CounselingCounseling

Presented by LEIGH Nga Yan

6/11/02

What is counseling?What is counseling?

• Different people have different interpretation.• No single definition.

In broad sense:

• Is a helping relationship• the helper helps another through communication

Case ScenarioCase Scenario

Tom, a 16 years old student, visited his GP one afternoon, fearing of a “genital ulcer”. The GP found nothing abnormal on physical examination.

• If you were the GP, how would you approach this patient?

• On further questioning, Tom was actually afraid of suffering from STD. He admitted unprotected sex with his girlfriend a week ago.

• What Tom’s GP did was assessing Tom’s knowledge about safe sex.

• He educated Tom about safe sex, advice his girlfriend to attend doctor if she has any fear or has delayed menstruation.

• Is the GP doing counseling?

• Why yes/ why not?

Tom’s GP is:

• Trying to help

• interview/ information gathering

• lecturing

• All these activities may lead to counseling, but was not counseling by themselves

To be counseling: what is To be counseling: what is lacking?lacking?

• unilateral, rather than interactive working relation.• Tom’s emotion not addressed; ?feeling guilty, ?

Ashamed• Tom’s GP was making the decision, rather than

guiding Tom to find out what fitted him.• Counseling should be person-oriented rather than

problem-oriented.

Definition of CounselingDefinition of Counseling

• The European Association of Counseling:– Counseling is an interactive learning process contracted between

counselor(s) and client(s), be they individuals, families or institutions, which approaches in a holistic way, social, cultural, economic and/or emotional issues.

– Counseling may be concerned with addressing and resolving specific problems, making decisions, coping with crisis, improving relationships, developmental issues, promoting and developing personal awareness, working with feelings, thoughts, perceptions and internal or external conflict.

– The overall aim is to provide clients with opportunities to work in self defined ways, towards living in more satisfying and resourceful ways as individuals and as members of the broader society.’

Definition of CounselingDefinition of CounselingThe Code of Ethics and Practice for Counselors (1993) describes “the

nature of counseling” in the following way;• The overall aim of counseling is to provide an opportunity for the

client to work towards living in a more satisfying and resourceful way.

• Counseling may be concerned with developmental issues, addressing and resolving specific problems, making decisions, coping with crisis, developing insight and knowledge, working through feelings of inner conflicts or improving relationships with others.

• The counselor’s role is to facilitate the client’s work in ways which respect the client’s values, personal resources and capacity for self-determination.

• Only when both the user and the recipient explicitly agree to enter into a counseling relationship does it become “counseling” rather than the use of “counseling skills”.

Aims of all counselingAims of all counseling

• promote self-help

• Move towards self-development

• provide an opportunity for the client to work towards living in a more satisfying and more resourceful way as individual/ as a member of a society.

Counseling and general practiceCounseling and general practice

• Opportunities for using counseling skills

• Formed working relation between GP and their patient, expose GP to counseling situation.

• Neglect patient’s need (? Holistic care)

• attempt counseling the patient after mutual agreement (contract).

• refer for specialist help ( assess self-resource)

Reasons for GPs of not doing Reasons for GPs of not doing counselingcounseling

• Time consuming

• not the type of person

• don’t know the skills

• not feeling competent

CounselingCounseling

How to do it?

Models of HelpingModels of Helping

Components of helping: The Components of helping: The helper & the skillshelper & the skills

• the helper: the most important tool

• attitude, counseling skill

• the core elements:genuineness, warmth and empathy

Genuineness/ congruenceGenuineness/ congruence• What you think and what you say is the same• not particularly obvious when present, but when it is

not there the clients are aware of the lack.• Skills: “to decide how much to share in the moment,

and how much should be considered later and elsewhere.”

• 3 aspects of genuineness:– do not overemphasize the helping role– avoid defensiveness– be open

• on achieving: build up trust

WarmthWarmth• Non-possessive warmth

– respect the other person and what that person is and stands for– counselor’s consistent acceptance of and enduring warmth

towards the client• unconditioned positive regard

– when people are ill: vulnerable, easily and quickly to feeling of being useless, sad and fearful (self-defeated cycle)

– positive reinforcement• comfortable silence• verbal support

– Drive to change

empathyempathy

• 2 way nature of empathy– ability to perceive accurately the feelings of

another person – to communicate this understanding to him/ her.(c.f. sympathy: suppress emotion, superimpose

inferiority)

• encourage facing emotion, enhance trust building, sense of sincerity

Empathy: 2 levels of empathyEmpathy: 2 levels of empathy

• Case scenario– patient: I feel really terrible today, worse than

yesterday.– Response A: you feel worse today?– Response B: don’t worry, these things take time– response C: you sound dejected at feeling

worse today.

