Diploma of Counselling & Community Service Work

Lesson 2CHCCSL503B:FACILITATE THE COUNSELLING RELATIONSHIP

PRESENTATION OBJECTIVES

By the end of this presentation you

will have knowledge and

understanding of:

• Enabling clients to work through

concerns

• Responding to strong emotions

• Working with uncertainty and

ambivalence

• Assisting clients to become aware

of underlying issues

• Referring clients appropriately

ENABLE CLIENTS TO WORK THROUGH CONCERNS

To enable clients to effectively work through their concerns, a

therapeutic relationship based on respect, empathy and

authenticity needs to be established.

ENABLE CLIENTS TO WORK THROUGH CONCERNS

Good listening and communication skills are key to building a

strong therapeutic alliance. In addition, Geldard and Geldard

(2005), suggest the following strategies for helping a client feel

at ease:

• As you walk with the client to the counselling room for the

first session initiate small talk and chat to the client about

day-to-day happenings.

• Use the first few minutes of the session to allow the client to

feel comfortable and settle in.

• Ask the client about how they travelled to the service or what

the traffic was like.

• Perhaps share something light-hearted about the day.

RESPONDING TO STRONG EMOTIONS

Strong emotional reactions are indicated by:

• Excessive talking

• Unstable emotional expression

• Extreme withdrawal

• Aggressive behaviour

• Excessive crying

RESPONDING TO STRONG EMOTIONS

Below are three examples of the basic listening sequence in action.

Source: Ivey, Ivey & Zalaquett (2013)

THE BASIC LISTENING SEQUENCE

Counsellors work with strong emotional reactions by applying

the key counselling communication skills, such as reflection of

feeling, paraphrasing and summarising.

Interviewers (regardless of profession) typically follow a

sequence of communication skills as a means of assisting

clients to share information. The basic listening sequence (BLS)

is as follows:

• Open question

• Closed question

• Encouragers

• Paraphrases

• Reflection of feeling

• Summary

WORK WITH UNCERTAINTY AND AMBIVALENCE

Clients often present to counselling with an understanding that

they would like their life to be somehow different. Nonetheless,

change can be difficult. Resistance and reluctance on the part of

the client can be driven by strong (often unconscious) driving

forces such as fear and uncertainty.

In addition, problems can represent significant gain, purpose or

payoff in a client’s life.

WORK WITH UNCERTAINTY AND AMBIVALENCE

Consider the following steps for working with uncertainty and ambivalence by:

ASSIST CLIENT IN BECOME AWARE OF UNDERLYING ISSUES

While expressing presenting issues and primary concerns, the clients may not be able to express themselves completely.

Presenting issues are surface level issues (just like the tip of the iceberg). They are often the visible symptoms of deeper underlying issues.

ASSIST CLIENT IN BECOME AWARE OF UNDERLYING ISSUES

Some techniques to assist clients in identifying and processing underlying concerns include:

Therapeutic dialogue Sandtray work

Homework and reflection exercises Relaxation and mindfulness techniques

Journaling or creative writing Art therapy

MAKING A REFERRAL

In the process of assisting a client to work through their emotions and

clarify their primary concerns, it may become apparent that the key

issue for which the client needs help is beyond the scope of the

counsellor’s skill or beyond the service provision arrangements of the

organisation.

MAKING A REFERRAL

Clients facing the following issues, for example, will require immediate action in the form of referral:

• Suicide risk

• Child abuse

• Domestic violence

• Mental and/or physical health issues

• Drug abuse

INDICATORS OF MENTAL HEALTH CONCERNS

Indicators of mental health issues may include:

• Agitation/pacing

• Being excessively loud

• Vacant or seemingly preoccupied (‘spaced out’)

• Dressed overtly inappropriately for the weather (eg wearing a coat when it’s 35 degrees)

• Withdrawn

• Displaying signs of paranoia

INDICATORS OF PHYSICAL HEALTH CONCERNS

Indicators of physical health issues may include:

• Shortness of breath

• Chest/upper body pain

• Stomach pain

• Dizziness/Light-headedness

• Excessive sweating

• Nausea and/or vomiting

MAKING A REFERRAL

• It is critical that workers within the community services maintain a

comprehensive and up to date network of local services.

• Workers should maintain this currency by attending regular

networking meetings and staying in touch with community

programs, waiting lists, eligibility requirements and services offered

at organisations relevant to their client base.

PRESENTATION SUMMARY

Now that you have completed this presentation you should have

acquired knowledge and understanding of:

• How to enable clients to work through concerns

• How to respond to strong emotional reactions

• How to assist a client in working with uncertainty and ambivalence

• Raising awareness of underlying issues for clients

• When to refer clients to alternative services

REFERENCES• Egan, G. (2010). The skilled helper: A problem management and

opportunity development approach to helping (5th ed.). Pacific Grove, CA:

Brooks/Cole.

• Geldard, D. & Geldard, K. (2005). Basic personal counselling: A training

manual for counsellors (6th ed.). Frenchs Forest NSW: Pearson.

• Ivey A. E., Ivey, M. B. & Zalaquett, C. P. (2013). Intentional interviewing

and counseling: Facilitating client development in a multicultural society

(8th ed.). Belmont, CA: Cengage.

• Maidment, J. (2009). Understanding endings: Evaluation and termination.

In J. Maidment & R. Egan (Eds). Practice skills in social work and welfare.

More than just common sense (2nd ed., pp 261 – 274). Crows Nest,

Australia: Allen & Unwin.

• Sheafor, B. W. & Horejsi, C. R. (2010). Techniques and guidelines for

social work practice (8th ed.). Boston: Pearson.

PHOTO CREDITS• www.plymouthhospitals.nhs.uk/ourservices/clinicaldepartments

• www.powerofmind.com.au/affordable-counselling

• www.trainstation.net.au

• www.anniecreativetherapy.co.uk/phdi/p1.nsf/supppages/5718?opendocument&part=4

• www.arttherapyblog.com/what-is-art-therapy/#.Vaw9ME0w9aQ

• www.blackthornbookkeeping.com/creative-writing

• visionpsychology.com/wp-content/uploads/2012/07/Mindfulness.jpg