Counseling

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Counseling

• Presented by LEIGH Nga Yan
• 6/11/02

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What is counseling?

• Different people have different interpretation.
• No single definition.
• In broad sense
• Is a helping relationship
• the helper helps another through communication

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Case Scenario

• Tom, a 16 years old student, visited his GP one
  afternoon, fearing of a genital ulcer. The GP
  found nothing abnormal on physical examination.
• If you were the GP, how would you approach this
  patient?

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• On further questioning, Tom was actually afraid
  of suffering from STD. He admitted unprotected
  sex with his girlfriend a week ago.
• What Toms GP did was assessing Toms knowledge
  about safe sex.
• He educated Tom about safe sex, advice his
  girlfriend to attend doctor if she has any fear
  or has delayed menstruation.

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• Is the GP doing counseling?
• Why yes/ why not?

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• Toms GP is
• Trying to help
• interview/ information gathering
• lecturing
• All these activities may lead to counseling, but
  was not counseling by themselves

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To be counseling what is lacking?

• unilateral, rather than interactive working
  relation.
• Toms emotion not addressed ?feeling guilty, ?
  Ashamed
• Toms GP was making the decision, rather than
  guiding Tom to find out what fitted him.
• Counseling should be person-oriented rather than
  problem-oriented.

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Definition of Counseling

• The European Association of Counseling
• Counseling is an interactive learning process
  contracted between counselor(s) and client(s), be
  they individuals, families or institutions, which
  approaches in a holistic way, social, cultural,
  economic and/or emotional issues.
• Counseling may be concerned with addressing and
  resolving specific problems, making decisions,
  coping with crisis, improving relationships,
  developmental issues, promoting and developing
  personal awareness, working with feelings,
  thoughts, perceptions and internal or external
  conflict.
• The overall aim is to provide clients with
  opportunities to work in self defined ways,
  towards living in more satisfying and resourceful
  ways as individuals and as members of the broader
  society.

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Definition of Counseling

• The Code of Ethics and Practice for Counselors
  (1993) describes the nature of counseling in
  the following way
• The overall aim of counseling is to provide an
  opportunity for the client to work towards living
  in a more satisfying and resourceful way.
• Counseling may be concerned with developmental
  issues, addressing and resolving specific
  problems, making decisions, coping with crisis,
  developing insight and knowledge, working through
  feelings of inner conflicts or improving
  relationships with others.
• The counselors role is to facilitate the
  clients work in ways which respect the clients
  values, personal resources and capacity for
  self-determination.
• Only when both the user and the recipient
  explicitly agree to enter into a counseling
  relationship does it become counseling rather
  than the use of counseling skills.

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Aims of all counseling

• promote self-help
• Move towards self-development
• provide an opportunity for the client to work
  towards living in a more satisfying and more
  resourceful way as individual/ as a member of a
  society.

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Counseling and general practice

• Opportunities for using counseling skills
• Formed working relation between GP and their
  patient, expose GP to counseling situation.
• Neglect patients need (? Holistic care)
• attempt counseling the patient after mutual
  agreement (contract).
• refer for specialist help ( assess self-resource)

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Reasons for GPs of not doing counseling

• Time consuming
• not the type of person
• dont know the skills
• not feeling competent

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Counseling

• How to do it?

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Models of Helping
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Components of helping The helper the skills

• the helper the most important tool
• attitude, counseling skill
• the core elements genuineness, warmth and
  empathy

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Genuineness/ congruence

• What you think and what you say is the same
• not particularly obvious when present, but when
  it is not there the clients are aware of the
  lack.
• Skills to decide how much to share in the
  moment, and how much should be considered later
  and elsewhere.
• 3 aspects of genuineness
• do not overemphasize the helping role
• avoid defensiveness
• be open
• on achieving build up trust

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Warmth

• Non-possessive warmth
• respect the other person and what that person is
  and stands for
• counselors consistent acceptance of and enduring
  warmth towards the client
• unconditioned positive regard
• when people are ill vulnerable, easily and
  quickly to feeling of being useless, sad and
  fearful (self-defeated cycle)
• positive reinforcement
• comfortable silence
• verbal support
• Drive to change

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empathy

• 2 way nature of empathy
• ability to perceive accurately the feelings of
  another person
• to communicate this understanding to him/ her.
• (c.f. sympathy suppress emotion, superimpose
  inferiority)
• encourage facing emotion, enhance trust building,
  sense of sincerity

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Empathy 2 levels of empathy

• Case scenario
• patient I feel really terrible today, worse than
  yesterday.
• Response A you feel worse today?
• Response B dont worry, these things take time
• response C you sound dejected at feeling worse
  today.

