verbal message, the counselor has to take
the nonverbal behavior more seriously than the verbal message because it carries the
true feelings of a person. The nonverbal behavior strengthens/emphasizes what the
client is saying. On the other hand, the nonverbal behavior can be used to deny and
confuse what the client has said verbally. In this case it’s used to control/regulate
what is being said and done, when listening to non-verbal behavior of the client, the
counselor is to watch and interpret the message behind a particular nonverbal behavior.

Reflection of Content

For active listening to be complete, effective information and feelings have to be

communicated back to the client. Reflecting information requires summarizing what
the client has said. The counselor has to cut out the important message and state it to
the client. Reflecting information involves identifying the emotional state of the client
and describing it to the client.

The aim of reflecting back the content to the client is to assure the client that you
understand what he/she is saying and now you feel of him or her. Reflection also helps
the counselor to check with the client whether the counselor has the right perception of
what the client feels or says.

When reflecting back information and feelings to client, the counselor constructs a
statement that carries the feeling and then the information. The information may be the

44
experience or the behavior of the client. It is more appropriate and polite to start the
state well with the feelings and then add on the experience on the behavior e.g. you
feel disappointed because .

Asking Questions

During counseling, it is not advisable to ask questions all the time because this turns
into an interrogation where the client waits for the next question before speaking. Such
a situation makes the counselor the controller of what the client says and may lead the
client into less important issues.

However questions are important for purposes of solving and clarification when
probing for more information. It is important to use open ended questions that
encourage clients to enlarge on his/her initial communication. These questions do not
need specific answers but build on what already has been said e.g. the counselor can
ask; say more about that, what happened next? Such questions encourage the client to
give additional information and lessen the need to question.

When clarifying, it is better to use close questions that help the client to look more
closely at specific details of the problem. A client who says everybody ignores me, am
always ignored. A counselor could ask; can you give me an example on the way you
are ignored? Or a client who says “I just can’t stand it anymore”, the question
should be what is that you can’t stand anymore.

The timing of questions is also important for instance clients should never be
interrupted with questions no matter how much they talk. The counselor should watch
out for unspoken indication to speaking along precise or a question from the client.

In conclusion, more minimal responses and reflection of content should be used

instead of questions. Questions may come at times when clients need help to open up
help, to be more concrete and by way of helping the counselor to reach a clear
understanding of the client communication.

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Information Giving

Counseling involves giving information and correcting misinformation. This implies

that the counselor has to be knowledgeable and ought to have the information to give
in reality. The counselor might not have all the information but should be aware of the
means of accessing such information.

Information that is given to clients is very important and can be supportive in bringing
relief to the client. Information can make clients also change unrealistic standards and
expectations. Information motivates clients towards accepting the realistic aspects of
self and the situation. It also helps clients to develop new possibilities about the
problem.

To facilitate a client’s integration and use of information, the timing of the

information is crucial. Information has to be provided at a point when the client is
more receptive in addition the information must be precise, direct, clear concrete. The
counselor has to make use of the basic attending skills while communicating the
message.

Differences between Health Education and Counseling

HEALTH EDUCATION COUNSELING

It is a one to many communication It is a one on one interaction involving

confidentiality, anonymity, privacy

One deals with issues is general One has to deal with personal issues of
the individual

One shares statistical information, data Have to understand the individual to

and analyses to show trends and dangers make an impact on specific attitude and

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 of (i) epidemics (ii) risky behavior. behavior

The interaction is impersonal The interaction can be very emotional

CONSELLING ETHICS

Introduction to Counseling Ethics

Every profession has guidelines that govern the behavior of those who offer the service
and protects the interests of the professional and their clients. Counseling as a
profession has general guidelines that protect the interests of the clients. In addition to
those general guidelines, counseling associations in different countries make additional
guidelines that address specific aspects of counseling unique to their areas. The
following are some of the general guidelines that govern the counseling profession.

a. Respect for the Client

The first ethical issue is respect for the client. The person who comes for counseling
has to be treated as an important person and has to be made to feel comfortable. The
client’s opinion and values have to be respected. This implies that the counselor is not
supposed to impose his/her personal opinions or values on the client. Imposing a
counselor’s value on the client damages the client’s self esteem and places the
counselor at risks of being rejected together with his/her values.

b. Responsibility

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 The first responsibility of a counselor when there is a conflict between the interest of
the client and the interest of the counselor or the interest of the organization. The
counselor’s first key responsibility goes to the client.

Counselors frequently experience key conflicts between their own interests or between
the interest of the organization they are working for and the interest of the client.
Therefore from the start the counselor should negotiate terms that are in the interest of
the client. When conflicts arise, the counselor will simply point out the terms and
follow the appropriate action depending on the terms of employment.

c. Competence

For a counselor, learning is continuous because the profession requires a high standard
of service. Continued learning implies attending workshops, seminars, conferences to
learn and share skills with others.

Competence also implies the counselor knowing his limits to avoid over loading and
stress. In addition competence requires a provision for adequate filing or record
keeping and submitting to supervision. Supervision helps the counselor to keep on
track and to avoid flaws that he/she would have encountered.

d. Referrals

When a counselor cannot meet the needs of the client adequately, then appropriate
referrals have to be made. Such referrals have to be made with the informed consent of
the client. At times, some problems may not be within the counseling scope. For
example, some problems need medical attention, instead of or before counseling.
Therefore, it’s proper to share a client with other professionals such as social workers,
legal officials, medical personnel, among others.

e. The limits of Client – Counselor relationship

Counselors can be vulnerable to offers of friendship that are inappropriate to the

counseling relationship. This is because counselors offer warmth, empathy and
acceptance. Such an atmosphere provides fertile grounds for clients to develop
romantic feelings towards the counselor.

The counselor has to set appropriate boundaries as to how the counseling relationship
should go. In doing so, the client should not be torn apart or insulted. Nevertheless, the
counselor must be assertive in showing the limits.

