Meaning

Counselling is the means by which one person helps another through purposeful conversation
 It involves a series of problem solving interviews
 A process by which two people meet to explore personal problems and to identify solutions
 Counselling is a method of identifying practical solutions to life.

Definition

The process by which the structure of the self is relaxed in the safety of the relationship with the
therapist, and previously denied experiences are perceived and then integrated into an altered self.

- Carl Rogers

Counselling is an activity . . . for working with relatively normal-functioning individuals who are
experiencing developmental or adjustment problems

- Kottler & Brown, 1996

What is Counselling?

Provision of assistance and guidance in resolving personal, social or psychological problems and
difficulties, especially by a professional

What does counselling involve?

Two way process:

 Client / Counselee – a person who needs help to deal with a problem
 Counsellor – a person who helps the client deal with his/her problem(s)

What happens in a counselling session?

Client

 Counsellor helps the client to look at his strengths & weaknesses

 Counsellor facilitates the process of looking at problem more clearly
  Counsellor facilitates the client to look at various solutions

Counsellor
 Client gains control over his
 The process leads to action on the part of the client
 Counsellor is a person who listens
 Personal growth of the client usually occurs
 Resolution of problems is an expectation

What counselling does not include? Telling clients what to do

 Making decisions on behalf of clients
 Judging clients
 Preaching or lecturing to clients
 Making promises that you cannot keep
 Imposing your own attitudes/beliefs on clients
 Treating mental illness

Objectives

 To make the person self sufficient, self dependent, self directedfandfto adjust
 To help individuals overcome obstacles / problems / tensions in their personal
 To help clients to understand themselves as they are
 To bring about voluntary change in their behaviour
 To help clients get insight into their problems
 To Relate, Relieve, Release, Relearn, Relax and Return to normal self (6 R‘ s)

Goals

 Problem-solving and decision making

 Improving personal effectiveness
 Insight and understanding
 Self actualization
 Achievement of positive mental heath

Need for counselling

 Emotional difficulties - People are getting anxious, tensed/nervous

 Behavioral difficulties
 Do not mobilize their energies / resources
 Not able to solve problems with the resources they have
 Stress - thinking is clouded
 Need for counselling Cannot make/take a decision
 Lack of motivation
 Relationship difficulties
  Lack interpersonal skills
 Lack of guidance and support

Scope

 Educational setting
 Industrial setting
 Hospital setting
 Community setting
 Youth health / development organisations
 Career guidance
 Geriatric population
 Correctional centres
 Premarital and marital counselling
 Vulnerable Population

Fundamental values of counselling Respecting human rights and dignity

 Ensuring the integrity of practitioner-client relationships

 Improving the quality of professional knowledge and its application
 Reducing personal distress and suffering
 Fostering a sense of self that is meaningful to the person(s) concerned
 Enhancing the quality of relationships between people
 Appreciating the variety of human experience and culture
 Striving for the fair and adequate provision of counselling services

Values are the basis of principles/ethics

Ethics

Ethics is a critical issue in every helping profession

Ethics deals with ethical /moral problems and moral judgments

What are ethics?

Ethics - Definition

The Cambridge Dictionary of Philosophy states

Ethics is commonly used interchangeably with ‘morality'

Standard definitions of ethics have typically included such phrases as -'the science of the ideal
human character' or 'the science of moral duty‘ 

Ethics is "a set of concepts and principles that guide us in determining what behaviour helps or
harms sentient creatures“

- Richard William Paul and Linda Elder

Principles

Principles direct attention to important ethical responsibilities:

1. Ethical decisions need to be strongly supported by one or more of these principles without any
contradiction from others

2. A counsellor’s obligation is to consider all the relevant circumstances with as much care as is
reasonably possible and to be accountable for decisions made

Basic ethical principles

1. Fidelity: honouring the trust placed in the practitioner

–Being trustworthy is regarded as fundamental to understanding and resolving ethical issues

–Confidentiality as an obligation arising from the client’s trust; restrict any disclosure of confidential
information

2. commitment to participating in counselling on a ivoluntary

Practitioners who respect their clients’ autonomy:

◦ Ensure accuracy in any information given in advance of services

◦ seek freely given and adequately informed consent from client/

◦ make any disclosures of confidential information conditional on the

The principle of autonomy opposes the manipulation of clients against

3. Beneficence: a commitment to promoting the client’s well-being

◦ Means acting in the best interests of the client based on professional assessment
◦ Directs attention to working strictly within one’s limits of competence and providing services on
the basis of adequate training or experience

◦ There is an obligation to use regular and on-going supervision to enhance the quality of the
services provided and to commit to updating practice by continuing professional development

4. Non-maleficence: a commitment to avoiding harm to the client

• involves avoiding sexual, financial, emotional or any other form of client exploitation

• The counsellor has an ethical responsibility to strive to reduce any harm caused to a client even
when the harm is unavoidable or unintended.

5. Justice: the fair and impartial treatment of all clients and the provision of adequate services

◦ Refers to being just and fair to all clients and respecting their human rights and dignity

◦ A commitment to fairness requires the ability to appreciate differences between people and
avoiding discrimination against people or groups according to their personal or social characteristics.

6. Self-respect: fostering the practitioner’s self-knowledge and care for self

◦ There is an ethical responsibility to use supervision for appropriate personal and professional
support and development, and to seek training and other opportunities for continuing professional
development

Ethical Issues that Influence Counselling Practice

Client Welfare: Client’s needs should come before counsellor needs and the counsellor needs to act
in the client’s best interest.

Informed Consent: Counsellors need to inform clients as to the nature of counselling and answer
questions so that the client can make an informed decision.

Confidentiality: Clients must be able to feel safe within the therapeutic relationship for counselling
to be most effective.
Dual Relationships: When a counselor has more than one relationship with a client (e.g. The
counselor is a friend and the counselor)

When to break Confidentiality

 When a client threatens another person’s life or with significant bodily harm
 When the client is harmful to himself
 When a child is being sexually abused
 If the counselor determines the client needs hospitalization
 If the information is involved in a court action
 Professional / supportive communication doesn’t apply ……
 When a counselor is performing a court ordered evaluation.
 When the client is suicidal.
 when the client sues the counselor.
 When the client uses a mental disorder as a legal defense
 When an underage child is being abused.
 When a client discloses an intent to commit a crime or is dangerous to others.
 When a client needs hospitalization.

Qualities of a counsellor

Personal qualities to which counsellors and are strongly encouraged to aspire

 Empathy: the ability to communicate understanding of another person’s

 Sincerity: a personal commitment to consistency between what is professed
 Integrity: commitment to being moral in dealings with others, personal
 personally:diminished. Also includes ability to work with strong emotions
 Respect: showing appropriate esteem to others and their understanding of themselves
 Humility: the ability to assess accurately and acknowledge one’s own strengths and
weaknesses
 Competence: the effective deployment of the skills and knowledge needed to do what is
required
 Fairness: the consistent application of appropriate criteria to inform decisions and actions
 Wisdom: possession of sound judgment that informs practice and being creative
 Courage: the capacity to act in spite of known fears, risks and uncertainty

 Qualities of a Counsellor
Concern for people
 Warmth, acceptance and genuineness
 Optimism and confidence
 Flexibility and tolerance
 Ability to articulate thoughts and ideas
  Commitment to personal wholeness on physical, emotional, social, intellectual and spiritual
levels
 Commitment to the development of one’s own skills, knowledge, supervision and
mentorship
 Ability to maintain confidentiality
 Have a good understanding of human nature and behaviour
 positive regard
 concreteness
 sense of humour
 self awareness (Small Talk by Tasha Eurich on self awareness)

Providing good standard of Practice

All clients are entitled to good standards of practice and care from their practitioners in counselling

Good standards of practice and care require: - professional competence

- good relationships with clients and colleagues
- commitment to and observance of professional ethics

Good quality of care

 Giving careful consideration to the limitations of their training and experience and work
within these limits, taking advantage of available professional support
 Dual relationships arise when the practitioner has two or more kinds of relationship
concurrently with a client, for example client and trainee -The existence of a dual
relationship with a client is seldom neutral and can have a powerful beneficial or detrimental
impact
 Maintaining appropriate records of their work with clients unless there are adequate
reasons for not keeping any records
 All records should be accurate, respectful of clients and protected from unauthorized
disclosure.
 Regularly monitoring and reviewing one’s work is essential to maintaining good practice
 Be open and conscientious in considering feedback from colleagues, appraisals and
assessments. Responding constructively to feedback helps to advance practice.
 A commitment to good practice requires practitioners to keep up to date with the latest
knowledge.