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• Basic empathy words reflected
• the helper responds and shows that the client is
  heard
• advanced empathy more reflection of feeling than
  words
• the caring can be communicate through action, or
  words, more both.

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Other attitudes

• attentiveness
• to be with the person at the time (both body and
  spirit)
• the quality of the presence is what matters most
• a kind of willingness to share yourself and
  acceptance
• skill active listening
• ATTENDING
• RESPONDING

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• Non-judgmental suspend premature solutions,
  personal attitude, and personal value
• a notion of respect
• being hopeful believe in the intrinsic worth and
  goodness
• convey to the client that they are worth your
  effort, time and skilled care
• a drive for hopeless and helpless client to move
  forward
• being supportive willingness to give involved in
  the therapeutic relation

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The art of relating

• The helper can give clients the safety to explore
  their real feelings, and permission to talk about
  things that are of the utmost important to them,
  particularly the knowledge that they have been
  heard.
• Rapport Building

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Rating our counseling skills

• Scoring lt35, most likely benefit from learning
  and applying counseling skills

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Assess our resources

• Everyone has the potential to help others
• Counselor Vs helper
• counselors are trained persons to do counseling.
• It is guided by theories about the causes of
  problems, and methods needed to help.
• Counseling / counseling skill
• being untrained, we can polish counseling skills
  to facilitate our helping work

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Level of goals

• Immediate goal finding solution to simple
  problem
• intermediate goal self-understanding,
  satisfaction in relation, accomplish education,
  cope with work, handle emotion
• ultimate goal self-actualization
• harmony with environment
• self-acceptance
• self-motivation..
• Consider refer counselor/ psychotherapist to
  achieve this.

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Personal counseling

• The framework and approach

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Setting the stage5Rs of counseling

• Right purpose
• be pure to assist the client to solve his/her
  problem. Nothing more.
• Right time
• most relaxed, least pressure
• enough time
• Right place
• Right approach
• Right techniques

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5Rs of Counseling Right place

• Comfortable, less threatening.
• Peace quiet, allowing private and confidential
  communication
• isolated location with few, if any, observer
• no disturbance by phone calls
• setting as natural as possible, at least without
  a desk.
• informal atmosphere enable counseling to be
  carried out on an equal basis

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5Rs of Counseling Right approach

• Voluntary meetings
• people come to you for his/her problem
• less barrier
• Intervention counseling
• you sense a problem, and you step in to assist
• situation may be more volatile and emotionally
  charged
• more difficult to set up
• 1. Oblique approach indirect/ soft a polite
  way too set up a counseling session you believe
  is needed.
• 2.direct approach problem obviously surfaced.

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The 5Rs of Counseling the Right Technique

• Tools to facilitate communication
• develop your own counseling style.

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The rule of game the 4 base diamond

• Giving advance notice about how the counseling
  game is played can relax the player and improve
  the process.
• By reaching base 4 you are winning the game!

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Base 1 listening

• By getting to base 1 getting acquainted,
  relaxing, and accepting each other and preparing
  to tackle a problem
• counseling relation begins
• rapport building

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The skills of relating

• Attending SOLER acronym body language
• face the client Squarely
• Open posture
• Lean forward
• Eye contact
• Relaxed
• Being Non-judgmental, staying open
• paying attention to body language
• giving space, time (permission to talk and
  explore inner world)
• active listening the less talking you, the more
• effective you will be
• encouraging building on the clients own
  strengths and calling forth the clients own
  resource.

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Base 2 identify the problem

• Task to accomplish
• isolate and agree on the problem
• skills of assessing challenging
• Talking is therapeutic

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The skills of assessing allowing

• permission to tell the story, encouraging the
  continuation of the story-telling
• what is happening?
• problems are seen more clearly through
• verbalization
• talking sometimes provides insight not possible
  through self-analysis
• in being allow to tell the story of the events,
  shapes may begin to emerge, patterns can be
  recognized, and links made between happenings
  that never seemed to be related.

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The skills of assessing exploring

• Concern with both factual and inner feeling and
  meaning
• seeking information, questioning
• clarifying
• reflecting to reflect significant word/ concept,
  so the patient can move forward / deeper
  exploring
• paraphrasing
• help client to personalize the experience
• experiencing feelings I statement
• what is the meaning of it

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The skills of assessing

• Guiding to new perspectives
• knowledge about defense mechanism, stages of
  bereavement.
• Enable patient to treat his/her reaction as
  normal.
• summarizing
• Focusing
• what do you what?
• By this juncture, you usually will know whether
  you can proceed, or need referral for expert help

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Counseling skill challenging

• To recognize the blockage to change
• outmoded values, irrational belief
• blind spot, self-defeating pattern of thinking
  and behaving
• inconsistencies between what are said and done
• the defense mechanism
• avoidance
• helper to be alert and spot them out quickly
• done with empathy
• the sandwich technique give praise first, then
  the challenge.