• Basic empathy: words reflected:– the helper responds and shows that the client is

heard• advanced empathy: more reflection of feeling than

words• the caring can be communicate through action, or

words, more both.

Other attitudesOther attitudes

• attentiveness– to be with the person at the time (both body and

spirit)– the quality of the presence is what matters most– a kind of willingness to share yourself and

acceptance– skill: active listening:

• ATTENDING• RESPONDING

• Non-judgmental: suspend premature solutions, personal attitude, and personal value– a notion of respect

• being hopeful: believe in the intrinsic worth and goodness– convey to the client that they are worth your effort,

time and skilled care– a drive for hopeless and helpless client to move forward

• being supportive: willingness to give involved in the therapeutic relation

The art of relating:The art of relating:

• The helper can give clients the safety to explore their real feelings, and permission to talk about things that are of the utmost important to them, particularly the knowledge that they have been heard.

Rapport Building

Rating our counseling skillsRating our counseling skills

• Scoring: <35, most likely benefit from learning and applying counseling skills

Assess our resourcesAssess our resources

• Everyone has the potential to help others• Counselor Vs helper:

– counselors are trained persons to do counseling.– It is guided by theories about the causes of

problems, and methods needed to help.• Counseling =/ counseling skill• being untrained, we can polish counseling skills to

facilitate our helping work

Level of goalsLevel of goals

• Immediate goal: finding solution to simple problem• intermediate goal: self-understanding, satisfaction in

relation, accomplish education, cope with work, handle emotion

• ultimate goal: self-actualization– harmony with environment– self-acceptance– self-motivation…..– Consider refer counselor/ psychotherapist to achieve this.

Personal counseling:Personal counseling:

The framework and approach

Setting the stage:Setting the stage:5Rs of counseling5Rs of counseling

• Right purpose– be pure to assist the client to solve his/her problem. Nothing

more.

• Right time– most relaxed, least pressure

– enough time

• Right place

• Right approach

• Right techniques

55Rs of Counseling: Right placeRs of Counseling: Right place

• Comfortable, less threatening.– Peace & quiet, allowing private and confidential

communication– isolated location with few, if any, observer– no disturbance by phone calls– setting as natural as possible, at least without a

desk.– informal atmosphere: enable counseling to be

carried out on an equal basis

55Rs of Counseling: Right Rs of Counseling: Right approachapproach• Voluntary meetings:

– people come to you for his/her problem

– less barrier

• Intervention counseling:– you sense a problem, and you step in to assist

– situation may be more volatile and emotionally charged

– more difficult to set up

– 1. Oblique approach: indirect/ soft : a polite way too set up a counseling session you believe is needed.

– 2.direct approach: problem obviously surfaced.

The 5Rs of Counseling: the Right The 5Rs of Counseling: the Right TechniqueTechnique

• Tools to facilitate communication

• develop your own counseling style.

The rule of game: the 4 base The rule of game: the 4 base diamonddiamond

• Giving advance notice about how the counseling game is played can relax the “player” and improve the process.– By reaching base 4: you are winning the game!

Base 1: listeningBase 1: listening

By getting to base 1: getting acquainted, relaxing, and

accepting each other and preparing to tackle a problem

• counseling relation begins

• rapport building

The skills of relatingThe skills of relating• Attending: SOLER acronym: body language

• face the client Squarely• Open posture• Lean forward: • Eye contact• Relaxed

• Being Non-judgmental, staying open• paying attention to body language• giving space, time (permission to talk and explore inner

world)• active listening: the less talking you, the more • effective you will be• encouraging; building on the client’s own strengths and

calling forth the client’s own resource.

Base 2: identify the problemBase 2: identify the problem

• Task to accomplish:– isolate and agree on the problem

• skills of assessing & challenging

• Talking is therapeutic

The skills of assessing: allowingThe skills of assessing: allowing• permission to tell the story, encouraging the

continuation of the story-telling – ‘what is happening?”

– problems are seen more clearly through

verbalization• talking sometimes provides insight not possible through self-

analysis

• in being allow to tell the story of the events, shapes may begin to emerge, patterns can be recognized, and links made between happenings that never seemed to be related.

The skills of assessing: exploringThe skills of assessing: exploring

• Concern with both factual and inner feeling and meaning– seeking information, questioning– clarifying– reflecting: to reflect significant word/ concept, so the patient can

move forward / deeper exploring

– paraphrasing:

• help client to “ personalize the experience”• experiencing feelings: “ I statementI statement”• “what is the meaning of it”

The skills of assessingThe skills of assessing

• Guiding to new perspectives– knowledge about defense mechanism, stages of

bereavement….– Enable patient to treat his/her reaction as normal.