Keeping trust
The practice of counselling depends on gaining and honouring the

Keeping trust requires:

 ◦ attentiveness to the quality of listening and respect offered to clients

  ◦ culturally appropriate ways of communicating that are courteous and clear ◦ respect for
privacy and dignity
 ◦ careful attention to client consent and confidentiality
 clients and respect a client’s right to choose whether to continue or
 Any disclosures should be undertaken in ways that best protect the client’s trust
 Practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial
or any other kind of personal advantage
 Counsellors should think carefully about, and exercise considerable caution before, entering
into personal or business relationships with former clients
 Counsellors should not allow their professional relationships with clients to be prejudiced by
any personal views they may hold about lifestyle, gender, age, disability, race, sexual
orientation, beliefs or culture.

If things go wrong with the client

 Counsellors should respond promptly and appropriately to any complaint received from the
clients.
 Counsellors should try to remedy any harm they may have caused to their clients and to
prevent any further harm. An apology may be the appropriate response.
 Practitioners should discuss with their supervisor the circumstances in which they may have
harmed a client in order to ensure that the appropriate steps have been taken to reduce any
harm and to prevent any repetition.
 Care of self as a counsellor
 Attending to your well-being is essential to sustaining good practice
 Practitioners have a responsibility to themselves to ensure that their work does not become
detrimental to their health or well-being by:
 ◦ the way that they undertake their work must be as safe as possible and that they seek
appropriate professional support and services as the need arises

Steps in making ethical decisions

Identify the problem or dilemma

◦ Gather information to understand the nature of the problem
◦ Decide whether problem is ethical, legal, professional, clinical or moral

Identify the potential issues

◦ Evaluate the rights, responsibilities and welfare of all involved in the situation

Look at the ethical codes for general guidance on the matter

Consider the applicable laws and regulations

◦ Determine how they have a bearing on an ethical dilemma
Seek consultation from more than one source to obtain different perspectives on the issue

Brainstorm various possible courses of action ◦ With other professionals

◦ Include client also

Steps in making ethical decisions

Enumerate the consequences of various decisions and reflect on the implications of each course of
action for the client

Decide upon what appears to be the best possible course of action ◦ Implement the best course of
action
◦ Evaluate the outcomes ◦ Document the process

Situation for discussion…

A counsellor has been working in a school for several months and once two girls said they want to
see her. They looked very scared and hesitant. The counsellor started talking gently, asked them to
sit and slowly they relaxed. Then the counsellor asked them what the matter was. They looked at
each other fearfully and then one girl told the counsellor that they have secret to tell her. They told
her that the new PT sir has been acting very weirdly. With the pretext of teaching them badminton
he has been touching their body with bad intentions. This had been going on for some months and
all the girls are very scared to tell any one about it. Matters went worse once when one of them was
cornered by him in the sports room and he attempted to molest her. He also threatened her not to
inform this to anybody else. At this the girl who had been the victim started crying. They told the
counsellor that they like her and feel that they can trust her so they thought of telling her. They
asked her what to do. They did not want her to tell any one – that she should keep their secret …
what should the counsellor do in these circumstances?

How would you go about in this situation following steps learnt?

characteristics of Counselling

It is a relationship – non-possessive warmth, empathy, genuineness and a sense of understanding

It involves a repertoire of interventions – Interventions depend on needs and state of readiness

(feeling, thinking, acting)

It is a psychological process
◦ Goal of counseling has got mind component ◦ Counselling process is psychological
◦ Underlying theories are psychological
◦ Movement, flow and interaction influenced by behavior (2 persons)
Characteristics of Counselling

 It is concerned with normal problems rather than mental health problems

 ◦ Problems of living - acknowledging that changes can be unpredictable
 It is concerned with role functioning, with choices to be made and with actions to be taken
 It is concerned with present events than with past events
 It is more concerned with conscious, rational thinking than with unconscious functioning.

Important issues to be borne in mind

 To start on time
 To make the client comfortable to get him relaxed
 To facilitate client to narrate the situation and not making assumptions
 To note the demeanor of the client

Evolution of counselling

In 1800s, modern psychology originated in Western Europe and US ◦ Women and other minorities
were excluded from higher education
◦ Much of history was written by privileged white men from their perspective

Father of modern psychotherapy – Sigmund Freud

Before Freud, Pierre Janet was developing a theory on human functioning, Freud was validating it
◦ They both developed difference because Freud’s interest in inner conflicts were not considered
significantly

Movement on psychotherapy and counselling is informed to be developed in Western Europe and

then later US, however no clear evidence

Initially work focused on “human unconscious”

Earlier treatments for human distress and disturbance consisted of combination of 3 procedures
1. Medical – Biological 2. Spiritual
3. Psychosocial

Evolution of counselling

Bio-medical perspective
◦ Stone Age treatment – Trephining – using a stone tool to chip away the human skull till a circular
opening was established

◦ This opening is done by a medicine man (also called as Shaman) – to release the evil spirit dwelling
in afflicted individual’s brain
◦ Evidence reports that people lived many years after this crude procedure
◦ Then came Pre-frontol Lobotomy

Evolution of counselling

Lobotomy
◦ Drilling a small hole in the temple on both sides – insert a dull knife into the brain and make a fan-
shaped incision – then downwards a few minutes later

◦ Result - Cognitive and personality changes

Then came ECT and various drugs to change the function and balance of the neurotransmitters
which enhances human mental well-being

Religious / spiritual Perspective

◦ Advice / counselling was offered by clergy, shamans, mystics, monks, elders & religious / spiritual
leaders

◦ Strong belief in people was that spiritual concerns and practices are intricately related to
psychological matters

◦ Religious and spiritual leaders often have great wisdom, compassion and insight into the human
conditions

Psychosocial perspective
◦ Humans have understood that verbal interactions and relationship alterations can change thinking
patterns, mood and behavior

◦ Many wise healers of those time used psychological and relational techniques that are similar to
current theoretically driven strategies to help people with psychological difficulties

◦ Buddha / some of the roman philosophers work was considered forebears of current cognitive
theory / therapy

Psychosocial perspective
◦ Avicenna, important person in Islamic medicine – case study from his work

“A prince during his time had melancholia and suffered from delusion “that he was a cow”- Prince
used to tell everybody to kill him and eat his flesh and he never used to eat - Avicenna sent a
message first to inform the prince that the butcher is coming to kill, so be of good cheer - Avicenna
entered the sickroom with a knife and said where is the cow that I will kill it? – He felt the prince all
over and said this cow is too lean and ready to be killed, he must be fattened – then the prince ate
eagerly, gained weight, got rid of delusion and was completely cured”

In 1900s, counselling was in the form of advice and information

Counselling profession grew out of Industrial revolution between mid and late 18 century

Most of the pioneers in counseling identified themselves as teachers and social reformers /
advocates

Initially, these helpers were involved primarily in child welfare, educational / vocational guidance
and legal reform.

Evolution of counselling

These helpers’ work was built on specific information and lessons, such as
◦ moral instruction on being good and doing right and ◦ dealing with intra- and interpersonal
relations

1900 – 1909 – Frank Parsons – founder of guidance – choosing the vocation

1910s – National Vocational Guidance Association (NVGA) was found

◦ Military began to employ testing and placement practices for great numbers of military personnel

1920s – Educational courses for counsellors began

◦ 1st marriage and family counselling centre was established in 1929 in New York city

In 1930s the U.S. government became more involved in guidance and counseling

1940s – Carl Rogers theory on non-directive approach to counselling added significance

1950s – 4 major theories influenced the work of counsellors were: ◦ Psychoanalysis and insight
theory
◦ Trait factor of directive approach
◦ Humanistic and client centred theory ◦ Behavioral theories

1960s – Counselling as development profession ◦ Community mental health centres act

◦ Drug abuse counselling
◦ Code of ethics was drafted
◦ Training standard for school counsellors

1970s – Rapid growth of counselling outside educational institutions ◦ Helping skills program
◦ State licensure

1980s – standardisation of training and certification

1990s – American counselling association was formed

◦ Counselling was added as one of the primary mental health profession ◦ Multi-cultural counselling
competencies and standards

After 2000 – Counselling focus on dealing with violence, trauma, and crises; managed care; wellness;
social justice; technology; leadership; and identity.

Multicultural Counselling

Pederson (1994) proposed a broad definition of multicultural counselling which includes:

◦ ethnographic variables such as ethnicity, nationality, religion and language;
◦ demographic variables such as age, gender and place of residence;
◦ status variables such as social, educational and economic; and affiliations including both formal
affiliations to family or organizations and informal affiliations to ideas and a lifestyle

Recognises the differences in clients and opposes the presumption that differences in the clients
don’t matter in counselling help

Counselling Process

Principles of counselling

Counseling Process - Structure

1. Rapport and Relationship Building

2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. 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.

Rapport and Relationship Impacted by

Counselor’s personal and professional qualifications.

