HPCS4022 Counselling skills

Topic 4.2
Process of Counselling
Lecturer: Irene Tsang (irenetsang1510@gmail.com)

(2022/23)
 Learning outcome

• Understand the process involved in counselling.

• Establish how a counsellor can learn to structure the
course of therapy; and how a counsellor can locate his
position and progress during the treatment process.
• Describe the Helping Model by Gerard Egan.
 Counselling as a Process

• According to Rogers, an individual is

always developing.
• A counselling relationship can be
considered as a journey – a beginning,
middle and end.
• Individuals receiving counselling
would be going through a process of
changing and growing, consequently
moving forward from one stage in
their counselling process to the next.
Importance of the Initial Session
• There is always an initial session, and the
first impression is always important!
• During this time, both the client and the
counsellor are assessing one another to
see if the relationship will work.
• Let’s face it – unless you can get clients to
respect you and like what you are doing,
they won’t come back, and that makes it
very difficult to help them!
 Goals for the Initial Session
• In order to insure a successful first contact, the helper keeps in
mind the goals for that meeting. Those goals, in descending order
of importance are:
1. Establish a helping relationship / therapeutic alliance
2. Establish your role
3. Gather information in regard to the current situation and
corrective activity to date
4. Begin early problem definition
5. Establish preliminary, short-term goals
6. Agree on an assignment

Nachreiner (n.d.)
 A Successful Initial Session
• The following list is not exhaustive but should summarize how
the initial session normally proceed along the following lines:

1. Establish some sort of trust, confidence & rapport, also a

working relationship that is designed to elicit the info you
need (very important, as this allows the client can feel at
ease and safe enough to talk about some very threatening &
personal issues).
 A Successful Initial Session
(cont’d)

2. Summarize the problem in clear, unambiguous terms.

3. Systematically evaluate the problem, including its causes
and its effects.
4. Identify the client’s circumstances to help understand the
formulation of a ‘diagnosis’.
5. Feedback your understanding to the client to minimize
misunderstanding / miscommunication.
 A Successful Initial Session
(cont’d)

6. Communicate that you respect the client as a person of

value (helps to foster & maintain the client’s self-esteem).
7. Explore and evaluate the client’s motivation for counselling.
8. Clarify your expectations to the client.
9. Setting of mutual goals.
10. Establishing a contract.
11. Make the practical arrangements for counselling.
12. Embrace the opportunity to grow and thrive as intended.
 Contracts
• A contract is a formal, explicit agreement between counsellor
and client. It helps to ensure the professional nature of the
relationship.
o Venue
o Frequency of sessions
o Time limits (sessions & counselling)
o Fees, if appropriate
 Contracts
• (cont’d)
o Boundaries of confidentiality
o Broad requirements of the treatment
o The terms of the therapeutic relationship
o Duties and responsibilities of each party
o Goals of therapy & means by which these may be achieved
o The provision & completion of assignments
o The setting of boundaries & expectations
o How therapy will be evaluated
 Contracts
• (cont’d)
o Provision of renegotiation of contract
o Process of referral, if and when necessary
o Supervision
 A Successful First Contact
• Depending on a number of factors, the counsellor may or may
not accomplish problem definition or goal setting during the
initial contact.
• Remember, first impressions are difficult to change in any
interpersonal relationship.
• Ensure the first impression you leave during the initial contact is
positive and establishes you as sincere, trustworthy,
respectful, and helpful.
 The assessment
• For a few sessions after the initial
interview, the counsellor will need to
continue to assess the client's
psychological framework and his
problem situation.
• The procedure for evaluation is the
same as that followed during the
initial interview; however, more
detailed clarifications are sought.
 The assessment
Information gathering
• During this assessment phase, the counsellor modifies and updates his
working model of the client's psychological build and the definition of the
problem.
• During assessment, the counsellor continues to provide support,
guidance and other elements of counselling as the situation demands.
• Information in the assessment phase is obtained primarily from the client,
but it may also be sought, with the permission of the client, from
significant others in the client's life, if the counsellor deems it necessary.
 The assessment
Middle phase
• Considered to be the bulk of the
period of counselling.
• The phase during which the
counsellor analyses the client's
feelings and behaviours, provides a
feedback to the client, and provides
support and guidance to affect
behaviours change.
 The assessment
Middle phase
• Speed of the process may vary greatly -
some clients progress rapidly into this middle
phase of counselling and at other times there
is a sense of being "stuck" or even regression
• Be consistent about offering the core
conditions of empathy, congruence and
unconditional positive regard (UPR) to all
aspects of the client (refer to topic 3).
 The assessment
Middle phase
• From the client's perspective, do they feel…
o more willing to be open
o more prepared to take risks
o more prepared to explore negative or unpleasant feelings in the
counselling sessions.
• Why?
• Due to the counsellor's intense, non-condemning acceptance and
deeper levels of empathy than experienced in the beginning phase.
The assessment
The final stage

