COUNSELING

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Learning objectives
Definition and conceptualization
The process of counselling
Stages in the counselling processes

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Definition
Counselling is the act of working with a
patient to help them clarify personal
goals and find ways of overcoming their
problems with the aim of assisting the
individual change behaviour that are
interfering with attainment of basic
needs.

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Introduction
Counselling process Involves ;
1. responding to the feelings thoughts and actions
of the client
2. basic acceptance of the clients perceptions and
feelings, irrespective of outside evaluative
standards
3. confidentiality and privacy
4. communication of verbal and non-verbal
messages
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 The counselling process provides ; a step by
step representation of different goals and
activities at progressive stages
Provides ways of assisting counsellors to
think systematically.
 Progressive movement toward an ultimate
conclusion which should be the resolution
of whatever precipitated the need for help

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Stages of counseling process

STAGE ONE:
Relationship-Building

STAGE TWO:
Assessment

STAGE THREE:
Goal Setting

STAGE FOUR:
Interventions

STAGE FIVE:
Termination and Follow-Up
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Role of the counselor in the process
Listening to the patient
Understanding the choices that need to be made
Helping the patient explore their options and
circumstances
Helping the patient develop self-confidence enabling
them to carry out the decision made
The HCW is not responsible for resolving all of the
patient’s worries and concerns or for the decisions the
patient ultimately makes

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Stage 1;Relationship building
A tie is created between the client and the
counselor.
 rapport is established and respect, trust,
and a sense of relative psychological comfort
Good rapport sets the stage for positive
psychological growth
Main task is to start and establish a
collaborative working relationship.
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factors which influence relationship
building
The counsellor’s personal qualities
Clients experience in sharing personal
information
Clients previous experience interacting
with the opposite sex
Clients previous experience when
interacting with authority figures

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Guidelines to interacting with clients during
relationship building
Collect data on the client before first session
whenever possible
If referred client, study referral notes in
advance
Identify a comfortable room with privacy
Decide on arrangement of furniture and sitting
arrangement, remove distractions
Identify special materials and equipment
needed for the session

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Greet client and make introductions
Put client at ease
Give information on confidentiality
Deal with issue of time limit
Decide on the actual duration of the
relationship
Discuss client expectations of the session

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Stage 2: Assessment
Involves the collection and classification of
clients information related to reasons for
seeking help
May also be called the problem
identification process
The problems may be classified as needs,
stressors or maladaptive behaviours.

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  Purpose of assessment is to obtain information
about clients identified problems and concerns
 To identify the significant variables that
contribute to the problems

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Problem definition
Components of the problem: associated feelings,
behaviours, interpersonal aspects of the problem
Pattern of contributing events: when, where with
whom, what happens before, what makes it better,
what makes it worse
Intensity
Coping skills, strengths and recourses

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Stage 3: Goal Setting:
Its important to translate general client concerns
into specific desired goals
Goals represent the results or outcomes the client
would want to achieve at the end of the
counselling

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Skills in goal setting
Careful listening: hear, reflect feelings, summarize
desired changes
Questioning: How do you want.., In what ways….,
What would you like…
Confrontation: Client can face what they are
avoiding
The ability potential response: You can, you have
the potential..

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Stage 4: Interventions or counselling
strategies
Related directly to the nature or character
of the problem
More than one strategy may be necessary
Depends on the goal

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note
Client must be involved in choice of strategy
Choice that meet clients expectations and
preferences is bound to be more successful
Consider available client resources
Consider clients previous attempts at solving the
problem

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 Categories of counselling intervention
Affective strategies: Focus on feelings and emotions,
including body awareness
Cognitive strategies: Deal with thoughts, beliefs, attitudes,
self-talk and internal dialogue
Behavioural strategies: Focus on skills, actions, habits,
behavioural excesses, deficits
Interpersonal strategies: Systemic interventions that deal
with relationships with significant others, family, school,
work

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Stage 5: Termination and Follow up
Summarise the important awareness that have
emerged
It’s a transition from one set of conditions to another
Its another step in the clients growth
Client can terminate the process
Counsellor may also terminate

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Termination as a process
Assess the progress using identified goals
Summarise the progress by the counsellor
Generalising change
Planning and follow up
Issues of referral if applicable

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summary
The counseling process is often split into three major
stages:
1. exploration
2. understanding,
3. and action.