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f. Self promotion

According to the counseling ethics, it is unethical for a counselor to make inaccurate

claims about their services or skills. Inaccurate claims place clients at risk and give
clients false expectations. Counselors who make inaccurate claims about their services
or skills risk facing legal sanctions by the client or the counseling association in the
area.

Counselors who work in areas where there is a counseling association responsible for
the counselling services offered, give guidelines concerning appropriate limits for self
promotion.

g. Legal obligation

Counselors like other professionals have to work within the limits of the law.
Therefore they have to be familiar with the ethical codes that govern their professions
and the constitutional law in their country. When a counselor works outside the ethical
code or outside the constitutional law he/she risks undergoing legal action and losing
his practicing license.

h. Termination of the counseling relationship

There has to be an appropriate time to terminate the relationship with the client. The
counselor is not supposed to terminate the services when it’s clear that the client still
needs help. Therefore if a counselor cannot continue offering services because of
absence or moving to another country or town, appropriate referral for such a client has
to be made. At the same time, the counselor should avoid keeping the client in the
counseling relationship when it is clear that the problems for the client which sought
the counselor’s help have been cleared.

a. Confidentiality

Confidentiality is a very important ethical issue which every counselor is supposed to

ensure. However there are times when the counselor may not be able to offer total
confidentiality. There also some instances where total confidentiality is undesirable
and unethical. In such situations, the counselor is expected to share some of the
material from the counseling session with significant others. The following situations
place counselors in a state in which they cannot offer total confidentiality.

 Record keeping – a counselor has to keep records especially where a

counselor has many clients. Such records are normally accessible to supporting
staff such as secretaries or filing Clarks. In such a situation, a counselor can
still maintain a level of confidentiality by informing the staff never to discuss
material from the files.

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  Issues that concern saving life or affecting life- In situations where there is a
threat of life to other people, the confidentiality principle might be revoked.
But it must be clear to everyone that if such information is kept away from the
family members will affect the health of other people.

 Issues related with breaking of the national law, for example rape cases
especially among minors.

Don’ts in counseling

a) Avoid telling or directing a client

b) Counseling is not giving advice

c) Counseling is not a conversation.

d) Counseling is not an interrogation.

e) Counseling is not a praying session.

f) Do not over commit yourself if you know you will not deliver.

g) Do not ignore your limitations.

Types of counseling

a) Directive Counseling

E.G Williamson is the chief exponent in this view point. It is a Counsellor-Centred approach. Here the
counselor directs the client to take steps in order to resolve his conflict.

-It is based on an assumption that the client cannot solve his own problems for lack of information. Here
the counselor plays an important role in directing the thinking of the counselee by informing and advising

b) Non-Directive counseling/ Permissive counseling

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Carl R. Roger is the chief executive in this view point. This is a client-centred process. In this the
counselee is the pivot of the whole counseling process. The main function of the counselor is to create an
atmosphere in which the client can work out his problem.

c) Eclectic counseling

This is a combination of both directive and non-directive counseling. In this type of counseling, the
counselor is passive i.e. he is neither too active as in directing the session nor non-directive. He takes a
middle path position. He uses a method according to the need that is fit for that particular time.

COUPLE COUNSELING

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This is the type of counseling that is provided to people who are involved and preparing to be
involved in a sexual relationship. Sometimes it’s referred to as marriage counseling.

Advantages of Couple Counseling

1. It helps in the easy resolving of the matters for example issues related to finances, intimacy,
communication among others

2. It can be used as a platform to avoid future major problems.

3. It facilitates better communication with your partner.

4. It is a safe place to vent out issues that are difficult to share when counseled as an individual.

5. There is more physical and emotional intimacy.

6. It is easy to make action plans.

7. Decision making can be agreed upon as a couple than as an individual.

8. In couple counseling, the individuals can support each other during the counseling process.

Challenges of Couple Counseling

1. It is difficult to handle disagreements among couples.

2. One partner suppressing the other

3. It requires more time to handle a couple compared to individual counseling.

4. In most cases the female partner may fear to open up.

5. Disagreements in the counseling room may extend up to home.

6. It may be difficult to maintain impartiality

Principles of Couple Counseling

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1. Seek the consent of the couple to be counseled together in case of HIV related counseling.

2. Contract with both of them.

3. Let them know that their will be equal air space for both of them.

4. Let them know that both their opinions are important

5. Pay a lot of attention to both verbal and non verbal communication.

6. Address individual needs of the couple.

7. Do not judge or take sides

8. Be in control of the session and remain focused on the topic.

Individual Counseling

It’s a type of counseling offered to a person as an individual.

Advantages

1. It allows a person to express themselves freely.

2. It enables a client to fully participate in the session.

3. It facilitates the ownership of decisions.

4. It enables free discussion of sensitive issues.

5. It ensures confidentiality.

6. It helps in dealing with strong emotions.

7. It enhances the development of rapport between a counselor and a client.

Principles of Individual Counseling

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1. Use a client centered approach

2. Handle each client as an individual not as a case.

3. Perceive the situation from the client’s perspective (Start from where the client is)

4. Facilitate the client to fulfill their goal within their reach.

5. Facilitate self determination of the client.

GROUP COUNSELING

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Group counselling is a form of therapy where people with similar experiences/issues come
together with a professional therapist.
The therapist runs the session, but generally everyone contributes in some way, listening to
others and talking themselves. It’s usually focused on a particular issue, like:

 Addiction
 Bereavement

 Eating disorders

 Depression.

Group counseling is a form of counseling where a small group of people meet regularly to
discuss, interact, and explore problems with each other and the group leader. Group counseling is
counseling with multiple individuals facing a similar concern. Members gain insight into their
own thoughts and behavior, and offer suggestions and support to others.

Group counseling is common for those suffering from addiction and mental health disorders. The
individuals in the group act as a source of insight and support while reinforcing the idea that each
individual is not the only one experiencing these problems.

Goals of Group Counseling

People who participate in group counselling benefit in many ways. We believe that groups are
uniquely suited to help students.

