Basic Counseling

SkillsDr. Aida Abd El-

Razek*Associate Professor of Maternal and

Newborn HealthPhiladelphia University

Faculty of Nursing

Learning objectives

ILOs At the end of this

lecture the student’s will be able to

A. Knowledge and Understanding

Understand the

counselling

Explain Qualities of a

good counsellor

B. Cognitive Skills

Explain values and attitudes of a counsellor

Explore basic counselling

process

Classify barriers to effective

counselling

C. Interpersonal Skills and Responsibility

A Comprehensive basic counselling skills

Applying a Practical sessions on counselling

OutlineUnderstand counselling. Qualities of a good counsellor.

Values and attitudes of a counsellor.

Counselling process.

Explore basic counselling skills.

Barriers to effective counselling.

Practical sessions on counselling

Summary

Definition Of Counseling

A supportive and empathic professional relationship that provides a framework for the exploration of emotions, behaviors, and thinking patterns, and the facilitation of healthy changes.

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Counseling is directed towards people experiencing difficulties as they live through the normal stages of life-span development.

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Counseling Functions

RemedialFunctional Impairment

PreventiveAnticipate and Accommodate

EnhancementHuman Potential

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Counseling And Theory

Negligible differences in effects produced by different therapy types

Common elements between theories

Responding to feelings, thoughts and actions of the client

Acceptance of client’s perceptions and feelings

Confidentiality and privacyAwareness of and sensitivity to messages communicated in counseling 12

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Characteristics Of Effective Helpers

Self-awareness and understanding

Good psychological healthSensitivityOpen-mindednessObjectivityCompetenceTrustworthinessInterpersonal Attractiveness

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Components Of The Counseling Process

Relationship BuildingAssessmentGoal SettingInterventionTermination and Follow-Up

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What Works in Treatment:A Review of 40 Years of Outcome Research

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Relationship Building

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Conditions Of An Effective Therapeutic

Relationship

Accurate EmpathyGenuineness/CongruencePositive Regard/RespectClient’s perception of relationship is what counts!

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Counselor Skills Associated With

Facilitative Conditions Nonverbal and verbal attending behaviorsParaphrasing content of client communications

Reflecting client feelings and implicit messages

Openness and self-disclosureImmediacyAttending to Client's Theory of ChangeInteractive vs. Didactic ApproachPromoting Hopefulness

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Functions Of A Therapeutic Relationship

Creates an atmosphere of trust and safety

Provides a medium or vehicle for intense affect

Models a healthy interpersonal relationship

Provides motivation for change

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WAYS OF LISTENING

"Are you listening to me?" People like to be heard. To be heard helps reduce insecurity. It gives us a feeling of peace. And when someone really listens to us, we often discover something about ourselves. Often we solve problems just when we are really listened to and feel heard. In this handout I will explain two ways of listening and encourage you to try to listen better to those around you.

ANALYTIC LISTENING

This is the kind of listening we usually do. During Analytic Listening I am evaluating in my mind as I listen to you. I am busy judging and deciding what to say. I am analyzing. As a result, you don't feel heard. You may repeat yourself, or feel annoyed. Maybe I can even repeat back to you what I "heard" but it just doesn't feel like I listened to you.

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DEEP LISTENING This is a rare talent. In deep listening, my mind is very quiet when I listen to you. My feeling is peaceful and curious. I don't take anything personally. I don't judge or decide or figure anything out. I don't try to remember anything. My mind is quiet and open. As a result, you find you don't repeat yourself as much. You feel a connection. You are likely to say, "I don't know why, but I really felt you heard me." Your feelings will become more peaceful.

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Effective counselling skills

Active listening: Poor listening habits Paying attention:

Eye contact, nodding, etc.

Hearing before evaluating.

Listening for the whole message.

Paraphrasing what was heard.

Probe for causes and feelings.

Not paying attention Assuming in advance that

the subject is unimportant. Mentally criticizing. Permitting the speaker to

be inaudible or incomplete.

Pretending to be attentive. Hearing what is expected. Feeling defensive. Listening for a point of

disagreement. Rehearsing. 23

Effective Counselling Skills

Reflection feeling and meaning: recognizing client’s feelings and letting him know you have understood their feeling.

Questioning: Asking open‐ended questions which allow for more explaining. Help the client to go deeper into his problems and gain insight.

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Paraphrasing: Repeating in one’s own words what the client has said.

Interpretation: Giving back to the client the core issue that he is struggling with.

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Assessment

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Session Rating Scale (SRS V.3.0)

Name ________________________ Age (Yrs):____ ID# _____________Sex: M / F Session # __ Date:___________________

Please rate today’s session by placing a mark on the line nearest to the description that best fits your experience.

RelationshipI did not feel heard, understood, and respected. I felt heard,

understood, and respected.

I-------------------------------------------------------------------------I

Goals and Topics

We did not work on or talk about what I wanted to work on We worked on and talked about what I wanted to work on

and talk about and talk about.

I------------------------------------------------------------------------I

Approach or MethodThe therapist’s approach is not a good fit for me. The therapist’s

approach is a good fit for me.

I-------------------------------------------------------------------------I

OverallThere was something missing in the session today. Overall, today’s

session was right for me.

I------------------------------------------------------------------------I

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Purposes Of Assessment

Systematic way to obtain information about the client’s problems, concerns, strengths, resources, and needs.