Client’s

interpersonal history anxiety state interrelation skills and

previous ability to share

Counseling Process – Structure

1. Rapport and Relationship Building

2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. Termination
Assessment Involves specific skills
Observation

Inquiry

Associating facts

Recording information

Forming hypotheses (clinical “hunches”)

Observation

1. Take notice of the client’s general state of anxiety.

2. Establish sense of client’s 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.

Humans Share Basic Needs

1. Survival
2. Physical needs
3. Love and sex
4. Status, success, and self-esteem
5. Mental health
6. Freedom
7. Challenge
8. Cognitive Clarity

Formal Diagnostic Assessment

Interview

Focus

format:

Area

Basic Screening Questions Detailed Inquiry

Focus
Presenting problem and context
Basic Questions Detailed Inquiry

• What concerns brought you here?

• Why now?
• Has this happened before?
• How is it impacting your daily life?

• Clarify stressors

• Elicit
- coping skills,
- social support, - and resources

• Clarify life function - work

- family - health
- intimacy
Mental status

Basic Questions Detailed Inquiry

• 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?

• Note
- age & mannerisms - dress & grooming - orientation . . . .

• Probe
- anxiety symptoms
- form, content, thought. - suicidal ideation
- violent impulses . . . .

13

Focus
Developmental history and dynamics

Basic Questions Detailed Inquiry

• How would you describe yourself as a person?

• Clarify
- current self-view
- level of self-esteem - personality style
• Shift to the past, how were things when you were growing up?

• Note
- developmental milestones
- experience in school - best friends
- educational level

Social history and cultural dynamics

Basic Questions Detailed Inquiry

• What is your current living situation?

• What is your ethnic background?

• Elicit - job
- legal problems
- social support system - race, age, gender
- sexual orientation - religion
- language
- dietary influences - education

Health history and behaviors

Basic Questions Detailed Inquiry

• Tell me about your health?

• Health habits?
• Identify
- prescriptions
- substance usage - health status
- health habits

Client resources

Basic Questions Detailed Inquiry

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

Wind down and close

Basic Questions Detailed Inquiry

• What else would be important for me to know?

• Do you have any questions for me?

• Use an open-ended query

- Allows the client to add information.
- Creates sense of

reciprocal and collaborative relationship.

Counseling Process - Structure

1. Rapport and Relationship Building
2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. Termination

Conceptualizing Problems

Recognize client’s need

Understand that need
Meet that need

Conceptualizing Problems

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
• Concurrent events
• Cultural and socio-political issues

Counseling Process – Structure

1. Rapport and Relationship Building
2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. Termination

Goal Setting

Indicates how well counseling is working.

Indicates when counseling should be concluded.
Prevents dependent relationships.

Determines the selection of interventions.

Mutually defined by the client and counselor
Counselor

Greater objectivity

Training in
◦ Normal and
◦ Abnormal behavior

Process experience

Client

Experience with the 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 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.

Counseling Process - Structure

1. Rapport and Relationship Building
2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. Termination
Interventions

Objective - initiate and facilitate change in the client

After assessment and goals setting, answers the question, “How shall we accomplish these goals?”

Must be related to the problem.

Interventions
Selecting an intervention may become an adaptive process.

Skills to initiate interventions include

1. Competency with the intervention
2. Knowledge of appropriate uses
3. Knowledge of typical client responses
4. Observation skills to note client responses.

Broad steps in Problem Solving Approach

1. Problem identification
2. Exploring possible means or solutions to deal with the problem
3. Thinking through possible solutions – weighing pros and cons / evaluation of each solution
4. Action and follow-up

Counseling Process - Structure

1. Rapport and Relationship Building
2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. Termination

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
1. Suggested termination, with client’s agreement

2. Imposed termination
• Continuing is against client’s best interest
• Client is deteriorating, not progressing
• Incompatibility with the counsellor

3. Situational termination
• Client moves
• Employment or insurance changes

4. Early termination, clients just don’t return.

Methods & Process Gradual tapering off of sessions.

Therapeutic vacations, taking a break without breaking the connection.

Direct (imposed) termination.

Methods & Process

Counsellor must carefully consider the most effective way to terminate each client.

1. How will termination impact the client?

2. What is the client’s history of separation? Is the client likely to regress?
3. What is the client’s reaction / opinion about termination? Can he / she see it as a positive
step?
Basic principles in counselling relationship

Participation Individualisation Confidentiality Communication Acceptance

Self-awareness

Participation

Engagement, involvement and commitment by client and therapist that contributes to the bonding
component of the relationship.

Substantial evidence supports therapists and client's engagement as a central construct of the
therapeutic relationship (Fuhriman & Burlingame, 1990; Orlinsky & Howard, 1986)

Role of the counsellor Establish rapport

Be genuine
Good listener
Effective interpersonal communication
Be focused on the client’s problem

Individualisation
Recognition and understanding of each client’s unique qualities
Each client is an individual
Aims at helping client to use his/her abilities and resources to deal with his/her problem
Recognition and understanding of client’s difficulties and feelings are crucial for entering into a
helping relationship

Role of Counsellor Freedom from biases and prejudices

Knowledge of human behavior

Ability to listen and to observe
Ability to move at client’s pace
Ability to enter into the feelings of people
Ability to keep perspective

Means of Individualisation
Thoughtfulness in details
Privacy in interviews
Caring in keeping appointments
preparation for interviews
Enabling the client
Flexibility

Confidentiality

Preservation of secret / personal information concerning the client

Significant ethical obligation of the counsellor
Client’s personal information could be shared with others only after taking consent of the client

Role of the counsellor:

• Aware about his/her own habits & tendencies

• Avoid loose talks
• At a professional meeting, can share some details without giving any information on identification

Communication

Communication can be defined as the process by which people share ideas, experience, knowledge
and feelings through the transmission of symbolic messages.

Means of communication are usually spoken or written words, pictures or symbols.

Also include giving information through body language, gestures, and looks, facial expressions can
show how we feel and what we think about an issue or another person.

What are the most common ways we communicate?

Written Word
The Communication Process

Medium

Barrier

SENDER
(encodes)
Barrier

RECEIVER (decodes)

Feedback/Response

Characteristics of effective communicator

An effective verbal communicator: Clarifies
Listens

Encourages empathetically Acknowledges

Restates/repeats

An effective nonverbal communicator:

Relaxes Opens up
Leans toward the other person Establishes eye contact
Shows appropriate facial expressions

Barriers to communication

• Language

• Values and beliefs

• Sex/gender and age • Economic status

• Educational level • Physical barriers • Attitude
• Timing

• Understanding of message • Trust

Acceptance

Implies liking the client irrespective of his negative qualities and conduct
Expression of goodwill
Conveys deep concern and active understanding
Involves - observance of common courtesies – respect for the client’s ideas – treating him/her as
equal
Does not mean that we approve of deviant attitude and behavior
Pertinent reality
Purpose is therapeutic
Looking at client as s/he really is

• Keeping the relationship on realistic basis

• Constantly search for pertinent reality
• Looks at strengths & successes and weaknesses & failures
• Stimulates the client to reveal his/her problem to understand the reality

Obstacles to Acceptance

• Insufficient knowledge of human behavior

• Imputing / alleging to the client’s own feelings
• Bias and prejudices
• Unwanted reassurances
• Confusion between acceptance and approval
• Loss of respect for the client

Self-confidence

Self-confidence is the belief in oneself and abilities, it describes an internal state made up of what
we think and feel about ourselves

This state is changeable according to ◦ the situation we are currently in and

◦ our responses to events going on around us

It is not unusual to feel quite confident in some circumstances and less confident in others

Self-confidence

Influenced by
◦ past events and how we remember them
◦ recalling a former success has a very different outcome in terms of our confidence levels than
thinking about an occasion when we failed.

What would improve self-confidence? Learn to be more assertive and not feel guilty about saying no

Give oneself at least equal priority as those one love

Examine why one feel bad about him/herself and what you can do to change this
Monitor oneself’s talk and question their negative statements about oneself
Stop focusing on yourself too much and try to help others
Make time for yourself and treat yourself often
Don't be afraid to ask others for what you want
Effect of low self-confidence Shyness
Communication difficulties
Social anxiety
Lack of assertiveness
• Being aware of one’s own attitude, values and beliefs and how these have an affect on one’s
interaction with other people
• Usually we see the world not as it is, but as we are.
• Human perception is a creative process that relies on previous experience and knowledge to make
sense of present reality

Attitudes, Values and Beliefs •c Counsellor attitudes, values, beliefs can influence

•bCounselling values: not imposing own attitudes, values,

•positive/negative qualities, feelings, behaviours)sses,

• Be non-judgmental (not your task to assign blame)

Be aware…

• Identify & be aware of your own attitudes, values, beliefs

• Be aware of pressures from social & communal values
• Need to suspend (not give up) own attitudes, values, beliefs in order to show respect, empathy, etc
• If unable to do so, refer client to the colleague or another service

Self – awareness is important, reasons:

• Helps indentify any stereotypic way of thinking, prejudices or biases that could influence how one
helps certain clients
• Helps in understanding the client’s problem from his/her viewpoint
• Helps us to be more conscious in our reactions and feelings
Self – awareness is important, reasons:

Helps in personal growth and development as a counsellor

Prevents you from burnout

Counselling Skills

UNIT – III

Counselling Skills

 Active listening
 Empathy
 Paraphrasing and mirroring
 Reflecting feelings
 Clarifying
 Questioning & probing
 Summarizing
 Positive assets

Case for practicing skills

Sukanya is 38 year old married woman with 2 kids, from an economically backward nuclear family.
Her husband is an auto driver and she works as a domestic maid in 3 houses in the same locality.
Their monthly income is around Rs.8,000/- per month. Earlier the couple used to be very loving but
lately, her husband started drinking, comes home drunk and beat her up for simple reasons and he is
become suspicious too. Children are studying in primary school and performing pretty well in
studies. Because of this, Sukanya started having complaints like feeling tired, not able to sleep,
sometimes crying spells, worried about children etc.