 Give and receive support

 Gain understanding of problems and explore possible solutions
 Practice interpersonal skills in a safe group setting
 Learn more about how you come across with others.
 Increase observation and feedback skills
 Enhance problem-solving skills
 Improve emotional expressiveness
 Decrease social isolation
 Develop good communication skills
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Advantages of Group Counseling

 Clients learn from each other.

 Group therapy helps you realize you’re not alone

 Clients can practice new interpersonal skills in group.

 Clients hear a range of perspectives from the group members.

 Clients learn problem-solving skills.

 Through giving and receiving feedback, clients give and receive peer support.

 The group provides an opportunity for personal experimentation; it is a safe place

to risk enough to learn more about yourself.

 Group members may bring up issues which you might not have been aware of or
how to bring them out.

 A natural process of enhanced acceptance of self and others occurs as one learns
to relate more honestly and directly with others in the group.

 Clients can come out of their isolation.

 Clients have an opportunity for validation/proof of events.

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Stress Management (Caring for counselors)

Stress refers to the physical, emotional, psychological or spiritual strain or tension caused as a
result of overworking the mind, body and heart.

Causes of Stress

1. Doing more work than your mind or body can bare

2. Doing things that you do not enjoy

3. Doing routine work that gets boring with time.

4. Working to please others

5. Working with dying people

6. Financial hardships

7. Suppressing emotions like anger, sadness, affection etc.

8. Secrecy and fear to disclose secrets like HIV results

Symptoms of stress

1. Poor punctuality

2. Over involvement (emotionally taken)

3. Sleeplessness

4. Lethargy (lack of energy and enthusiasm)

5. Bowel disturbances

6. Mood swings

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7. Under involvement (Being withdrawn)

Burn Out

This is the adverse stage of stress. It is the kind that comes when the stress is not managed within
the right time.

Counseling in stress management includes;

1. Client should be counseled on knowing self.

Only when we begin to understand our own needs, our vulnerabilities and our emotional limits
that can we begin to anticipate professional stress. This involves;

- Pace setting (setting a pace in line with our biological nature reduces wear and tear).

- Limit setting (recognize the limits of your knowledge and expertise. Learn to say ‘I
don’t know’, No, I can’t to additional work, learn to say I need help.

- Listen to your early warning signs of excessive stress. Learn to identify your own
warning signs of excessive stress.

2. Take care of yourself

- Physically (exercise, sleep enough, eat well, sexual nurturing (where applicable) etc.

- Emotional and Social needs (develop and use your own social network)

- Spiritually (For those with a religious background, a leaning on God can reduce stress
levels).

- Intellectually (Seek educational opportunities and acquire more knowledge, this will
reduce professional related stress).

3. Develop boundaries between your personal and professional lives

- Regulate the balance between your work life and professional life.

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 - Avoid developing a work-related social network. It may be a continuation of the work.

- Develop a decompression routine. It’s a ritual to us that signals to us that one part of
our life is ending and another is beginning.

4. Enjoy Yourself

- Develop time alone activities

- Utilize time out activities

- Relax and have a good time.

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SELF AWARENESS

SELF /Personal Awareness

Self Awareness is having a clear perception of your personality, including strengths,

weaknesses, thoughts, beliefs, motivation, and emotions. Self Awareness allows you to
understand other people, how they perceive you, your attitude and your responses to them
in the moment.

Why Develop Self Awareness?

As you develop self awareness you are able to make changes in the thoughts and
interpretations you make in your mind. Changing the interpretations in your mind allows
you to change your emotions. Self awareness is one of the attributes of Emotional
Intelligence and an important factor in achieving success.

Self awareness is the first step in creating what you want and mastering your life. Where
you focus your attention, your emotions, reactions, personality and behavior determine
where you go in life. Having self awareness allows you to see where your thoughts and
emotions are taking you.

It also allows you to take control of your emotions, behavior, and personality so you can
make changes you want. Until you are aware in the moment of your thoughts, emotions,
words, and behavior, you will have difficulty making changes in the direction of your
life.

Importance of self awareness

1) An ability to understand one's own thoughts, feelings, and actions and manage them
positively.
2) Self awareness helps a person to genuinely love yourself.

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3) The ability to redirect your negative thoughts and emphasize positive ones.

4) The ability to act consciously instead of reacting to people and events.

5) Understanding why other people think, feel, and act the way they do.

6) Ability to empathize and practice compassion toward others.

7) Identifying your strengths and areas for improvement.

8) Living your life more authentically because you understand who you really are deep
inside.

9) Being more open to new information, experiences, and change.

10) Choosing positive friends and significant others.

11) Feeling more balanced and together.

12) A sense of deeper understanding of yourself and your path in life.

13) A more meaningful and fulfilling life.

14) The ability to make your dreams come true.

FREE AREAS BLIND AREA

(Known to self and Known to (Unknown to self but known to

others like being brown or dark, others like being intelligent, being
Male or Female) arrogant e.t.c.

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 HIDDEN AREA DARK AREA

(Its known to self but unknown to (This part of life is unknown to self
others and a person prefers that it and unknown to others. These are
remains hidden from others like areas of potential growth like being
being a thief, night dancer, a musician, political skills, career
womanizer e.t.c. capacities e.t.c.

This is a model that is useful for understanding oneself and others. It was developed by Joseph
Luft and Harry Ingham (1950’s).

Areas of the Jahari Window:

Free Area

This is an area of an individual that is known to self and others e.g. being female or male.

Blind Area

This is an area which is unknown to self but is known to others e.g. intellectual ability, arrogance
etc.

Hidden Area

It is known to self but unknown to others and preferred to remain unknown to them e.g. habits
like theft, night dancing, witchcraft etc.

Dark Area

It is an area unknown to self and unknown to others. This is normally an area of potential for
personal growth and development e.g. political skills, professional and career ability, some fears
etc.

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A guide to developing Self Awareness

The following questions are a good guide for better understanding of self.

1. Where am in my life journey?

2. What social and cultural factors influence me?

 My country
 My tribe
 My social norms
 My beliefs e.g. cultural, religious etc.
 My judgments and principles.
3. From birth, what influences me?