• To its simplest, the counselling relationship

comes to an end.
• Gradually (or sometimes abruptly), the client
feels more able to cope on his own.
 The assessment
The final stage

• Anxieties may be experienced by both the counsellor and the client – the
relationship has developed into a close one and, to some degree, both
people have become dependent on each other.
• Separation Anxiety – a term coined by Bowlby (1975) to describe the
anxiety some people feel when they find a relationship coming to an end.
• Important that such ‘separation’ is smooth and that both parties are
comfortable with the ending.
 The assessment
The final stage
• Evaluate readiness for termination
• Provide advance notice of termination
• Discuss readiness for termination
• Review the course of therapy
• Emphasize the client's role in effecting change
• Warn against ‘flight into health‘ (avoid confrontation for growth)
• Give instructions for maintenance of adaptive functioning
• Discuss follow-up sessions
• Stress 'open doors'
When the above is completed to the satisfaction of both the clients and the counsellor,
the therapy is terminated formally.
 Let’s try
• Try to think of an issue you are going to make decision
• What is the issue?
• Who will be involved?
• When you need to make the decision, any deadline (timebound)?
• Where will it take place (or elements related to venue)?
• Why you need to decide? (significance)
• How to proceed (any plan/strategies in hand)?
 The helping model
The final stage

From Egan’s book, ‘The Skilled Helper’

• The values needed to establish authentic helping relationships
with others
• The communication skills needed to engage others in a
collaborative helping dialogue
• A universal problem-management and opportunity-development
framework that outlines the fundamental stages, tasks, and
process of helping.
Egan’s
Skilled Helper Model
 Three-Stage Model of
the Counselling Relationship
A client-centered model, Egan’s (1990, 2002) stated the three stages:

• TO SEE, identifying and clarifying problem situations

• TO JUDGE, goal-setting, developing and choosing preferred scenarios
• TO ACT, action, moving towards the preferred scenario
 Three-Stage Model of
the Counselling Relationship
Stage 1 TO SEE
• Help the client to tell his story – to explore his present life situation as he
sees it now.
• During this exploratory process, the specific problems of living would
emerge.
• For Egan, this stage is useful for exploring ‘blind spots’ – aspects of the
client’s life that he had not considered.
Case 1
Martina, 27, asks a counsellor in private practice for an appointment to discuss
“a number of issues.” Martina is both verbal and willing to talk. Her story comes
tum- bling out in rich detail. Although the helper uses the skills of attending,
listening, sharing highlights, and probing, she does so sparingly. Martina is too
eager to tell her story.
Although trained as a nurse, Martina is currently working in her uncle’s business
because of an offer she “could not turn down.” She is doing very well financially,
but she feels guilty because service to others has always been a value for her.
And although she likes her current job, she also feels hemmed in by it. A year of
study in Europe during college whetted her appetite for “adventure.” She feels
that she is nowhere near fulfilling the great expectations she has for herself. She
feels that she is denying the “entrepreneur” inside her.