Foundation for goal-setting and treatment planning.

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Assessment Considerations

Assessment is always an ongoing process, changing as you learn more about the client.

Who is complaining or alarmed? Who thinks there is a problem? What is the person complaining about?

What is the person motivated for? What does he or she want?

What does the person do well? (Find contexts of competence.) Skills, hobbies, sports, activities, avocations, life experiences, etc.

Exceptions/previous solutions/times when situation was better

Best coping momentsWhat are the goals? How will we know when we are done? Get specific about the problem-free future.

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What are the patterns of the problem? How is it performed? Search for regularities of action and interaction, time, place, body behavior, etc. Get specific (so could imagine seeing/hearing the problem on a videotape)

Scan for potentially harmful actions of clients or others in clients' lives (e.g., physical violence, drug/alcohol abuse, sexual abuse, self-mutilation, suicidal intentions/attempts, etc.) that may not be obvious or may be minimized during an initial interview.

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Assessment ToolsIntake formsIntake interview

Clinician questionsFormal instruments

ASAM PPCDSM IVDrIncSASSISOCRATES………..

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Assessment Tool “Rules Of Thumb”Never diagnose with a test or screening

instrument only.Tests are useful in validating information

provided by the client in the subjective interview.

Testing tools should only be used by those with training in using that tool.

All testing tools have limitations.Never replace the expertise, training, and

experience of the clinician with a test.

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Stages of Change (Meeting the client

where they are) Precontemplation - "I really don't want to change.

Contemplation- I'll consider it." Preparation- "I'm making a plan for it."

Action- "I'm doing it, but not regularly."

Maintenance- "I'm doing it." Termination- "I have no desire to go back to my own ways."

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Extratherapeutic Factors

These factors exist prior to and are independent of participation in treatment

Client factorsStrengths ResourcesAreas of Competence

Chance factors

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Goal-Setting

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Goal FunctionsDefine desired outcomesGive direction to the counseling process

Specify what can and cannot be accomplished in counseling

Client motivationEvaluate effectiveness of counseling

Measure client progress

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Seven Qualities Of Well Formed Treatment Goals* Saliency to the Client/CollaborativeSmallConcrete, Specific, and BehavioralThe Presence Rather Than the Absence of Something

A Beginning Rather Than an EndRealistic and Achievable Within the Context of the Client’s Life

Perceived as Involving “Hard Work”

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Interventions

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Categories Of Counseling

InterventionsAffectiveCognitiveBehavioralInterpersonal/Systemic

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Affective Models

Person-centered therapyGestalt TherapyBody awareness therapiesPsychodynamic therapiesExperiential therapies

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Cognitive Models

Rational-emotive therapy

Information-givingProblem-solving and decision-making

Transactional Analysis

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Behavioral Models

Behavior therapyReality therapyCognitive-behavioral therapy

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Systemic Models

Structural therapyStrategic therapyIntergenerational systems

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Collaborative Therapy

A collaborative therapy is one in which:

The expertise of clients is given at least as much weight as the expertise of therapists.

Clients are regularly part of the treatment planning process.

Clients are consulted about goals, directions and responses to the process and methods of therapy.

The therapist asks questions and makes speculations in a non-authoritarian way, giving the client ample room and permission to disagree or correct the therapist. Therapists give clients many options and let them coach the therapist on the next step or the right direction.

Client status is elevated from passive needy recipients to active expert contributors.

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The art of therapy revolves aroundhelping clients to bow out of their

symptoms gracefully

- Milton Erickson

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Termination and

Follow-Up

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Indicators Of Counseling Success

Clients “own” their problems and solutions

Clients develop more useful insight into problems and issues

Clients acquire new responses to old issues

Clients learn to develop more effective relationships

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Accountability For Mental Health Professionals

Continuing educationPaying attention to relevant research findings

Applying research findings to clinical practice

Validating efficacy of our work

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Outcome Rating Scale (ORS)Name ________________________Age (Yrs):____ Sex: M / F Session #____Date:_______________________

Who is filling out this form? Please check one: Self _______Other_______ If other, what is your relationship to this person? ____________________________

Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks tothe right indicate high levels. If you are filling out this form for another person, please fill out according to how you think he or she is doing.

Individually(Personal well-being)

I----------------------------------------------------------------------IInterpersonally

(Family, close relationships)I----------------------------------------------------------------------I

Socially (Work, school, friendships)

I----------------------------------------------------------------------IOverall

(General sense of well-being)I----------------------------------------------------------------------I

Institute for the Study of Therapeutic Changewww.talkingcure.com© 2000, Scott D. Miller and Barry L. Duncan

Qualities of an Effective Counselor

Positive regard or respect for people.

Open, non judgmental and high level of acceptance.

Caring and empathetic. Self‐aware and self‐disciplined. Knowledgeable/informed about

subject and awareness of resources available within the community.

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Qualities of an Effective Counsellor

Culturally sensitive. Patient and a good listener. Ability to maintain

confidentiality. Objective and having

clarity.

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Summary

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The session defined counselling as a face-to-face communication between a counsellor and client which aims at helping the client understand their problems and make informed decisions for change.

Qualities of a good counsellor, skills in counselling and barriers to effective counselling, which included physical barriers, differences in social and cultural background, non-verbal communication, and barriers caused by clients are also detailed.

 

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