 Those from my family

 From the family I marry into
 From education
 Opportunities
 Work
 Friends
4. What do I think about my physical appearance?

 How do I see myself?

 I am I satisfied with my appearance?
5. What are my weaknesses?

 What frightens me?

 What makes me angry?
6. What is my image of God?

 Distant or near?

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 Loving Father or a judge?
 Existing or not?

7. What unique gifts, talents and skills do I bring to this world?

UNIT FOUR
BEREAVEMENT AND OTHER TYPES OF LOSS

Bereavement refers to loss of something dear to a person, family or community such as a toy for a child,
money, good health, and loss of a person through migration, disability, displacement or death.
Bereavement to the majority of people simply means loss of people and the grieving and mourning that
follows.

Grief

It is the psychological response or feeling resulting from the loss.

Mourning

It refers to society’s response to loss-the behaviors and rituals that are considered appropriate in any
particular community or country.

What do patient with life limiting illnesses lose?

Patients with life limiting lose their good health however; the result of this loss can lead to many other
losses.

There are the various kinds of losses that can be felt by each person.

Physical losses Psychological losses

 Appearance  Affection/love
 Privacy  Care
 Figure  Self esteem
 Beauty  Independence
Social Losses Economic losses

 Status  Money
 Respect  Income
 Freedom of socialization  Jobs
 Company  Property
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  Other assets
Opportunities lost Spiritual losses

 Employment  Faith
 Promotion  Position in church/mosque.
 Future plans
 Political mandate
 Family life.

Factors that determine the magnitude of bereavement

There are several factors that contribute to the magnitude of bereavement.

FACTOR HIGH MAGNITUDE LOW MAGNITUDE

Cause Sudden Natural

Age Young Aged

Relationship Close Distant

Social status High Low

Geographical distance Far Near

Expectations High Low

There are two main forms of grief.

1) Normal Grief

a. Anger

There are some fundamental responses to the pain of separation.

i. The urge to cry.

ii. Searching for the person.

iii. Anxiety, particularly when certain things were usually followed by the appearance of the loved one, or
things they used to do together.

b. Numbness/lack of sensation/feeling:

This may be a protective mechanism which takes the bereaved person through the practicalities of the
funeral. It may last from hours to a week but should not extend beyond this.
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c. Disbelief:

May last for weeks or months presuming that the deceased has only gone away. It is only when this is
over that the person is open to grieving.

2) Abnormal (Complicated) Grief

May be delayed, inhibited, or prolonged.

Delayed

If grieving does not take place, it may be suppressed and either triggered off by another minor
bereavement or become chronic.

Inhibited Grief

The bereaved seems mildly affected. This may be normal in the elderly who do not see the parting for
long as they prepare for their own demise.

However children are often “protected” in some communities from the funeral proceedings or from
viewing the body and area not allowed to grieve. This may come out later in life as a
neurosis/fixated/obsessed.

It is important for children to realize the loss and the funeral is an important opportunity to let out tears.

Inhibited grief may surface later as: irritability, hyperactivity, psychiatric symptoms, but most often
depression. Management is by encouraging the person to think about the deceased, using photographs and
memories. Involve family members, friends and volunteers.

Prolonged or Chronic Grief

Its’ a situation where the grieved person continues to feel the effects of loss which extends beyond the
normal time and behaves in an abnormal way.

Management of grief:

 Different ways of grieving: thinking, crying, praying, meditating, writing, or drawing.

 Keep a diary – feelings and memories of the loved one
 Live a day at a time.
 Do not make any major decisions like selling the house.

Self care

 Set time for getting up, meals, and going to bed.

 A balanced diet.
 Relaxation-Music
 Avoid seeking relief from alcohol, smoking, medication and other drugs.

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 Be patient, tolerant and gentle with oneself during grief.

Bereavement Counseling to AIDS

The ultimate goal of counseling is to help the patient and family accept that death is the ultimate/last stage
of life and to prepare the patient die in peace. Never block a patient from talking about matters concerning
death.

 Encourage them talk about their fears.

 Find out from the patient how these fears can be eased or how the gap can be filled or what wishes
need to be fulfilled.
 Help the patient remember, talk about achievements, good times spent in the past.
 Help the patient and family members to identify people or organizations who can provide support,
e.g. friends, relatives, health workers or the church.
 Provide information on how to deal with distressing symptoms.
 Explore the patient’s religious and cultural beliefs and help contact appropriate sources of spiritual
support e.g. church elders, traditional healers.
 Encourage the patient to talk about what will happen to his/her possessions with family members. Is
there a will? Does patient need help to make one?
 Help to ensure that patients are allowed to remain in control of decisions (even when patient has lost
consciousness, family members should hold discussions in patients presence.)
 Explore alternative sources of income
 Bring family together to discuss future plans.

HIV/AIDS Pre and Post Counseling

Pre-Test counseling Session

(A session where basic facts about HIV are discussed with the client). It is informative by nature.

Post-Test Counseling Session

Procedure

a) Build Rapport

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b) Find out if you have the right person
c) Assess readiness
d) Give results clearly and correctly
e) Allow time for the client as you observe non-verbal language
f) Assess understanding
g) Discuss the implication of the result (Talk about stigma)
h) Discuss window period if results are –ve.
i) Discuss positive living if results are +ve.
j) Discuss support persons
k) Talk about the need for disclosure
l) Discuss any client fears
m) Referral

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CRISIS/ TRAUMA COUNSELING

What is a Crisis?

This can be defined as a dangerous experience that may disrupt life, cause pain, accelerate
anxiety and bring about loss or suspense. Such may include natural disasters, floods, earth
quakes, drought, famine, war and conflict, accidents, sudden death in the family e.t.c.

Typically crises happen without a warning, leaving many in pain and traumatized. They result in
shock, disbelief, anger, a feeling of betrayal, broken trust, loss and a shattered sense of security.

According to Collins (1988), “crises present people with an opportunity to change, grow, and
develop better ways of coping.” God does not allow crises to break us but to build us; not to
make us bitter, but to make us better.