• summarizing• Focusing

– ‘what do you what?’

• By this juncture, you usually will know whether you can proceed, or need referral for expert help

Counseling skill: challengingCounseling skill: challenging

• To recognize the blockage to change– outmoded values, irrational belief– blind spot, self-defeating pattern of thinking and

behaving– inconsistencies between what are said and done– the defense mechanism– avoidance

• helper: to be alert and spot them out quickly– done with empathy– the “sandwich technique”: give praise first, then the

challenge.

ChallengingChallenging

• Pre-requisition: good working relation– confronting with reality: challenge the blind spot so

that the reality can be seen as it really is at that point --> develop new perspectives

– expressing feeling: help patient to face their realistic feeling: to experience and express feeling

– immediacy: mirroring the difficulty of the client in interpersonal relation/ comparing behavior with you as helper

– self-sharing– intuition– empowering: leave patient with power/

confidence• challenge the person’s strength, rather than

weakness, through the process of awareness, acknowledgement and change.

Counseling: a therapeutic Counseling: a therapeutic relationshiprelationship

• Sense of being understood, accepted.

• Relief of emotional pain

• improve self-understanding

• gaining drive to self-help: support and hope

• By accomplishing base 2: 1.viewing the problem from different

perspectives, objectively understand the dimensions of what to accomplish

2. Isolate and agree on the problem

• a sign of progress: the client become ready to move forward and outward.

Skills to drillSkills to drill

• Effective listening• Being sensitive: look beneath and beyond what people say

– Use your senses link between outer and inner world.– Body language, non-verbal signal.– Awareness:

• the more you are aware of yourself, the more you are aware of other people.

• When we increase our self-understanding, we increase our capacity to help• Helping is possible only from a basis of self-awareness and insight of how

people live and work, think and feel

• uncover important aspect by asking question

Base 3: look for & clarify the Base 3: look for & clarify the alternativesalternatives

– An elegant solution: the ideal solution under the circumstances.

• Counseling is a sensitive process that requires you to understand the feeling of the other party -- it is not always easy for a person to accept an elegant solution

• The counselor should emphasize the weighing part of the process, and let the other party do the deciding on which road to ride.

Base 3: suggested stepsBase 3: suggested steps• Get several alternatives

– in most situations, possibilities are greater than 1st perceived.

– Frequently, an advisor can suggest an alternative not previously considered by the other party

• the weighing process– mentally “try on” the alternatives and visualize the

outcomes

• discarding alternatives– prevent prematurely discard possibility, while get rid

quickly not elegant ones– the “rule of 3”

Counseling skill: goal settingCounseling skill: goal setting

• New perspectives: choosing from alternatives• imagination

– what do you want? How are you going to do this• Visualization• managing feeling: awareness, experiencing, expressing,

controlling– thinking skills, action skills: anger, anxiety, depression

• managing resistance– self-responsibility, commitment

• planning for change• a moral contract

• Making the decision– signals of attaining a solution1. The person see the light at the end of the tunnel

2. The individual has developed the necessary confidence to select the best available alternative and make a decision

3. The person’s burden has been lifted. Self-esteem has been restored.

• As a counselor, you can direct the person to the ideal solution, base on your own understanding of the problem.

• DO NO HARM

Base 4: solution acceptedBase 4: solution accepted

The process starts on 3rd base where (hopefully) alternatives have been isolated

Steps to close the session1. Ask the individual to restate & review (the implications

of) the decision (skills: ask/ listen/ accept)

2. Help to reinforce the individual’s self-esteem (skills: compliment/ be optimistic/ supportive)

3. Discuss how the solution is to be implemented (skill: promote confidence in decisions)

4. Leave the door open for a return visit. (skill: accept/ support)

– a return visit, to a counselor, is a compliment

The psychology of CounselingThe psychology of Counseling

• Be a guide, not a leader– you don’t make decision, your client do.

• be someone who helps another sort out, solve a problem, and take action– be a person who take the initiative

– be comfortable to know

– a problem burdens the other party, not you.

– When you can help a person to solve a problem, you lighten the burden they carrier

The psychology of counselingThe psychology of counseling

• Promote self-esteem– listen respectfully, and say the right thing at the right time

• foster independence, not dependence– principle of empowerment: leave people confidence that

they can solve their own problems and improves their lives.

• be honest about your role– tell what you can do, and what you can

DO NO HARM

Unforgivable MistakesUnforgivable Mistakes

1. Overtalking & underlistening

2. Acting like a psychologist or clinical counselor when you are not

3. Using a counseling relationship to your own advantage

4. Failure to keep information obtained from a counseling relationship

5. Making decisions for the person being counseled.