COUNSELLING- BASIC COUNSELLING SKILLS

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Counselling Procedure/Skills

• Hitha.P.S
• II MSc Clinical Psychology

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Counselling - Definition

• An interactive process characterized by a unique
  relationship between the counselor and client
  that leads to change in one or more of the
  following areas
• Behavior
• Beliefs or emotional concerns relating to
  perceptions
• Level of emotional distress

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Counseling Process Structure

• Rapport and Relationship Building
• Assessment / Problem Definition
• Goal-setting
• Initiating Interventions
• Termination

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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 history,
• anxiety state,
• interrelation skills, and
• previous ability to share,

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Clinical Assessment

• Involves specific skills
• Observation
• Inquiry
• Associating facts
• Recording information
• Forming hypotheses (clinical hunches)

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Observation

• Take notice of the clients general state of
  anxiety.
• Establish sense of clients cultural context.
• Note gestures / movements that denote emotional /
  physical dysfunctions.
• Hear how the client frames his / her problems.
• Note verbal and non-verbal patterns.

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Formal Diagnostic Assessment

• Interview format
• Focus
• Basic Screening Questions
• Detailed Inquiry

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FocusPresenting problem and context

• Basic Questions
• What concerns brought you here?
• Why now?
• Has this happened before?
• How is it impacting your daily life?

• Detailed Inquiry
• Clarify stressors
• Elicit
• coping skills,
• social support,
• and resources
• Clarify life function
• work
• family
• health
• intimacy

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Focus Mental status

• Basic Questions
• How do you feel now?
• How is your mood affected?
• Had any unusual experiences?
• How is your memory?
• Do you think that life isnt worth living?

• Detailed Inquiry
• Note
• age mannerisms
• dress grooming
• orientation
• Probe
• anxiety symptoms
• form, content, thought.
• suicidal ideation
• violent impulses

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FocusDevelopmental history and dynamics

• Basic Questions
• How would you describe yourself as a person?
• Shift to the past, how were things when you were
  growing up?

• Detailed Inquiry
• Clarify
• current self-view
• level of self-esteem
• personality style
• Note
• developmental milestones
• experience in school
• best friends
• educational level

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FocusSocial history and cultural dynamics

• Basic Questions
• What is your current living situation?
• What is your ethnic background?

• Detailed Inquiry
• Elicit
• job or military
• legal problems
• social support system
• race, age, gender
• sexual orientation
• religion
• language
• dietary influences
• education

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FocusHealth history and behaviors

• Basic Questions
• Tell me about your health?
• Health habits?

• Detailed Inquiry
• Identify
• prescriptions
• substance usage
• health status
• health habits

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FocusClient resources

• Basic Questions
• How have you tried to make things better?
  Results?
• How do you explain your symptoms?
• What is your / my role in your treatment?
• When will things change / get better?

• Detailed Inquiry
• Probe
• Efforts to change
• Efforts vs. successes
• Clarify client explanatory model
• Identify treatment expectations
• Specify readiness for change

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FocusWind down and close

• Basic Questions
• What else would be important for me to know?
• Do you have any questions for me?

• Detailed Inquiry
• Use an open-ended query
• Allows the client to add information.
• Creates sense of reciprocal and collaborative
  relationship.

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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.

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• 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.

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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.

• Client
• Experience with the problem
• History of the problem
• Potential insights
• Awareness of personal investment in change

• Counselor
• Greater objectivity
• Training in
• Normal and
• Abnormal behavior
• Process experience

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• Process goals
• Related to establishing therapeutic conditions
  for client change.
• Includes
• Establishing rapport,
• Providing a non-threatening setting, and
• Possessing and communicating accurate empathy and
  unconditional regard.

• Outcome goals
• Are different for each client and directly
  related to clients changes.
• Always subject to modification and refinement.
• To begin, formulate tentative outcome goals.
• Modify goals as needed to support effective
  change.

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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
• Competency with the intervention
• Knowledge of appropriate uses
• Knowledge of typical client responses
• Observation skills to note client responses.

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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
• Continuing is against client best interest
• Client is deteriorating, not progressing
• Incompatibility with the therapist
• Client using therapy in place of life

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• 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.

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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

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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

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Non verbal attending and observation

• Take notice of the clients general state of
  anxiety.
• Establish sense of clients 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 client
• Hear how the client frames his / her problems.
• Note verbal and non-verbal patterns.

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A Good Listener

• Maintains eye contact
• Makes few distracting movements
• Leans forward, faces speaker
• Has an open posture
• Allows few interruptions
• Signals interest with encouragers and facial
  expressions

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Bad listening

• Makes little eye contact
• Makes distracting movements
• Faces away from speaker
• Has a closed posture (egarms crossed)
• Interrupts speaker
• Does too many other things while listening
• Has a flat affect, speaks in a monotone, gives
  few signals of interest

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Looking Like Your Listening is Not Enough
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Responding

• Ask open and closed questions
• Use encouragers
• Paraphrase what you have heard
• Reflect on feeling
• Summarize

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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?

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Closed Questions

• Generally start with is, are, or do
• Serve to
• Gather lots of specific information quickly
• Tend to close down discussion
• Eg
• Nurse Are you giving the medicine every day?
• Nurse Is the baby able to tolerate the medicine
  in the morning?

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Encouragers

• There is a category of responses that fall
  between non verbal attending and actual responses
  ,termed by Ivey Ivey(1999) as minimal
  encouragers.
• Eg Yes, I understand or repeat a word or two
  of what was said, uh-huh, hmn hmnand?and
  then..?
• Serves to
• Encourage further discussion

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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

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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.

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Summarizations

• Finally pull together ideas from the interview
• Serves to
• Organize the structure of the interview
• Check the accuracy of understanding

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Influencing or Changing Behavior
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Influencing or Changing Behavior

• Directives
• Reframes and interpretations
• Advice
• Feedback
• Logical consequences

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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

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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

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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

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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

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Logical Consequences

• Focuses on the logical consequences of a persons
  behavior, actions, thoughts, or feelings
• Serves to
• Increase awareness of consequences

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