GOALS OF TRAUMA COUNSELING

1. To understand the counselee’s position.

This should include an appreciation of the here and now, where counseling focuses on the counselee’s
experience as narrated in form of a story.

2. Bringing God’s message of comfort and hope.

Ezekiel 47:1-12 presents a powerful; analogy of Gods’ healing flowing in form of a river from the center
of the temple towards the desert. Wherever the river goes, everything lives (verse 9). Therefore a
counselor is called to act as a channel of Gods’ healing for those in need.

3. Helping the counselee to avoid denial.

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Some culture do discourage overt expressions of emotional pain. Even among Christians, lamenting and
open declaration of despair is often frowned upon. Help them identify the support around him to over
come this denial like the family members but most importantly let him know that there is a creator who
will never forsake us even in times like these. It is He who quickly wipes the tears of His children.

4. Relieving emotional pain and confusion.

A crisis situation normally shatters an individuals’ secure world, and crisis counseling, especially within
a Christian context, is an attempt to restore that safety and hence a sense of sanity.

5. Assisting the counselee to change the focus from pain to opportunity.

Every crisis situation presents a new beginning. The counselee needs another person to help provide the
lens through which he or she can examine the traumatic event without the fear of relieving the trauma
alone.

A trauma counselor also reconnects the counselee to a caring community, where God begins to transform
the bad experience into a new beginning, wiping the slate clean and affording the person to see a positive
aspect of trauma.

6. Teaching the counselee skills to speed up the recovery process.

The counselees will need to recover physically, mentally, spiritually, socially and in their relationships.
Yet such restoration does not happen instantly, and relieving the trauma through narrating events
associated with it is a powerful, cathartic/ cleansing experience. However this is usually the beginning,
the community need to provide continued support especially where the pain involves pain within the
family.

7. To challenge and motivate the counselee towards change.

God provides resources to enable the counselee to move towards change and transformation; accordingly
part of trauma counseling is to teach disciplines and provide opportunities where this can happen for
example restoring the counselees’ time of prayer and meditation.

8. To provide leadership for crisis prevention

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The work of a trauma counselor does not begin and end with bringing end to wounded hearts. It is an
ongoing ministry of prevention through capacity building in grass root communities for the prevention of
critical incidents.

The Model in Crisis Counseling

1. Assessing the Situation

The first element of crisis counseling involves assessing the client’s current situation. This involves
listening to the client, asking questions and determining what the individual needs to effectively
cope with the crisis. During this time, the crisis counseling provider needs to define the problem
while at the same time acting as a source of empathy, acceptance and support. It is also essential to
ensure client safety, both physically and psychologically.
2. Education
People who are experiencing a crisis need information about their current condition and the steps
they can take to minimize the damage. During crisis counseling, mental health workers often help
the client understand that their reactions are normal, but temporary. While the situation may seem
both dire and endless to the person experiencing the crisis, the goal is to help the client see that he or
she will eventually return to normal functioning.

3. Offering Support
One of the most important elements of crisis counseling involves offering support, stabilization and
resources. Active listening is critical, as well as offering unconditional acceptance and reassurance.
Offering this kind of nonjudgmental support during a crisis can help reduce stress improve coping.
During the crisis, it can be very beneficial for individuals to develop a brief dependency on
supportive people. Unlike unhealthy dependencies, these relationships help the individual become
stronger and more independent.

4. Developing Coping Skills

In addition to providing support, crisis counselors also help clients develop coping skills to deal with
the immediate crisis. This might involve helping the client explore different solutions to the
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 problem, practicing stress reduction techniques and encouraging positive thinking. This process is
not just about teaching these skills to the client, it is also about encouraging the client to make a
commitment to continue utilizing these skills in the future.

SUBSTANCE ABUSE AND ADDICTION

Drug Abuse is the use of illegal drugs or use of medically acceptable drugs contrary to health workers
advice.

Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user
consumes the substance in amounts or with methods which are harmful to themselves or others,
and is a form of substance-related disorder.

In some cases criminal or anti-social behavior occurs when the person is under the influence of a
drug, and long term personality changes in individuals may occur as well. In addition to possible
physical, social, and psychological harm, use of some drugs may also lead to criminal penalties,
although these vary widely depending on the local jurisdiction.

Drugs most often associated with this term include: alcohol, cannabis, barbiturates, cocaine,
methaqualone, opioids and some substituted amphetamines. The exact cause of substance abuse
is not clear, with theories including one of two: either a genetic disposition which is learned from
others, or a habit which if addiction develops, it manifests itself as a chronic debilitating disease.

In 2010 about 5% of people (230 million) used an illicit substance. Of these 27 million have
high-risk drug use otherwise known as recurrent drug use causing harm to their health,
psychological problems, or social problems or puts them at risk of those dangers. In 2015
substance use disorders resulted in 307,400 deaths, up from 165,000 deaths in 1990.

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SIGNS AND SYMPTOMS

Depending on the actual compound, drug abuse including alcohol may lead to health problems,
social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents,
homicides, suicides, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause
the increased risk of suicide include the long-term abuse of alcohol and other drugs causing
physiological distortion of brain chemistry as well as the social isolation.

Alcohol abuse is also associated with increased risks of committing criminal offences including
child abuse, domestic violence, rapes, burglaries and assaults.

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which
resembles mental illness. This can occur both in the intoxicated state and also during the
withdrawal state. In some cases these substance induced psychiatric disorders can persist long
after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine
abuse.

Severe anxiety and depression are commonly induced by sustained alcohol abuse, which in most
cases abates with prolonged abstinence. Even sustained moderate alcohol use may increase
anxiety and depression levels in some individuals. In most cases these drug induced psychiatric
disorders fade away with prolonged abstinence.

Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather

than careful thought. Individuals with substance abuse have higher levels of impulsivity, and
individuals who use multiple drugs tend to be more impulsive.