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Exploration Stage
This is the beginning stage in which the counselor helps the
patient clarify their current difficulties, problems, issues,
concerns, and undeveloped opportunities.
The aim here is to establish a relationship with the patient so
that they feel safe enough to explore the issues that they face
by identifying and clarifying problem situations, unused
opportunities and the key issues calling for change.
It is essential to concentrate on the patient’s agenda, not to
impose one’s own agenda or try to satisfy one’s own curiosity.
The counselor should also help the patient to be specific and
focus on core concerns.

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Understanding Stage

This is the stage of understanding and insight,

promoting new perspectives, and looking at the
preferred scenario.
Extra skills are needed to draw together themes
offer new perspectives, provide accurate empathy, work
in the here and now, promote self-disclosure, help them
set appropriate goals and be genuine in support.
The patient must feel supported, yet challenged, to face
the difficulties ahead.
By the end of this stage the patient will have an idea of
how they want to change
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Action Stage

 The key tasks here are to help the patient find a

realistic set of choices, make decisions and formulate
an action plan, and to assist the patient in the
implementation of the plan.
It is the patient who chooses the course of action, and
the counselor needs to know different decision making
strategies and problem solving techniques to help the
patient do this.

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Qualities of counsellor
Patience
Warmth
Empathy
Confidentiality
Respect of opinion
Honesty.
Non-jugdmental attitude.

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 Questions

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 THEORIES OF
COUNSELING

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 THEORIES OF COUNSELING
Person Centered (Humanistic) Theory(carl
rogres-1902-1987)
Assumptions: Every human being has an ability to
self actualize, can achieve true potential.
Emphasiss: on being human as the essential
component, genuineness, inherent worth and
dignity of human beings, and belief that individuals
have the freedom to explore their subjective
experiences.

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 Psychoanalytic theory(Sigmund freund)
Assumption: Humans as basically driven by
irrational forces, unconscious motives, and
biological drives that mainly evolved during
childhood years.
Emphasis : on understanding repressed
experiences which may be contributing to the
current problems the patient is experiencing.

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BEHAVIOURAL THEORY(Albert Bandura, B.F.
Skinner, Arnold Lazarus )
Assumptions: People are born as ‘blank
slates’. Everything we are as individuals, we
have learnt from other people or from our
experiences in life.
Emphasis: on identification of maladaptive
behaviours of clients and altering them
approppriately.

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 Counseling skills

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Types of counseling
Different patients come for Counseling with various
problems.
The type of Counseling is, therefore, determined by
the nature of problems presented by the patients

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 Individual Counseling
Group Counseling
Marital Counseling
Family Counseling
Special Group Counseling

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Individual Counseling

Individual Counseling occurs when a Counselor is

working with only one person at any given time, i.e.
when a nurse is dealing with a single patient.

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Group Counseling

This occurs when a Counselor is working with more

than one person at any given session.
Group Counseling is recommended for people facing
the same problem, for example, alcoholics.
People are encouraged to discuss personal experiences
and changes in their daily life

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Marital Counseling

This occurs when the Counselor is working with

married couples.
 Marital Counseling is conducted by a trained
therapist who understands the problems and trials of
marriage and married life.
 Marital Counseling is done when both couples are
present.

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Family Counseling
This occurs when a counselor is working with more
than two members of a family at any given session.
Family Counseling focuses on family issues and is
conducted when all the family members concerned are
present.
 Effective Counseling cannot occur if some family
members are excluded from Counseling sessions.