(from J. Egan “The Skilled Helper”)

She also talks about her problems with her family. Her father is dead. She has
never gotten along well with her mother, and now that she has moved out of
the house, she feels that she has abandoned her younger brother, who is 12
years younger than she is and whom she loves very much. She is afraid that her
mother will “smother” her brother with too much maternal care.
Martina is also concerned about her relationship with a man who is 2 years
younger than she. They have been involved with each other for about 3 years.
He wants to get married, but she feels that she is not ready. She still has “too
many things to do” and would like to keep the arrangement they have.
This whole complex story—or at least a synopsis of it—comes tumbling out in a
torrent of words. Martina feels free to skip from one topic to another. The way
Martina tells her story is part of her enthusiastic style. At one point she stops,
smiles, and says, “My, that’s quite a bit, isn’t it!”

(from J. Egan “The Skilled Helper”)

Case 2
Nick is referred to the centre by a doctor in a local clinic because of the trouble
he is having with his son. He has been divorced for about two years and is living
in a housing project on public assistance.
After introductions and preliminary formalities have been taken care of, he just
sits there and says nothing; he does not even look up. Because Nick offers
almost nothing spontaneously, the counsellor uses a relatively large number of
probes to help him tell his story. Even when the counsellor responds with
empathy, Nick volunteers very little.
Every once in a while, tears well up in his eyes. When asked about the divorce,
he says he does not want to talk about it. “Good riddance” is all he can say about
his former wife. Gradually, almost torturously, the story gets pieced together.
Nick talks mostly about the “trouble” his son is getting into, how uncontrollable
he seems to be getting, and how helpless he [Nick] feels.

(from J. Egan “The Skilled Helper”)

 Mehrabian and Reed (1969) suggested the following formula as a way of
determining the severity of any given problem situation

Severity = Distress x Uncontrollability x Frequency

For Case 1 and 2, which you think are in need of counselling? Why?

(from J. Egan “The Skilled Helper”)

(from J. Egan “The Skilled Helper”)
(from J. Egan “The Skilled Helper”)
 Three-Stage Model of
the Counselling Relationship
Stage 2 TO JUDGE
• Client to imagine a possible future situation that would be preferable to
the present one.
• May begin with imagining a variety of possible future scenarios.
• Once a realistic scenario has been discussed, the client & the counsellor
can identify goals that can help in the achievement of the proposed
future state.
(from J. Egan “The Skilled Helper”)
 Three-Stage Model of
the Counselling Relationship

Stage 3 TO ACT
• The client and the counsellor devise ways in which the proposed
future scenario is achieved – e.g. brainstorming
• Identify a particular approach out of all the possibilities and draw
up an action plan in order to help the achievement of the desired
scenario further.
(from J. Egan “The Skilled Helper”)
 Summary

• Individuals receiving counselling would be going through a journey

which usually consists of a beginning, middle and end.
• All stages are equally important in establishing and/or maintaining
the therapeutic alliance.
 Reference & Useful Resources

Burnard, P. (2005). Counselling Skills for Health Professionals (4th ed). Nelson Thornes Ltd.

Egan, G., & Reese, R. J. (2019). The skilled helper: A problem-management and opportunity-
development approach to helping. Cengage Learning.

Jenkin, P. (2000). Gerard Egan’s Skilled Helper Model, in Palmer, S. & Woolfe, R. (ed.), Integrative and
Eclectic Counselling and Psychotherapy. SAGE Publications Ltd.

Neukrug, E. (2013). Theory, practice, and trends in human services – an introduction (5th ed.).
Brooks/Cole.
 Image source

https://www.clearwaycommunitysolar.com/blog/science-center-home-experiments-for-
kids/measuring-plant-growth-with-sunlight/
https://online.grace.edu/news/mental-health-counselor-theories/
https://fullpotentialgroup.com/3-steps-to-problem-solving-faster-better-simpler/
https://kappanonline.org/goal-setting-practices-support-learning-culture-nordengren/
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