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Challenging

• Pre-requisition good working relation
• confronting with reality challenge the blind
  spot so that the reality can be seen as it really
  is at that point --gt develop new perspectives
• expressing feeling help patient to face their
  realistic feeling to experience and express
  feeling
• immediacy mirroring the difficulty of the client
  in interpersonal relation/ comparing behavior
  with you as helper

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• self-sharing
• intuition
• empowering leave patient with power/ confidence
• challenge the persons strength, rather than
  weakness, through the process of awareness,
  acknowledgement and change.

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Counseling a therapeutic relationship

• Sense of being understood, accepted.
• Relief of emotional pain
• improve self-understanding
• gaining drive to self-help support and hope

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• By accomplishing base 2 1.viewing the
  problem from different perspectives, objectively
  understand the dimensions of what to accomplish
• 2. Isolate and agree on the problem
• a sign of progress the client become ready to
  move forward and outward.

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Skills to drill

• Effective listening
• Being sensitive look beneath and beyond what
  people say
• Use your senses link between outer and inner
  world.
• Body language, non-verbal signal.
• Awareness
• the more you are aware of yourself, the more you
  are aware of other people.
• When we increase our self-understanding, we
  increase our capacity to help
• Helping is possible only from a basis of
  self-awareness and insight of how people live and
  work, think and feel
• uncover important aspect by asking question

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Base 3 look for clarify the alternatives

• An elegant solution the ideal solution under the
  circumstances.
• Counseling is a sensitive process that requires
  you to understand the feeling of the other party
  -- it is not always easy for a person to accept
  an elegant solution
• The counselor should emphasize the weighing part
  of the process, and let the other party do the
  deciding on which road to ride.

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Base 3 suggested steps

• Get several alternatives
• in most situations, possibilities are greater
  than 1st perceived.
• Frequently, an advisor can suggest an alternative
  not previously considered by the other party
• the weighing process
• mentally try on the alternatives and visualize
  the outcomes
• discarding alternatives
• prevent prematurely discard possibility, while
  get rid quickly not elegant ones
• the rule of 3

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Counseling skill goal setting

• New perspectives choosing from alternatives
• imagination
• what do you want? How are you going to do this
• Visualization
• managing feeling awareness, experiencing,
  expressing, controlling
• thinking skills, action skills anger, anxiety,
  depression
• managing resistance
• self-responsibility, commitment
• planning for change
• a moral contract

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• Making the decision
• signals of attaining a solution
• 1. The person see the light at the end of the
  tunnel
• 2. The individual has developed the necessary
  confidence to select the best available
  alternative and make a decision
• 3. The persons burden has been lifted.
  Self-esteem has been restored.

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• As a counselor, you can direct the person to the
  ideal solution, base on your own understanding of
  the problem.
• DO NO HARM

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Base 4 solution accepted

• The process starts on 3rd base where (hopefully)
  alternatives have been isolated
• Steps to close the session
• 1. Ask the individual to restate review (the
  implications of) the decision (skills ask/
  listen/ accept)
• 2. Help to reinforce the individuals self-esteem
• (skills compliment/ be optimistic/
  supportive)
• 3. Discuss how the solution is to be implemented
• (skill promote confidence in decisions)
• 4. Leave the door open for a return visit.
  (skill accept/ support)
• a return visit, to a counselor, is a compliment

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The psychology of Counseling

• Be a guide, not a leader
• you dont make decision, your client do.
• be someone who helps another sort out, solve a
  problem, and take action
• be a person who take the initiative
• be comfortable to know
• a problem burdens the other party, not you.
• When you can help a person to solve a problem,
  you lighten the burden they carrier

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The psychology of counseling

• Promote self-esteem
• listen respectfully, and say the right thing at
  the right time
• foster independence, not dependence
• principle of empowerment leave people confidence
  that they can solve their own problems and
  improves their lives.
• be honest about your role
• tell what you can do, and what you can
• DO NO HARM

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Unforgivable Mistakes

• 1. Overtalking underlistening
• 2. Acting like a psychologist or clinical
  counselor when you are not
• 3. Using a counseling relationship to your own
  advantage
• 4. Failure to keep information obtained from a
  counseling relationship
• 5. Making decisions for the person being
  counseled.