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Special Group Counseling

The special group is composed of any group of people

who require Counseling to enable them to adjust
better in their life. For example:
1. Drug and substance abusers
2. Rape victims and rapists
3. HIV/AIDS infected and affected people
4. Terminally ill people of all categories
5. Families/individuals with handicapped persons
6. Marital or family disputes
7. Those who need abortion or have procured abortion
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 8. People requiring reproductive health/family
planning assistance
9. Those experiencing sexual difficulties
10. Retirees
11. Retrenchees

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 Skills for Counseling

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1.Active listening
Complete listening involves:
Listening to and understanding the patient’s verbal
messages
Observing and reading the patient’s non-verbal
behaviour; posture, facial expressions, movement,
tone of voice
Listening to the context; the whole person in the
context of the social settings of their life
Listening to sour notes; things the patient says that
may have to be challenged
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2. Attending Skills
Attending demonstrates that you are visibly tuned in
to the patient.
Effective attending tells the patient that you are
listening and puts you in a position to listen carefully
to the patient’s concerns.
Attentive presence invites patients to open up and
explore the significant dimensions of their problem
situations.

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 To attend to patients, Counselor s can use the
SOLER skills.
S- sitting
O- open posture
L- Leaning forward
E-Eye contact
R- Relaxed

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 S – Sitting squarely facing another person is
considered a basic posture of involvement.
If for any reason facing the person squarely is too
threatening, then an angled position may be more
helpful.
It is the quality of your presence that is most
important.

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 O –Open posture should be adopted. Crossing the
legs and arms can be a sign of lessened involvement
with others or less availability to them.
Open posture may signify that you are open to the
patient and to what the patient is saying.

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 L – Leaning forward towards the patient at times is a
natural sign of involvement.
It is a sign of bodily flexibility or responsiveness that
enhances the Counselor ’s communication with the
patient

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 E – Eye contact should be maintained, without
staring or glaring.
Maintaining good eye contact is a way of
communicating your presence and interest.
It is helpful for Counselor s to explore with their
supervisor why they may be uncomfortable or
unwilling to maintain eye contact with certain
patients.

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 R – Being relatively relaxed and natural when doing
all of the above is important. Do not fidget or chat
nervously. Feeling comfortable with your body can be a
vehicle of personal contact and expression.
These external behaviours help to convey your respect
and genuine caring.
However, these are just guidelines and not rigid rules,
and Counselor s must take into consideration the
patient’s culture as well as their own.

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3. Paraphrasing
A skill that allows the Counselor to confirm and
clarify statements made by the patient by repeating
them using different words.

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4. Reflecting Feelings

This involves understanding a patient’s emotional

responses and communicating this back to them.
For example, if a patient says, 'I am worried that I will
suffer a lot with HIV.' the Counselor might reflect
these feelings back to the patient by saying: 'You are
feeling anxious and fearful about the discomfort and
pain that HIV may bring you.'

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5. Questioning

Helps the Counselor to identify, clarify and break

problems down into more manageable components.
 Open-ended questions that begin with ‘how’, ‘what’
or ‘when’ encourage responses that can lead to further
discussion.
For example, a Counselor may ask: 'What concerns do
you have about having an HIV test?'

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6. Clarifying

Prevents misunderstanding and helps people focus

and sort out what has been said.
For example, if a patient says, 'I can’t exclusively
breastfeed my baby.'
the Counselor may ask: 'In what way is exclusive
breastfeeding a concern for you?'

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7. summarizing
The Counselor should review the important points of
the discussion and highlight any decisions made.
Use summarising throughout the entire the
Counseling session.
Offer support and encouragement to patients to help
them carry out the decisions they have made.
Agree on the return date and on any assignments the
patient is expected to do at home.
Ensure the patient has enough time to ask questions.

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Termination of Counseling

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 Termination means ending the Counseling
relationship.
Termination is decided by the Counselor when the
patient shows signs of improvement and the ability to
solve their problems.
As a good Counselor , you should prepare your patient
to be ready for termination of Counseling
relationships

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 Questions ?

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