Active listening – body language

Active listening (listening in order to understand) involves
–Attending
–Verbal & non-verbal behaviour of counsellor
–Helps counsellor to listen properly & to let client know that he/she is listening
Active listening
A skill which can be learned, developed
It requires training and practice
Active, engaging, disengaging from personal concerns, opens to personal world view of client and
respond empathetically to what is heard

What do you listen?

– Verbal messages (what is said in words)
– Non-verbal messages (what is conveyed by non-verbal signs)
– Message in context (meaning of what is said in client’s context)
Allowing time
– Don’t rush, allow silence
– Give client time to express him/herself, yourself time to digest, before responding
Active Listening

When you listen….

• Know what you are listening
• Listen for the specific content
• Why, when and how of the situation
• Suspend your personal judgment
• Resist distractions
• Recall tone of voice, words used

Active Listening

What is the client saying ? - paying attention to needs, background, values and beliefs
How is he/she saying it ?
Does the client’s non-verbal communication agree with what he/she is saying in words ? If not, what
does that mean ?
Is there a gap in what the client is saying ? Why is he/she leaving it out ?
What are my (counsellor’s) own reactions (physical, emotional, values, attitude) to what the client is
saying?

Active Listening
Attending skills
- Greeting skills
- Politeness
- Kindness

Attending – entire attention physically and psychologically

Attending – Non verbal communication with body and behaviour (80%) and verbal
communication/language (20%)
Demonstrating active listening
To sit facing the client
Posture yourself in a way that shows interest
Have eye contact
Eliminate distracting behaviour
Tone of voice, lips, hands and the way we send message
Active Listening

Why we need to listen?

• To build trust, relationship and create the "safe space" for client to express feelings and
thoughts
• To give feedback, clarify, to reflect

Empathy
Empathy is the ability to put ones own self in the place of the client and feel what he or she could be
feeling at the moment.

Different from sympathy - feel & express pity (sympathy emphasizes helplessness of client)
Why is empathy important ?

•Emphasis on feelings & reflection of feelings (rather than content)

•Recognises feelings of another person & communicates understanding in verbal or non-verbal ways
•Validates client’s feelings, reduces defensiveness
•Shows respect for client’s ability to cope with feelings
Provides emotional support to client
Builds rapport, encourages dialogue, builds relationship with client
Helps counsellor to identify underlying concerns (rather than only the most obvious concerns)

Ways to communicate empathy

Can be expressed in one word, phrase or sentence

Link feelings to situation / context (“you seem to feel… because…”)
Should be tentative / provisional

Activities that can destroy empathy

•Pretending to understand when you don’t – rather ask for clarification

•Not responding at all or giving a shallow response which gives the impression the client was not
‘heard’ or what he/she expressed was not worth responding to
•Giving a long response that says more about the counsellor than the client’s feelings
•Just repeating word-for-word what the client said when expressing intense emotion
•Sympathizing e.g. “I feel so bad for you, you are stuck at home since you have been ill”
• Asking a question or giving advice instead of responding to a feeling expressed
• Using words like “I understand”
• Sharing a personal experience that the counsellor perceives as similar (but may not be)
• Preaching or moralising (“that’s not the way to treat your partner”)
• Interpretations that suggest personal judgments or blame (“it seems you tend to lose your
temper easily”)

Paraphrasing, mirroring & clarifying

• Repeating in one’s own words what the client has said to show one’s understanding
• It helps the process of counselling by
–Clarifying for the client what he/she has said
–Clarifying for the counsellor what the client has said – by feeding back what you have heard, you
can check on the accuracy of your listening
–Helping client talk in more details about issues of concern to them
–Helping a talkative client to stop repeating the same facts or story

Reflecting feelings

To pick up the client’ s feelings & letting him/her know you have understood how & what he/she is
feeling
To do this one needs to observe
• Emotional words used by the client
• Non-verbally expressed emotional words
Reflecting feelings

1. Begin with words such as, “you feel…”, “sounds like you feel…”
2. Feeling words may be added eg. Sad, happy, glad
3. The context may be added through a paraphrase or repetition of key content
eg. “looks like you feel happy about getting a job”
4. A present tense reflection is more effective eg. “you feel..” rather than “you felt…”
5. After identifying a feeling, you can clarify so that the client can correct you if needed
eg. “am I hearing correctly ?”

Clarifying

Unclear or contradictory information need to be verified with the client

In case of incomplete information, clarify the gaps with the client
Do not jump into conclusions or judgments without adequate information from the client
Questioning

•Includes questions, statements (with questioning intonation), requests, non-verbal prompts

•Open questions - open up communication

–Responses - more detailed
–Used more often early in counselling, to get broad overview

•Closed questions - channel communication

–Responses - single word or short answer (“yes/no”, “yesterday”)
–More useful later on, to clarify specific issues

Purposes of open ended Questions

 To begin an interview
 To encourage client elaboration
 To elicit specific examples
 To motivate clients to communicate
 Purposes of close ended questions
 To obtain specific information
 To identify parameters of a problem or issue
 To narrow the topic of discussion
 To interrupt an over talkative client

Probing

• Fill in incomplete information, encourage client to continue

– “& then ?”, “what happened next ?”, “mmm…”
• Get a more detailed picture
– “please tell me more about that…”
• Clarify information that is not clear
– “could you give me an example ?”, “so you thought he could help?”
• Clarify emotional reaction
– “how do you feel about that ?”, “you’re feeling sad about what happened ?”
Summarizing
• Normally done at the end of the session
• Re-state main (content) points of client’s message
• Not just repeating – Counsellor puts into his/her own words how s/he understands client’s
situation
• Don’t state as fact - use words that show Counsellor is checking whether s/he has
understood correctly
• Use at intervals to check understanding (paraphrasing) or to review bigger chunks
Positive assets search / strokes
• These are used through out the session
• Helps raise the persons self esteem
• Builds confidence and rapport

Example:

Client: I was very tired by the time I reached home, than I cooked food for the family
Counsellor: In spite of being very tired you managed to cook a full meal for your family.

Counselling Skills

 Active listening
 Empathy
 Paraphrasing and mirroring
 Reflecting feelings
 Clarifying
 Questioning & probing
 Summarizing
 Positive assets

Group & Family Counseling

History

• Group counseling in the United States can be traced back to the late nineteenth and early
twentieth centuries
• Millions of immigrants moved to American shores and most of these immigrants settled in
large cities and had difficulties to adjust to life in US
• Many organizations such as Hull House in Chicago were founded to assist them known as
settlement houses
• These agencies helped immigrant groups lobby for better housing, working conditions, and
recreational facilities.
• These early social work groups valued group participation, the democratic process, and
personal growth.
Origins in Social Work

• Some early psychoanalysts, especially Alfred Adler, a student of Sigmund Freud, believed
that many individual problems were social in origin.
• In the 1930s Adler encouraged his patients to meet in groups to provide mutual support.
• At around the same time, social work groups began forming in mental hospitals, child
guidance clinics, prisons, and public assistance agencies.

What is a group?

•Gladding defined a group as

“a collection of two or more individuals who meet in face-to-face interaction, interdependently, with
the awareness that each belongs to the group and for the purpose of achieving mutually agreed-on
goals.”

Types of Groups
• Task Groups: A group that comes together to perform a task that has a concrete goal (e.g.
community organizations, committees, planning groups, task force)

• Guidance / Psycho-educational Group: Preventative and educational groups that help group
members learn information about a particular topic or issue and might also help group members
cope with that same issue (E.g. motivation, career guidance etc)

• Counseling/Interpersonal Problem-Solving Groups: These groups help participants resolve

problems of living through interpersonal support and problem solving.

• Psychotherapy Groups: These groups focus on personality reconstruction or remediation of

deep-seated psychological problems.

•Support Groups: These deal with special populations and deal with specific issues and offer
support, comfort, and connectedness to others.

•Self-help Groups: These have no formal or trained group leader. (e.g. Alcoholics Anonymous or
Gamblers Anonymous.)

What is Group Counselling? 

Group Counselling

• Group counselling refers to the routine adjustment or developmental experiences provided

in a group setting.
• Group counselling focuses on assisting counselees to cope with their day to day adjustment
and developmental concerns.
• Examples might focus on behavior modifications, developing personal relationship skills,
concerns of human sexuality, values or attitudes, or career decision making
Why Choose Group Counseling?

