Counselling Procedure/Skills

1
Counselling Procedure/Skills

• Hitha.P.S
• II MSc Clinical Psychology

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
• Behavior
• Beliefs or emotional concerns relating to
  perceptions
• Level of emotional distress

3
Counseling Process Structure

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

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 by
• Counselors personal and professional
  qualifications.
• Clients-interpersonal history,
• anxiety state,
• interrelation skills, and
• previous ability to share,

5
Clinical Assessment

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

6
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.

7
Formal Diagnostic Assessment

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

8
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

9
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

10
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

11
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

12
FocusHealth history and behaviors

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

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

13
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

14
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.

15
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.

16

• 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.

17
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

18

• 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.

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

20
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

21

• 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.

22
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

23
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

24
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.

25
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

26
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

27
Looking Like Your Listening is Not Enough
28
Responding

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

29
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?

30
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?

31
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

32
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

33
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.

34
Summarizations

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

35
Influencing or Changing Behavior
36
Influencing or Changing Behavior

• Directives
• Reframes and interpretations
• Advice
• Feedback
• Logical 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 concrete
• Serves 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) one
• Serves to
• Increase insight and understanding
• Shift emotional or intellectual response

39
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

40
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

41
Logical Consequences

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

42
thank youuu..