TREATMENT

Psychological

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From the applied behavior analysis literature, behavioral psychology, and from randomized
clinical trials, several evidenced based interventions have emerged: behavioral marital therapy,
motivational Interviewing, community reinforcement approach, exposure therapy, contingency
management. They help suppress cravings and mental anxiety, improve focus on treatment and
new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.

In children and adolescents, cognitive behavioral therapy (CBT) and family therapy currently has
the most research evidence for the treatment of substance abuse problems. Well-established
studies also include ecological family-based treatment and group CBT. These treatments can be
administered in a variety of different formats, each of which has varying levels of research
support Research has shown that what makes group CBT most effective is that it promotes the
development of social skills, developmentally appropriate emotional regulatory skills and other
interpersonal skills. A few integrated treatment models, which combines parts from various types
of treatment, have also been seen as both well-established or probably effective. A study on
maternal alcohol and drug use has shown that integrated treatment programs have produced
significant results, resulting in higher negative results on toxicology screens. Additionally, brief
school-based interventions have been found to be effective in reducing adolescent alcohol and
cannabis use and abuse. Motivational interviewing can also be effective in treating substance use
disorder in adolescents.

Medication

A number of medications have been approved for the treatment of substance abuse. These
include replacement therapies such as buprenorphine and methadone as well as antagonist
medications like disulfiram and naltrexone in either short acting, or the newer long acting form.
Several other medications, often ones originally used in other contexts, have also been shown to
be effective including bupropion and modafinil. Methadone and buprenorphine are sometimes
used to treat opiate addiction. These drugs are used as substitutes for other opioids and still cause
withdrawal symptoms.

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Antipsychotic medications have not been found to be useful. Acamprostate is a glutamatergic
NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal
is associated with a hyperglutamatergic system.

STAGES OF SUBSTANCE ABUSE

Generally, substance abuse is a difficult topic to talk about. Many people have been affected in
some manner by drugs and alcohol, yet the stigma surrounding the condition continues to
suppress a public dialog on programs to improve treatment options and get those struggling with
substance abuse into detox centers. In many ways, openly talking about drugs and alcohol can be
an effective means to educate people from starting or continuing down a self-destructive path.

While addiction affects every person in different ways, the five stages of substance abuse are a
general guideline for how even casual use can transform into behavior that may not be easily
controlled

1. Experimentation
The first stage of substance abuse is also the most innocuous or harmless. Many people’s first
exposure to potentially addictive substances begins as a social event. Teenagers may drink at
parties or with friends, while adults may dabble with drugs just for the experience. For many
people who are able to control their intake of drugs and alcohol, their experience with substance
abuse does not progress past this stage.

2. Regular use
Once a person has progressed past the experimentation phase, regular use of drugs and alcohol
ensues. This may include drinking or consuming drugs only on weekend or other periods of
downtime. People may often miss the fact the their consumption has increased because they are
doing it in the company of other people.

This second stage is also where drug and alcohol use begins to affect people’s lives. Collateral
damage from substance abuse such as falling grades in school or missed social engagements may
be examples of this.

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3. Risky use

With the onset of the third stage, serious collateral complications begin to manifest as people’s
normal lives clash with the instability of substance abuse. While some may think that a drink or
two after work is harmless, they may not be able to realize that they are too drunk to drive. The
University of Rochester Medical Center explained that even though people may acknowledge
that drugs or alcohol are beginning to affect their lives, they may look down at attempts to
decrease their substance consumption or to get them help.

4. Dependence
The fourth stage of substance abuse is where things begin to take a serious turn. Dependence
means that while no physical changes have taken place in the chemical makeup of the brain,
people will continue to drink and use drugs regardless of the impact to their health, job, friends
or anything else. Dependence may be characterized by higher doses or increased potency of
substances to overcome a growing tolerance and withdrawal symptoms without a constant
supply.

5. Addiction

At the final stage, a chemical change has taken place within the body so no matter how hard
people may try, giving up the substance of choice is almost impossible without help. People in
this stage may experience sudden and intense cravings for drugs or alcohol and will act on these
cravings until they go away.

Recovery or Behavior change process in drug abuse

1. Pre-contemplation. In this stage, we've either literally never thought about needing to
change a particular behavior or we've never thought about it seriously. Often we receive
ideas about things we might need to change from others—family, friends, doctors—but
react negatively by reflex. After all, we're usually quite happy with our current stable of
habits.

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 2. Contemplation. Here we've begun to actively think about the need to change a behavior,
to fully wrap our minds around the idea. This stage can last anywhere from a moment—to
an entire lifetime. What exactly causes us to move from this stage to the next is always,
in my view, the change of an idea ("exercise is important") into a deeply held belief ("I
need to exercise"). This is the stage in which obstacles to change tend to rear their ugly
heads. If you get stuck here, as many often do, seek another way to think about the value
of the change you're contemplating. Remember, it's all about finding and activating a
motivating belief.

3. Determination. In this stage, we begin preparing ourselves mentally and often physically
for action. The person may reduce the number of times he drinks per week though not so
practical at some other times. This mustering of a determination is the culmination of the
decision to change and fuels the engine that drives you to your goal. I firmly believe that
human beings possess the ability to manifest an unlimited amount of determination when
properly motivated by a deeply held belief.

4. Action. And then we start. We wake up and take a power walk to that desired new life or
stop abusing alcohol, or stop smoking. Wisdom—in the form of behavior—finally
manifests.

5. Maintenance. This is continuing abstinence from the old behavior (Substance Abuse).
Continuing to practice the new behavior is like the hardest part of the process of change,
we often fail to adequately prepare for the final phase of Maintenance. Yet without a
doubt, maintaining a new behavior is the most challenging part of any behavior change.
One of the reasons we so often fail at Maintenance is because we mistakenly believe the
strategies we used to initiate the change will be equally as effective in helping us
continue the change.