Group counseling offers

• multiple relationships to assist an individual in growth and problem solving
• members are encouraged to discuss the issues that brought them into counseling openly
and honestly
• an atmosphere of trust and acceptance that encourages members to support one another
Group Counseling

Stages of Groups

•Stage One (Orientation/Forming): Group members become oriented to the group and to each
other.

•Stage Two (Transition/Storming): Anxiety and ambiguity become prevalent as group members
struggle to define themselves and group norms.

• Stage Three (Cohesiveness / Norming): A therapeutic alliance forms between group

members. Trust between members has been established.

• Stage Four (Working/Performing): Group members experiment with new ideas, behaviors or
ways of thinking. Egalitarianism develops.

• Stage Five (Adjourning/Terminating): This is the time when the group disbands.
Lets have a group counselling session

Stages / structure of group counselling

1. The beginning stage or the opening stage

2. The middle stage or the working stage
3. The closing stage or the ending stage

• Introductions and discussion on:

• The purpose of the group
• what may happen
• fears
• group rules
• comfort levels and
• the content of the group
• Ice-breaking sessions
• Helping the members get acquainted with the group
• Setting a positive tone
• Clarifying the purpose of the group
• Explaining the leaders role
• Explaining how the group will be conducted
• Helping members verbalize expectations
• Using exercises
• Checking out the comfort levels of the members
• Assessing members interaction styles
• Being sensitive to multicultural/diversity issues and any dynamics that may be present
• Explaining group roles
• Explaining any special group terms that will be used
• Focusing on the content
• Addressing questions
• Getting members to look at other members

The middle stage or the working stage

Focus of middle stage

• Members focus on the purpose

• The members learn new material
• Thoroughly discuss various topics
• Complete tasks
• Engage in personal sharing and the therapeutic work

The middle stage or the working stage What do you do?

• Assessing the benefits

• Assessing members interest and commitment
• Assessing each members participation
• Assessing members level of trust and group cohesion
• Assessing how much to focus on content and how much to focus on process
• Screening out members
• Dealing with breach of confidentiality

Techniques to be followed in middle stage

• Using progress reports

• Introducing topics for discussions
• Stimulating members thoughts
• Varying the format
• Changing the leadership style, if required
• Changing the structure of the group, if required
• Using voice to get members to think
• Using outside materials and assignments
• Meeting with members individually
• Informing members in advance when group is ending

The closing stage or the ending stage

•During this period:

• members share what they have learned

• how they have changed and
• how they plan to use what they have learned
•The length of the closing stage will depend
• on the type of group
• the length of time it has been meeting and
• its development

The closing stage or the ending stage

• Dealing with feeling of separation

• Guarding against ending with strong emotions
• Helping members in their transition
• Conducting exit interviews
• Holding follow up sessions
• Evaluating the group

Advantages of Group Counseling

• It provides a social atmosphere that is similar to the real world.

• Members can test out and practice new behaviors.
• Members can practice new interpersonal skills.
• They are cost effective.
• Groups help members see that they are not the only one who has that particular problem or
issue.
• Groups provide members with support.

Therapeutic / Curative Factors

1. Instillation of hope - encouragement that recovery is possible

2. Universality - feeling of having problems similar to others, not alone
3. Imparting of information - teaching about problem and recovery
4. Altruism - helping and supporting others
Given by: Dr. Irvin D Yalom, Psychiatrist
Therapeutic / Curative Factors
5. Corrective recapitulation of family of origin issues – identifying & changing the dysfunctional
patterns or roles one played in primary family
6. Developing Social Skills - learning new ways to talk about feelings, observations and
concerns
7. Imitative Behavior - modeling another’s manners & recovery skills
8. Interpersonal learning - finding out about themselves & others from the group
Given by: Dr. Irvin D Yalom, Psychiatrist
Therapeutic / Curative Factors
9. Group Cohesiveness - feeling of belonging to the group, valuing the group
10. Catharsis - release of emotional tension
11. Existential Factors - life & death are realities

Given by: Dr. Irvin D Yalom, Psychiatrist

Disadvantages of Group Counseling

• Less individualized attention from the counselor.
• Confidentiality is more difficult to maintain.
• There are concerns with conformity and peer pressure.
• Not everyone can be in a group (e.g. those with issues too severe or those with poor
interpersonal skills.)
• Scapegoating may occur.
• Group leaders are not always properly trained.

Leadership in Group Counseling

Leadership Styles

• Authoritarian: Leader centered.

• Democratic: Participant centered.
• Laissez-Faire: No designated leadership.

Leadership Functions

•Emotional Stimulation: Challenging, confronting, modeling self-disclosure etc.

•Caring: Showing support, praise, warmth, acceptance etc.
•Meaning Attribution: Explaining, clarifying, interpreting etc.
•Executive Function: Setting limits, providing rules, managing time etc.

Group Leadership Techniques

• Facilitating communication: Giving constructive feedback, preventing members from

engaging in negative behaviors (gossiping, storytelling etc.)

• Group Processing: Making comments on group process to keep the group therapeutic and
attending to group dynamics.

• Directing the focus on the Here and Now: Keeping the focus on right now and not going
Group Leadership Techniques

•Experimentation: Helping members try out new attitudes and behaviors.

•Universalizing: Helping members realize they are not alone in their problem(s).

•Linking: Connecting various feelings and concerns expressed by group members to present a
common theme or universalizing aspect.

Factors to be considered in Group counselling

•Group Size: Varies from 3-4 members to several hundred depending upon the group (e.g.
psychotherapeutic or task group).

• Group counseling and psychotherapy generally work best with 6-8 members.
•Participant Selection: Screening is needed with counseling and psychotherapy groups. Some
people are not well suited for group work.

•Length and Duration of Sessions: Individual sessions are usually 50 minutes, group sessions range
from 1-2 hours. No. of sessions will be determined by the nature of the group and the problem.

•Ethics: Confidentiality is hard to guarantee due to the number of participants.

•Group Evaluation: Outcome measurements are difficult to obtain.

Getting Started

•Ground rules must be set at the beginning, such as maintaining confidentiality of group discussions,
showing respect for each other, taking turns talking, etc. (Students assist in creating rules)

•Encourage members to discuss the issues that brought them into the group openly and honestly.
Take adequate care of physical and emotional safety

Role of the Facilitator

•The Counselor facilitates the group process; the effective functioning of the group, and guides
individuals in self-discovery.

•Depending upon the group's goals, sessions may be either highly structured or fluid and relatively
undirected.

•Typically, the facilitator steers a middle course, providing direction when the group gets off track,
yet letting members set their own agenda.

•The facilitator should guide the group by reinforcing the positive behaviors they engage in.

• Compliment members for their good behaviour

•The facilitator should emphasize the commonalities among members during each session to instill a
sense of group identity.

Facilitator Tasks and Techniques

Careful Planning

• Selection
• Group Composition
• Creation of Group

Careful Observation of Group Process

• Formative Stages
• Subgrouping
• Conflict
• Self-disclosure
• Termination
• Problem Behaviors

What do you look for in groups in Formative Stages?

I. The Initial Stage:

• Orientation, Hesitant Participation, Search for Meaning, Dependency
II. The Second Stage:
• Conflict, Dominance, Rebellion
III. The Third Stage:
• Development of Cohesion
IV. The Fourth Stage:
• Termination/Transparency

Subgrouping

Fractionalization - splitting off of smaller units

• extra group socialization - cliques of 3-4
• two become sexually involved
• coalitions form within the group
• Inevitable often disruptive event in life of group

Conflict

• Inevitable; absence suggests impairment of developmental sequence

• Two step process includes:
1) experience (affect expression);
2) understanding of that experience

• Can control conflict by having members switch from 1 to 2 - request group discuss their
experience and understand it can learn to express anger more directly

Self-Disclosure’

• Involves some risk on part of discloser

• As disclosure proceeds in a group, entire membership gradually increase it’s involvement,
responsibility and obligation to one another. 

Group Resistance and Drop-Out

• Facilitator must check-in with members individually to assess the value of group
participation (difficulty communicating in a group setting, unable to handle aggressive / hostile
comments from other members
• On-going assessment of group participation during the group
• Recognize the role of each group member
Termination

• Groups terminate for various reasons

• Brief therapy - preset termination dates

• Counselor’s role is to:

A. keep task in focus for members

B. remind group regularly of the approaching termination
C. ensure focus on goal attainment prior to termination
D. share own feelings about separation; real loss for all

Termination

•The termination of a group may cause feelings of grief, loss, abandonment, anger, or rejection in
some members
•The facilitator should attempt to deal with these feelings and foster a sense of closure by
encouraging the exploration of feelings and the use of newly acquired coping techniques for
handling them.
•Working through this termination phase is an important part of the process.

