2 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:BehaviorBeliefs or emotional concerns relating to perceptionsLevel of emotional distress
3 Counseling Process Structure Rapport and Relationship BuildingAssessment / Problem DefinitionGoal-settingInitiating InterventionsTermination
4 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 byCounselor’s personal and professional qualifications.Client’s-interpersonal history,anxiety state,interrelation skills, andprevious ability to share,
6 Observation Take notice of the client’s general state of anxiety. Establish sense of client’s cultural context.Note gestures / movements that denote emotional / physical dysfunctions.Hear how the client frames his / her problems.Note verbal and non-verbal patterns.
8 Focus Presenting problem and context Basic QuestionsWhat concerns brought you here?Why now?Has this happened before?How is it impacting your daily life?Detailed InquiryClarify stressorsElicitcoping skills,social support,and resourcesClarify life functionworkfamilyhealthintimacy
9 Focus Mental status Basic Questions Detailed Inquiry Note Probe How do you feel now?How is your mood affected?Had any unusual experiences?How is your memory?Do you think that life isn’t worth living?Detailed InquiryNoteage & mannerismsdress & groomingorientationProbeanxiety symptomsform, content, thought.suicidal ideationviolent impulses
10 Focus Developmental history and dynamics Basic QuestionsHow would you describe yourself as a person?Shift to the past, how were things when you were growing up?Detailed InquiryClarifycurrent self-viewlevel of self-esteempersonality styleNotedevelopmental milestonesexperience in schoolbest friendseducational level
11 Focus Social history and cultural dynamics Basic QuestionsWhat is your current living situation?What is your ethnic background?Detailed InquiryElicitjob or militarylegal problemssocial support systemrace, age, gendersexual orientationreligionlanguagedietary influenceseducation
12 Focus Health history and behaviors Basic QuestionsTell me about your health?Health habits?Detailed InquiryIdentifyprescriptionssubstance usagehealth statushealth habits
13 Focus Client resources Basic QuestionsHow have you tried to make things better? Results?How do you explain your symptoms?What is your / my role in your treatment?When will things change / get better?Detailed InquiryProbeEfforts to changeEfforts vs. successesClarify client explanatory modelIdentify treatment expectationsSpecify readiness for change
14 Focus Wind down and close Basic QuestionsWhat else would be important for me to know?Do you have any questions for me?Detailed InquiryUse an open-ended queryAllows the client to add information.Creates sense of reciprocal and collaborative relationship.
15 Conceptualizing Problems Recognize a client need.Understand that need.Meet that need.1. Beliefs mayContribute to the problem.Impede the solution.Become the problem.2. Feelings / responses oftenExaggerate the problem.Impede comprehension of the problem.
16 3. Behavior / responses may Be inappropriate.Contribute to the problem.Complicate the problem.4. Interaction patterns includeMiscommunication channels,Expectations,Self-fulfilling prophesies.Coping styles.5. Contextual factorsTimePlaceCultural and socio-political issues.
17 Goal Setting 1. Indicates how well counseling is working. 2 Goal Setting 1. Indicates how well counseling is working. 2. Indicates when counseling should be concluded. 3. Prevents dependent relationships. 4. Determines the selection of interventions. 5. Mutually defined by the client and counselor.ClientExperience with the problemHistory of the problemPotential insightsAwareness of personal investment in changeCounselorGreater objectivityTraining inNormal andAbnormal behaviorProcess experience
18 Process goalsRelated to establishing therapeutic conditions for client change.Includes:Establishing rapport,Providing a non-threatening setting, andPossessing and communicating accurate empathy and unconditional regard.Outcome goalsAre 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.
19 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 includeCompetency with the intervention;Knowledge of appropriate uses;Knowledge of typical client responses;Observation skills to note client responses.
20 TerminationNo 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 TerminationSuggested termination, with client agreementImposed terminationContinuing is against client best interestClient is deteriorating, not progressingIncompatibility with the therapistClient using therapy in place of life
21 3. Situational termination Client moves Employment changes 4. Early termination, clients just don’t return.MethodsGradual tapering off of sessions.Therapeutic vacations, taking a break without breaking the connection.Direct (imposed) termination.
22 Basic skills of Counselling Listening is not passive. It is important to indicate that the person is being heardGood counselling skills means listening before acting to solve problemsVerbal listening skillsShow interestGather informationEncourage speaker to develop ideasCommunicate our understanding of ideasRequest clarification of understandingBuild the therapeutic allianceWe are problem solvers by nature…that is why we chose our profession
23 Listening SkillsUsing good verbal listening skills, you increase the chances that:You will understand what the other is saying and they will understand youYou will create a situation where you will be able to develop a helping relationship
24 Non verbal attending and observation Take notice of the client’s general state of anxiety.Establish sense of client’s cultural context.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 clientHear how the client frames his / her problems.Note verbal and non-verbal patterns.
25 A Good Listener Maintains eye contact Makes few distracting movements Leans forward, faces speakerHas an open postureAllows few interruptionsSignals interest with encouragers and facial expressions
26 Bad listening Makes little eye contact Makes distracting movements Faces away from speakerHas a closed posture (eg:arms crossed)Interrupts speakerDoes too many other things while listeningHas a flat affect, speaks in a monotone, gives few signals of interest
28 Responding Ask open and closed questions Use “encouragers” Paraphrase what you have heardReflect on feelingSummarize
29 Asking questions Open Questions Generally start with “what”, “how”, “why” or “could “Questions serve to:Gather lots of general informationEncourage discussionEg: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?”
30 Closed Questions Generally start with “is”, “are”, or “do” Serve to: Gather lots of specific information quicklyTend to close down discussionEg:Nurse: “Are you giving the medicine every day?”Nurse: “Is the baby able to tolerate the medicine in the morning?”
31 EncouragersThere is a category of responses that fall between non verbal attending and actual responses ,termed by Ivey & Ivey(1999) as minimal encouragers.Eg: “Yes, I understand” or repeat a word or two of what was said, “uh-huh”, “hmn hmn””and…?”and “then..?”Serves to:Encourage further discussion
32 Reflection of Feelings Focus on feelings (stated and unstated)Serves to:Communicate understanding of emotionsWhen combined with a paraphrase, confirms the accuracy of understanding (“Check out” the the other person)Encourages discussion of feelingsStem + feeling + (context) + check out
33 Paraphrasing Briefly summarize the content of the discussion Reflective listeningCheck your understandingShow that you heard what was saidAcknowledge and accept feelings without judgingEg: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.”
34 Summarizations Finally pull together ideas from the interview Serves toOrganize the structure of the interviewCheck the accuracy of understanding
36 Influencing or Changing Behavior DirectivesReframes and interpretationsAdviceFeedbackLogical consequences
37 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 concreteServes to:Move a person to take a specific act
38 Reframing and Interpretations Attempts to replace an old, maladaptive response with a newer, more useful (usually positive) oneServes toIncrease insight and understandingShift emotional or intellectual response
39 AdviceProvides information to help client make a decision. Can be very directive or less soServes to:Share information that would be relevant for a person’s decisions, actions, or understandingDisadvantages of adviceIt’s often disempowering (You can’t solve this on your own)People may say (but not really mean) that they want advice
40 FeedbackGives information about how the person is experienced by othersServes to:Help client see self more objectively (as others see him or her)Feedback works best whenIt is requested or desiredIt is concreteIt is positiveIf negative, it addresses something changeable or controllable
41 Logical ConsequencesFocuses on the logical consequences of a person’s behavior, actions, thoughts, or feelingsServes to:Increase awareness of consequences