ONE STAGE LEADS TO ANOTHER

The true power of this model really becomes apparent when we recognize these stages are
sequential and conditional. In my medical practice, I first identify the stage in which a patient sits
with respect to the behavior I want them to change. A smoker who's never seriously considered
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giving up tobacco would be in the stage of Pre-contemplation—and if I expected them to jump
from that stage over Contemplation and Determination directly to Action, they'd almost certainly
fail to change and frustrate us both. If, however, I focus on ways to move them from one stage to
the next, I can "ripen" them at a pace with which they're comfortable: from Contemplation to
Determination to Action to Maintenance. As an example, I often give patients in the stage of Pre-
contemplation a simple assignment: I ask them to think about how the change I want them to
make would improve their lives. That doesn't seem like such a difficult step, but if they do it, I've
just moved them into Contemplation! That may seem like insignificant progress, but it's actually
1/5 of the work that needs to be done. Most people (though certainly not all) seem to be more
comfortable embracing change in a step-wise fashion.

Finally, and most importantly, you can use this model on yourself. By recognizing which of the
five stages of change you find yourself in at any one time with respect to any one behavior you're
trying to change, you can maintain realistic expectations and minimize your frustration. Focus on
reaching the next stage rather than on the end goal, which may seem too far away and therefore
discourage you from even starting on the path towards it.

RELAPSE

The final stage of any process leading to behavior change is one extremely difficult to avoid:
relapse. Though it may sometimes be inevitable, if you train yourself to view relapse as only one
more stage in the process of change rather than as a failure, you're much more likely to be able to
quickly return to your desired behavior. Alternatively, when you allow yourself to view relapse
as a complete failure, that assessment typically becomes self-fulfilling. Just because you fell off
the diet wagon during a holiday doesn't mean you're doomed to return permanently to poor
eating habits—unless you think you are and allow yourself to become discouraged, in which case
you will. Long term weight gain or loss, it turns out, isn't correlated to calorie intake on any one
day but rather to calorie intake over a period of time, which essentially means if you overeat here
or there on a few days only, it won't actually affect your long-term ability to lose weight.

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Substance Abuse Counseling Techniques

Introduction

Counseling and therapy for addiction help individuals understand what causes addiction, learn to
recognize risk factors for relapse and develop tools for coping with stressful situations. Common
techniques include cognitive behavioral therapy, motivational interviewing and dialectical
behavioral therapy.

The underlying causes of addiction are mostly genetic and environmental. A person’s genetic
makeup can make him or her more prone to sensation-seeking behavior, more compulsive and
more vulnerable to addiction. Life events such as trauma, stress and early exposure to substances
of abuse can also affect a person’s vulnerability.

Addiction causes physical and mental side effects. Physical side effects include cravings and
withdrawal symptoms, and mental side effects include increased stress and feelings of
depression, anxiety or loneliness.

Effective treatment focuses on the genetic and environmental causes of addiction. It also treats
the physical and mental side effects.

Detox keeps patients physically safe and as comfortable as possible during withdrawal. Therapy
treats the mental aspects. Depending on the severity of the disease, detox can remove cravings
and withdrawal symptoms in one to three weeks. However, most people require months or years
of continuous counseling to recover from the mental side effects.

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The main purpose of counseling and therapy for addiction is to address the underlying causes of
the disease to prevent them from causing relapse. Although detox is a vital component of
treatment because it helps patients handle withdrawal and ease cravings, it does nothing to
address the factors that led to drug abuse in the first place.

Research during the last 30 years has led to advances in evidence-based behavioral therapy for
alcohol and drug addiction. The therapies have proved effective in treating substance use
disorders in addition to co-occurring mental health issues such as depression, anxiety and
obsessive-compulsive disorder.

Today, therapy for substance use disorders is available in a variety of settings, including
inpatient residential rehab programs, outpatient rehab programs, sober living communities,
private practices and a variety of support groups.

The goal of therapy during a 30-, 60- or 90-day rehab program is to prepare individuals in
recovery for life after intensive treatment, but many patients require continued therapy for many
months or years after rehab.

Therapy often decreases in frequency and duration as a person learns to cope with the causes of
his or her addiction and to handle life’s stressors. However, many experts believe a person
never fully recovers from addiction. People who experience a traumatic event or increased stress
should turn to therapy to decrease the chances of relapse.

Therapy isn’t a one-size-fits-all process. Different approaches are more appropriate and
effective for different people, depending on their age, type of addiction and the factors that
contributed to their addiction.

Addiction Counseling Helps Clients:

 Understand the root of their addiction

 Learn how to regain the trust of loved ones

 Understand forgiveness

 Identify co-occurring mental illness

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  Teach life skills and responsibility

 Inspire permanent life changes

 Encourage permanent positive habits

 Begin an authentic relationship with God

 Restore confidence based on positive self-esteem and image

 Achieve freedom from negative habits

a) Behavioral Therapies
Addiction treatment centers use behavioral therapies more than any other therapeutic technique,
according to the 2014 National Survey of Substance Abuse Treatment Services. Behavioral
therapies help patients understand the causes of high-risk behavior and develop tools for
avoiding or coping with high-risk situations.

1. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a classification of mental health counseling founded in

the 1960s by Dr. Aaron T. Beck.

Cognitive behavioral therapy helps people address problematic thoughts and feelings to
overcome addiction. Cognitive behavioral therapy is used widely today in addiction treatment.
CBT teaches recovering addicts to find connections between their thoughts, feelings and actions
and increase awareness of how these things impact recovery. CBT also treats co-occurring
disorders such as anxiety, attention Deficit Disorder (ADD), Obsessive Compulsive Disorder
(OCD), Eating Disorders, Post-Traumatic Stress Disorder (PTSD) and others.

Cognitive behavioral therapy (CBT): CBT focuses on identifying, challenging, and neutralizing
unhelpful thoughts or beliefs. It teaches you different ways to think, behave, and respond to stressful
situations.
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Cognitive behavioral therapy focuses on learning to reduce problematic behavior associated with
substance abuse. The main purpose in CBT is to anticipate risky situations and apply coping
strategies, such as avoidance or self-control, to prevent relapse.

During CBT, patients learn to recognize and modify risky behavior by using a variety of skills. They learn
the underlying causes of problematic behavior so they can fix the problems at their source. They’re able
to recognize cravings or triggers and develop strategies for handling those situations.