Group Membership

• Individuals that share a common problem or concern are often good candidates for group
counseling, where they can share their mutual struggles and feelings.
• In schools, groups for students who have or are currently experiencing their parents
divorce, grief/loss, social skills deficiencies
• Consider the age, grade level, gender, etc

Group Membership Not Recommended

•Children who are

• Suicidal or having psychiatric diagnosis

• in the midst of a major life crisis
•People with severe cognitive impairments may also be poor candidates for group counseling, as are
patients with sociopathic traits, who show little ability to empathize with others.
Group Membership Not Recommended
•Siblings or relatives should not be in the same group.
•Children who habitually lie or steal
•Children who are victims of abuse
•Children who are so different from the others that they may not be accepted
•Children who are extremely aggressive

Family Counselling 

Understanding family
• Sociologists Burgess and Locke defines
“ Family is a group of persons united by the ties of marriage, blood or adoption; consisting of a single
household, interacting and intercommunicating with each other in their respective social roles of
husband and wife, mother and father, son and daughter, brother and sister creating a common
culture”

Stages of family development – Duvall & Miller, 1985

1. Married couples without children

2. Child bearing families, in which the oldest child is < 30 months of age
3. Families with pre-school children, in which the oldest child is from 2 & ½ to 6 years of age
4. Families with school children, in which the oldest child is between 6 & 13 years of age
Stages of family development – Duvall & Miller, 1985
5. Families with teen agers with the oldest child between 13 and 20 years of age
6. Families launching young adults, starting with the first child’s departure from the home and
ending when the last one goes
7. Middle-aged parents, from the “empty nest” to retirement
8. Stage of ageing family members, the period from retirement to death

Causes of family dysfunction

• Family dysfunction often is a result of unmet family developmental tasks.

• Family life cycle changes are a major source of stress and disequilibrium for families.
• As families grow, there are developmental tasks that are required; when a family negotiates
these successfully, family roles and structures change.
• When the family does not or can not accommodate these changes, stress and
symptomatology will occur.

• It is not the normal difficulties that create the problem but rather the chronic mishandling of
problems over time.
• Denying the need for change and treating normal family development as a problem or
striving for perfection are all catalysts for family dysfunction.
• Remarried families can have a lot of difficulty with the family life cycle. This happens when
an individual’s development is out of sync with the development of the family.

Family Problems

• Hierarchy: Problems occur when there is no hierarchy or if it is ambiguous or culturally

inappropriate.
• Communication: When communication is unclear, inadequate, confusing, incongruent etc.,
• Low Self-Esteem: in married partners and children
• Family of Origin: When there is conflict over which family of origin to model
• Narrow and Rigid Beliefs

Family Counselling Process

1. Intake
2. Assessment
3. Establishing treatment goals
4. Intervention
5. Termination

1. Intake

• First point of contact between a family and the therapist

• Lasts for 20 to 45 minutes
• Therapist aims to understand the reason for the family being referred to family therapy
• Therapist draw a contract with the family with regard to:
• Number of sessions or weeks involved in FT
• Course of therapy
2. Assessment and Formulation
• Therapist take 2 – 3 sessions in order to understand
• the family’s evolution through various life cycle stages
• Kind of dynamics that exist within the family
• Therapist use family assessment schedule
• Semi-structured interview tool

2. Family Assessment schedule / proforma

• Family structure
• Leadership patterns
• Role structure & Functioning
• Communication – Patterns of communication
• Reinforcement
• Cohesiveness
• Adaptive patterns

3. Establishing treatment goals

• Defining the desired state the families would like to reach

• Intermediate and final goals – helping the family members to have short-term & long-term
goals
• Motivating families to consider and set objectives

4. Intervention

• Therapist with other team members plan intervention based on the assessment of family
• Intervention may vary from 6 – 15 sessions or more depending on the family dysfunction,
members’ willingness and affordability of the family
• Implement an integrated model of family counselling approaches with families

5. Termination (Epstein & Bishop, 1980)

• Orientation regarding termination
• Summarising what has happened during the treatment
• Discussing long-term goals
• Follow – up
1. Interventive interviewing – process of interviewing itself brings about changes in the family
• Strategic questions are designed to influence

2. Family sculpting
• Places the family members in positions and postures that represent aspects of their
relationship and interactions with each other
• Sculptor – One of the family member, therapist – monitor & Actors – family members
• Helping family members to get in touch with their feelings
• Sculptor directs the tableau – other family members do what the sculptor says
• Discuss and comment on the tableau

3. Role-playing
• Role-playing brings of something of reality of family life

4. Videotape replay
• Playing back to families of tapes of their therapy

5. Network therapy
• Getting the family’s complete network together including kinship system, friends & other
significant people

6. Multiple family therapy

• Engaging 4 or 5 families (all family members of each family) in a group experience and asking
them to share their opinion about their performance of their role

7. Vector therapy
• Aims to alter either the magnitude or the direction of the relevant emotional forces

8. Multiple impact therapy

• Each of the family members are seen by different therapist in the mental health team

Other Techniques include

• Guidance.
• Advise.
• Education.
• Reflection.
• Suggestions.
• Clarifications.
• Interpretations.

Unit - III
Approaches to Counselling
Approaches to Counselling
• Psychoanalytical
• Adlerian
• Person-centered
• Cognitive Behavioral
• Rational emotive behavioral
• Existential
• Gestalt
• Reality
• Problem Solving

Psychoanalytic Approach

Sigmund Freud

The Development of Personality

• ORAL STAGE (First year)
• Related to later mistrust and rejection issues
• ANAL STAGE (Ages 1-3)
• Related to later personal power issues
• PHALLIC STAGE (Ages 3-6)
• Related to later sexual attitudes
• LATENCY STAGE (Ages 6-12)
• A time of socialization
• GENITAL STAGE (Ages 12-60)
• Sexual energies are invested in life

The Structure of Personality

•THE ID — The Demanding Child

• Ruled by the pleasure principle
•THE EGO — The Traffic Cop
• Ruled by the reality principle
•THE SUPEREGO — The Judge
• Ruled by the moral principle

Levels of mind
• Conscious – Basically the thought, feeling and actions that we are aware about
• Preconscious – thoughts, wishes, feelings and memories that are stored temporarily which
can be retreived to concious awareness when required
• Unconscious – contains the thoughts, wishes, feelings and memories which we are not
aware at all
– Freud believes, we repress or forcibly block a mass of our unacceptable thoughts which are
stored at unconcious level
– In his view, our unacknowledged impulses express themselves in disguised forms like the
work we choose, the beliefs we hold, our daily habits…
The Unconscious

Clinical evidence for postulating the unconscious:

• Dreams
• Slips of the tongue
• Material derived from free-association
• Material derived from projective techniques
• Symbolic content of psychotic symptoms
Ego-defense mechanisms:

• Are normal behaviors which operate on an unconscious level and tend to deny or distort
reality
• Help the individual cope with anxiety and prevent the ego from being overwhelmed

Psychoanalytic Techniques

Maintaining the analytic framework

• Refers to range of procedural and stylistic factors such as analyst’s anonymity, regularity and
consistency in meetings

Free Association

• Client reports immediately without censoring any feelings or thoughts

•Interpretation
• Therapist points out, explains, and teaches the meanings of whatever is revealed
Psychoanalytic Techniques

Dream Analysis

• Therapist uses the “royal road to the unconscious” to bring unconscious material to light
•Analysis and interpretation of resistance
• Refers to an idea, attitude, feeling and action that fosters the status quo and gets in the way
of change

Analysis and interpretation of transference

• Transference is considered valuable because its manifestations provide clients with an

opportunity to re-experience a variety of feelings that would otherwise be inaccessible

Adlerian Approach
Alfred Adler
Alfred Adler’s Individual Psychology

• A phenomenological approach – client’s subjective frame of reference

• Social interest is stressed
• Birth order and sibling relationships
• Therapy as teaching, informing and encouraging
• Basic mistakes in the client’s private logic
• The therapeutic relationship — a collaborative partnership

The Phenomenological Approach

• Adlerians attempt to view the world from the client’s subjective frame of reference
• How life is in reality is less important than how the individual believes life to be
• It is not the childhood experiences that are crucial , it is our present interpretation of these
events

• Unconscious instincts and our past do not determine our behavior

Social Interest

Adler’s most significant and distinctive concept

• Refers to an individual’s attitude toward and awareness of being a part of the human
community
• Mental health is measured by the degree to which we successfully share with others and are
concerned with their welfare
• Happiness and success are largely related to social connectedness

Birth Order

Adler’s five psychological positions:

1. Oldest child - receives more attention, spoiled, center of attention
2. Second of only two - behaves as if in a race, often opposite to first child
3. Middle - often feels squeezed out
4. Youngest - the baby
5. Only - does not learn to share or cooperate with other children, learns to deal with adults

Therapeutic Goals

• Fostering social interest

• Helping clients overcome feelings of discouragement and inferiority
• Modifying client’s views and goals
• Changing faulty motivation
• Encouraging the individual to recognize equality among people
• Helping people to become contributing members of society

