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