How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy shows that many harmful actions and emotions are not logical or
rational. These feelings and behaviors may come from past experiences or environmental factors.

When an addicted person understands why they feel or act a certain way — and how those
feelings and actions lead to substance use — they are better equipped to overcome their
addiction.

Cognitive behavioral therapists help recovering addicts identify their negative “automatic
thoughts.” An automatic thought is based on impulse and often comes from misconceptions and
internalized feelings of self-doubt and fear. Often, people try to self-medicate these painful
thoughts and feelings by drinking or abusing drugs.

By continually revisiting painful memories, recovering addicts can reduce the pain caused by
them. They can then learn new, positive behaviors to replace their drug or alcohol use.

CBT helps patients overcome drug addiction and alcoholism by:

 Helping to dismiss false beliefs and insecurities that lead to substance abuse
 Providing self-help tools to better their moods

 Teaching effective communication skills

2. Dialectical Behavior Therapy (DBT)

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Dialectical behavioral therapy (DBT): DBT focuses on enhancing your motivation and teaching
emotional regulation skills to help you cope with specific life challenges.

This technique is effective for patients who struggle to regulate emotions and have thoughts of self-harm
or suicide. The therapy emphasizes an acceptance of uncomfortable thoughts, feelings or behaviors to
allow patients to overcome them. DBT has been proved to treat several disorders that co-occur with
addiction, including mood disorders, personality disorders, eating disorders, Self-destructive
behavior.

DBT involves relaxation techniques, such as yoga, that help the patient become more aware of thoughts
and emotions. They learn skills such as controlled breathing and muscle relaxation to tolerate self-
destructive thoughts or urges. The goal is to decrease the frequency and severity of self-harming behavior
and encourage healthy change.

Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions
and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in
four key areas. First, mindfulness focuses on improving an individual's ability to accept and be
present in the current moment. Second, distress tolerance is geared toward increasing a
person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion
regulation covers strategies to manage and change intense emotions that are causing problems in
a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to
communicate with others in a way that is assertive, maintains self-respect, and strengthens
relationships.

b) Motivational Therapies

Motivational therapies are the second-most-common therapies used by drug rehab facilities. The
therapies help patients find internal motivation to begin or continue treatment. They often
provide incentives for maintaining sobriety and are used in combination with behavioral
therapies.

1. Motivational Enhancement Therapy

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Motivational enhancement therapy is a specific type of motivational interviewing for substance
abuse. It reduces patients’ doubts or uncertainties about engaging in treatment or stopping drug
use. The goal is to encourage change as opposed to teaching patients how to change. Multiple
studies have shown that motivational enhancement therapy is effective in patients addicted to
alcohol, marijuana and nicotine.

MET begins with an assessment and is followed by two to four individual counseling sessions.
The therapist begins by eliciting motivational statements. He or she supports the patient’s self-
motivation, and the pair discusses ways to cope with risky situations. The remaining sessions
involve monitoring change, reviewing strategies and continuing support of internal motivation.

Motivational interviewing (MI): This approach aligns well with the Stages of Change model and
is used frequently in drug and alcohol rehab and addiction treatment to elicit positive behavioral
changes by uncovering strong personal motivators to get well.

2. Contingency Management and Motivational Incentives

Contingency management and motivational incentive approaches to therapy reinforce positive

behavior with tangible rewards. The therapies augment other forms of therapy to increase
abstinence during counseling.

Studies show contingency management and motivational incentives reduce drug use in patients
in recovery from addiction involving alcohol, cocaine, marijuana and nicotine.

The therapies incorporate vouchers or chances to win prizes to promote abstinence. Voucher-
based therapy involves rewarding clean drug screens with vouchers that can be exchanged for
food, movies and retail goods.

Prize-based incentives reward drug-free screens with a chance to win a prize by drawing from a
bowl. Some experts worry that prize-based incentives might promote gambling behavior, but
studies do not show an association between the therapy and gambling.

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IMPORTANT LIFE SKILLS FOR PROPER REHABILITATION

These are the Positive and adaptive behaviors that guard individuals against self destruction and anti-
social behavior. These are skills that are needed by every individual in behavior change or can be adopted
to fit well in society.

1. Decision-making skills
 Be firm in making decision
 Don’t move in band wagon
 What steps might you take if you have to decide something crucial
 Should seek advice
 Accept responsibility for each action, avoid regrets
 What are your values?
Decision is the ability to make use of information in weighing out the disadvantages and advantages of
taking certain courses if action.

2. Peer resistance
This is a conscious effort to withstand the coercive forces from peers to go along without thinking about
the possible consequences. The individual should be able to say no to anything that is contrary to ones’
values, beliefs principles without undue explanation and apologies.

3. Communication skills
It is important in expressing one’s self clearly and appropriately when interacting with others. This can
be done by use of verbal or non verbal ways.

This skill involves active listening, understanding people’s feelings.

It is important not to assume what person is saying

Don’t be mind readers.

4. Creative thinking
 The ability to explore several ways and possibilities of going about a task or a problem
 The individual with the skill feels energized when faced with the challenge.
 He or she tries out new ideas aimed at solving the problem.

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 Individuals who lack this skill, problems and challenges wear down their defenses.

5. Relationships
 Ability to engage in relationships that is life giving. This relationship gives health and
meaning to the parties involved.
 Such friendship would involve sharing of hope, fears, anxieties, ambitions, success,
failures etc.
6. Self awareness
 Some individuals may not be aware of what capabilities and limitations they have
 An individual who lacks self awareness skills may continuously make choices that are
beyond his/her capabilities.
7. Coping with stress and emotions: Ability to deal with physical, psychological and
emotional challenges without breaking down or using negative and destructive behavior.
Stress is part and parcel of daily living.

 Reward yourself (but not extravagantly)

 Save a certain percentage for the future
 Change with change, it will change you
 Don’t look up back with a lot of hatred, you are not the first neither the last.

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