Therapeutic Techniques and Procedures

1. Establish proper therapeutic relationship

2. Explore the psychological dynamics operating in the client (an assessment)
3. Encourage the development of self-understanding (insight into purpose)
• Disclosure and well-timed interpretations facilitate the process of gaining insight
4. Help the client to make new choices – reorientation and reeducation
Encouragement

•Encouragement is the most powerful method available for changing a person’s beliefs
• Helps build self-confidence and stimulates courage
• Discouragement is the basic condition that prevents people from functioning
• Clients are encouraged to recognize that they have the power to choose and to act
differently
Person-Centered Therapy

Carl Rogers

Person-Centered Therapy

•A reaction against the directive and psychoanalytic approaches

Challenges:
• The assumption that “the counselor knows best”
• The validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation
• The belief that clients cannot understand and resolve their own problems without direct
help
• The focus on problems over persons
Person - centered therapy (PCT)
• Process of “being with” clients and entering their world of perceptions and feelings is
sufficient for bringing about change (Bohart, 2003)
• Focuses on the constructive side of human nature, on what is right with the person and on
his / her assets
• This is rooted in the client’s capacity for awareness and selfdirected change in attitudes and
behavior
• Emphasis is on:
• How clients act in their world with others
• How they can move forward in constructive direction
• How they can successfully encounter obstacles

Goals of PCT

The counselor facilitates the client towards:

• Realistic self-perception
• Greater confidence and self-direction
• Sense of positive worth
• Greater maturity, social skills and adaptive behavior
• Better stress coping
• More fully functioning in all aspects of their lives

Techniques used in PCT

•Genuineness or congruence - ability of being real, integrated and authentic in providing help
•Unconditional positive regard – ability to convey a unconditional acceptance of the client’s
personhood
•Accurate empathic understanding – ability to understand the emotions of the client and correctly
communicate this understanding
Role of the counsellor
• Focuses on the quality of therapeutic relationship
• Serves as a model of a human being struggling toward greater realness
• Is genuine, integrated, and authentic, without a false front
• Can openly express feelings and attitudes that are present in the relationship with the client
Person-centered expressive arts therapy

•Offering clients an opportunity to create movement, visual art, journal writing, sound and music to
express their feelings and gain insight

Behavior Therapy

Behavior Therapy

• A set of clinical procedures relying on experimental findings of psychological research

• Based on principles of learning that are systematically applied
• Treatment goals are specific and measurable
• Focusing on the client’s current problems
• To help people change maladaptive to adaptive behaviors
• The therapy is largely educational - teaching clients skills of self-management

Basic characteristics and assumptions

1. BT is based on the principles and procedures of the scientific method

2. BT deals with client’s current problems and factors influencing them
3. Clients are expected to assume an active role by engaging in specific actions to deal with the
problem
4. BT assumes that change can take place without insight into underlying dynamics
5. Focus is on assessing overt and covert behavior directly
6. BT interventions are tailored to specific problems experienced by the clients

General therapeutic Goals

•To increase the personal choice and to create new conditions for learning
Therapist role
• Conducting a thorough functional assessment
• ABC model – Antecedent events – Behavior – Consequences
• Strategies to promote generalization and maintain behavior change
• Evaluate the success in behavior change and follow-up

Four Aspects of Behavior Therapy

• Classical Conditioning
• In classical conditioning certain respondent behaviors, such as knee jerks and salivation, are
elicited from a passive organism
• Operant Conditioning
• Focuses on actions that operate on the environment to produce consequences
• If the environmental change brought about by the behavior is reinforcing, the chances are
strengthened that the behavior will occur again.
• If the environmental changes produce no reinforcement, the chances are lessened that the
behavior will recur
Four Aspects of Behavior Therapy
•Social Learning Approach
• Gives prominence to the reciprocal interactions between an individual’s behavior and the
environment

•Cognitive Behavior Therapy

• Emphasizes cognitive processes and private events (such as client’s self-talk) as mediators of
behavior change
Exposure Therapies
• Desensitization
• Brief and graduated exposure to an actual fear situation or event
• Flooding
• Prolonged & intensive in vivo or imaginal exposure to highly anxiety-evoking stimuli without
the opportunity to avoid them
• Eye Movement Desensitization and Reprocessing (EMDR)
• An exposure-based therapy that involves imaginal flooding, cognitive restructuring, and the
use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders
and fearful memories of clients

Aaron Beck’s Cognitive Therapy (CT)

•Insight-focused therapy
•Emphasizes changing negative thoughts and maladaptive beliefs
•Theoretical Assumptions
• People’s internal communication is accessible to introspection
• Clients’ beliefs have highly personal meanings
• These meanings can be discovered by the client rather than being taught or interpreted by
the therapist

Theory, Goals & Principles

•Basic theory:
• To understand the nature of an emotional episode or disturbance it is essential to focus on
the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts
•Goals:
• To change the way clients think by using their automatic thoughts to reach the core
schemata and begin to introduce the idea of schema restructuring
•Principles:
• Automatic thoughts: personalized notions that are triggered by particular stimuli that lead to
emotional responses

CT’s Cognitive Distortions

•Arbitrary inferences
•Selective abstraction
•Overgeneralization
•Magnification and minimization
•Personalization
•Labeling and mislabeling
•Polarized thinking
CT’s Cognitive Triad

• Pattern that triggers depression:

• 1. Client holds negative view of themselves
• 2. Selective abstraction: Client has tendency to interpret experiences in a negative manner
• 3. Client has a gloomy vision and projections about the future

Cognitive Behavior Therapy 

Cognitive Behavior Therapy

According to Beck et al., 1979

“CBT is an active, directive, time-limited, structured approach… based on an underlying theoretical
rationale that an individual’s affect and behavior are largely determined by the way in which he
structures the world”
Principles in CBT

•CBT uses two basic approaches in bringing about change:

1. Restructuring of cognitive events and
2. Social and interpersonal skills training
• The two reinforcing inbuilt components:
1. Strengthening the thoughts that lead to positive behaviors and
2. Strengthening behavior due to the positive consequence of that behavior.

• Cognitive strategies

• Distraction techniques include focus on an object, mental exercises and pleasant memories
• Counting thoughts – just making note of occurrence of negative automatic thoughts
• Behavioral strategies
• Monitoring activities – clients are asked to record the activities which gives pleasure and
which they have mastered over (Mastery)
• Scheduling activities
• Graded task assignment – starting with simple achievable task to complex tasks
•CBT strategies

• Identifying negative automatic thoughts – includes identifying unpleasant emotions,

problem situation and associated negative automatic thoughts
• Questioning those thoughts and behavioral experiments
Preventive strategies
• Identifying and challenging assumptions – means identifying dysfunctional assumptions and
challenging them
• Use of set-backs - using difficult situations as an opportunity to practice
• Preparing for the future – Review and evaluate the progress made in order to prepare the
clients for future

Rational Emotive Behavior Therapy

 
Rational Emotive Behavioral Therapy (REBT)
• Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-
effect relationship
• Is highly didactic, very directive, and concerned as much with thinking as with feeling
• Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and
reactions to life situations

The Therapeutic Process

• Therapy is seen as an educational process
• Clients learn:
• To identify and dispute irrational beliefs that are maintained by self-indoctrination
• To replace ineffective ways of thinking with effective and rational cognitions
• To stop absolutistic thinking, blaming, and repeating false beliefs
View of Human Nature
• We are born with a potential for both rational and irrational thinking
• We have the biological and cultural tendency to think crookedly and to needlessly disturb
ourselves
• We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk
• We have the capacity to change our cognitive, emotive, and behavioral processes
The A-B-C theory

Steps in REBT

•Identifying the underlying irrational thought patterns and beliefs

How does these irrational beliefs reflected?
• “I must have love or approval from all the significant people in my life.”
• “I must perform important tasks competently and perfectly.”
Other irrational beliefs:
• Believing you will be happier if you avoid life’s difficulties or challenges
Steps in REBT
• Challenging the irrational beliefs
• Disputing these beliefs using direct and confrontational methods
• Gaining insight and recognizing irrational thought patterns
• While changing the irrational thoughts and beliefs, counsellor should focus on emotions and
behavior of the client

Relationship between CBT and REBT

• REBT is considered as a form of CBT

• CBT focuses on cognitive and behavioral aspects of the client whereas REBT focuses on
challenging irrational beliefs and bringing in emotional change
• Both uses cognitive and behavioral techniques
• Way of questioning differ – Framing questions in CBT is more client centered whereas in
REBT is very direct and challenge negative beliefs
• REBT focus more on emotional techniques also

Existential Therapy
Existential Therapy
•Individuals are not victims of circumstances because to a large extent, we are what we choose to
be
•Major aims
• To encourage clients to reflect on life
• To recognise the range of alternatives and to decide among them

Existential Therapy

Basic dimensions of the human condition

• The capacity for self-awareness
• The tension between freedom & responsibility
• The creation of an identity & establishing meaningful relationships
• The search for meaning
• Accepting anxiety as a condition of living
• The awareness of death and non-being

The Capacity for Self-Awareness

•The greater our awareness, the greater our possibilities for freedom
•Awareness is realizing that:
• We are finite - time is limited
• We have the potential, the choice, to act or not to act
• Meaning is not automatic - we must seek it
• We are subject to loneliness, meaninglessness, emptiness, guilt and isolation

Freedom and responsibility

• Choosing among alternatives play a large role in shaping destinies of people

• Freedom implies that we are responsible for our lives, actions and for our failure to take
action
• Existential guilt
• Being aware of having evaded a commitment / having chosen not to choose.
• This condition grows out of a sense of incompleteness or a realization that we are not what
we might have become

Identity and Relationship

• Identity is “the courage to be” – entails the will to move forward in spite of anxiety
provoking situations
• Our great fear is not to discover that there is no core, no self, no substance and merely
reflections of everyone’s expectations of them
• Experience of isolation – comes when we realize that we can not depend on anybody
• Relatedness - In case of standing alone for ones own strength, the relationship with others
is based on our desire for fulfillment, not on our deprivation
• What they get from their relationship?
• How they avoid intimate relationship?
• How they prevent themselves from having equal relationships?

The Search for Meaning

• Meaning - like pleasure, meaning must be pursued obliquely
• Finding meaning in life is a by-product of a commitment to creating, loving, and working
• “The will to meaning” is our primary striving
• Life is not meaningful in itself; the individual must create and discover meaning
• Try to help clients to discard old values, handle the sense of meaninglessness and create
new meaning

Anxiety – A Condition of Living

• Existential anxiety is normal - life cannot be lived, nor can death be faced, without anxiety
• Anxiety can be a stimulus for growth as we become aware of and accept our freedom
• We can blunt our anxiety by creating the illusion that there is security in life
• If we have the courage to face ourselves and life we may be frightened, but we will be able
to change

Awareness of death and nonbeing

•Holds awareness of death is a basic human condition that gives significance to living
•Focus is on exploring the degree to which clients are doing the things they value
•Clients can develop healthy awareness of death as a way to evaluate
• how well they are living?
• what changes they want to make in their lives?

Relationship Between Therapist and Client

• Therapy is a journey taken by therapist and client

• The person-to-person relationship is key
• The relationship demands that therapists be in contact with their own phenomenological
world
• The core of the therapeutic relationship
• Respect & faith in the clients’ potential to cope
• Sharing reactions with genuine concern & empathy

Gestalt Therapy
Gestalt Therapy

•Existential & phenomenological approaches is grounded in the client’s “here and now”
•Initial goal is for clients to gain awareness of what they are experiencing and doing now
•Awareness usually involves insight and sometimes introspection, but Gestalt therapists consider it
to be much more than either

Gestalt Therapy

Gestalt means – whole or completion or a form that can not be separated into parts without loosing
its essence.
Important processes and goals include
•Self – awareness
•Knowledge of the environment
•Responsibility for choices and
•Ability to make contact with their dynamic system of inter-relationships and the people in it
Basic assumption
•Individuals have capacity to self-regulate when they are aware of what is happening in and around
them
•Clients need to “be” as fully as possible and not striving to what “should be”

Outcome of Gestalt

• Client will move towards increased awareness of themselves

• Gradually assume ownership of their experience
• Develop skills and acquire values
• Become aware of all of their senses
• Learn to accept responsibility
• Be able to ask for and get help from others

The Now

•Our “power is in the present”

• Nothing exists except the “now”
• The past is gone and the future has not yet arrived
•For many people the power of the present is lost
• They may focus on their past mistakes or engage in endless resolutions and plans for the
future

Unfinished Business

•Feelings about the past are unexpressed

• These feelings are associated with distinct memories and fantasies
• Feelings not fully experienced linger in the background and interfere with effective contact
•Result:
• Preoccupation, compulsive behavior, wariness, oppressive energy and self-defeating
behavior

Layers of Neurosis

•Perls likens the unfolding of adult personality to the peeling of an onion

• Phony layer - stereotypical and inauthentic
• Phobic layer - fears keep us from seeing ourselves
• Impasse layer - we give up our power
• Implosive layer - we fully experience our deadness
• Explosive layer - we let go of phony roles

Contact and Resistances to Contact

• CONTACT - interacting with nature and with other people without losing one’s individuality
• RESISTANCE TO CONTACT - the defenses we develop to prevent us from experiencing the
present full

• Five major channels of resistance:

• Introjection – unconsciously adopting ideas
• Retroflection – regression kind
• Deflection – turning away from reality
• Projection
• Confluence – try to merge differing ideas

Therapeutic Techniques

•The experiment in Gestalt Therapy

•Preparing clients for experiments
•Internal dialogue exercise
•Rehearsal exercise
•Reversal technique
•Exaggeration exercise

Reality Therapy
.
Understanding Reality Therapy

• William Glasser developed this theory in 1965

• Form of cognitive behavioral therapy that focuses on improving present relationships and
circumstances
• Goal – help people take control of improving their own lives by learning to make better
choices, particularly in the way they think and behave
Basic beliefs of reality therapy
•We often mistakenly choose misery in our best attempt to meet our needs
•We act responsibly when we meet our needs without keeping others from meeting their needs

Basic Needs

•All internally motivated behavior is geared toward meeting one or more of our basic human needs
• Love and belonging
• Power
• Freedom
• Fun
• Survival (Physiological needs)

Procedures That Lead to Change: The “WDEP” System

•W Wants: What do you want to be and do? Your

“picture album”
•D Doing and Direction: What are you doing (action, thoughts, feeling, physical functioning)?
•E Evaluation: Does your present behavior have a reasonable chance of getting you what
you want?
•P Planning – “SAMIC”
Planning For Change – SAMIC

• S - Simple: Easy to understand, specific and concrete

• A - Attainable: Within the capacities and motivation of the client
• M - Measurable: Are the changes observable and helpful?
• I - Immediate & Involved: What can be done today? What can you do?
• C - Controlled: Can you do this by yourself or will you be dependent on others?

Focus of reality therapy

• Focus on the present, not the past

• Avoid discussing symptoms
• Focus their energy on changing their thoughts and behaviour
• Avoid criticizing, blaming, and/or comparing themselves to others
• Avoid relying on excuses for their behavior, whether they are legitimate or not
• Make specific plans and smart goals.

Problem Solving Approach 

Problem solving

Helping the client to talk freely

• Client is encouraged to talk and reveal as many emotions and thoughts about the problem as
possible

Ways to encourage client to talk freely:

1. Reflection
2. Clarifications
3. Open Ended Questions

Problem solving contd…

Stage 1
Clear Definition of the Problem
•Get all the details of the problem
•Place the problem in all its aspects in front of the client
Example (Problem Definition):
A 16 year old boy with low self-esteem
Because
he is not able to perform well in studies o he is dark and small
Problem solving contd….

Stage 2

Looking for Alternative Solutions Together

•What are the various solutions you can you think of?
Example (Alternative solutions)
Solutions:
Spend more time to study
Learn techniques for studying and memorizing (e.g. taking notes in class, drawing charts, diagrams)
Making a time table for studying in the daily routine
Ask him to take the help of a fellow student Go for extra coaching / tuition class
oPlay some games that might improve his height oEat nutritious food to become more strong
oHelp him look at his positive qualities to improve his self-
esteem/confidence oEncourage him to do things that he is good at
Problem solving contd...

Stage 3

Evaluation of Possible Solutions

• Consider advantages and disadvantages of each solution
• Help the client to consider consequences of each solution
“ What would happen if you behave in this manner? Can you think of any reason why this solution
won’t work?”

Example (Evaluating solutions)

Solution – 1:
• Spending more time for studies / going for tution classes Advantages:
• Will perform better in studies
• Self-esteem will improve Disadvantages:
• Always he has to spend more time in studies to do well
• He can not play games to become tall and strong
Example (Evaluating solutions)

Solution – 2:
•Using techniques for studying and memorising
Advantages:
• Learn skills to study better
• Perform better in studies
• Self-esteem will improve
• He does not have to spend lot of time in studies
• He can play and do physical exercises so that he become tall and strong
Disadvantages
• Might not get chance to play in some games because he is small
Problem solving contd….

Stage 4

Arrive at the best possible solution and implement the same

•Let the client practice / implement the solution decided upon
Example (Deciding on one solution):
• Decided on solution – 2 to deal with the problem

Follow-up

• Help the client to plan and implement the solution that was decided  
Evaluation
• Improvement?
• continue support till the problem is resolved
• No improvement?
• Involve others (family, friends and significant others WITH PERMISSION)
• Refer to other services, if required
Why does problem solving work?
• Respects the client
• Encourages him/her to find solutions him/ her self
• Enhancing thinking skills
• Motivates the client to take responsibilities