A brief description of the key aspects involved in the counselling process

1. SCHOOL OF ALLIED HEALTH SCIENCES
DEPARTMENT OF RADIOGRAPHY
ARG 2102 PRINCIPLES OF PSYCHOLOGY AND PATIENT COUNSELLING
NOTES
What is counselling?
There are many definitions of ‘counselling’ formulated by professional bodies and leading
figures in the field:
 Counselling is a professional relationship that empowers diverse individuals, families,
and groups to accomplish mental health, wellness, education, and career goals,
(American Counselling Association, 2013).
 Counselling is a principled relationship characterised by the application of one or more
psychological theories and a recognised set of communication skills, modified by
experience, intuition, and other interpersonal factors, to clients’ intimate concerns,
problems, or aspirations, (Feltharn and Dryden, 1993).
 Counselling is defined as a process, organized in a series of steps, which aims to help
people cope better with situations they are facing. This involves helping the individual
to understand their emotions and feelings and to help them make positive choices and
decisions.
 Counselling is an approach for assisting people to reduce initial distress resulting from
a difficult situation, and to encourage short and long-term adaptive functioning
(positive coping).

2. In short, counselling is
 A process of one-to-one interaction between a therapist and the patient
 Therapist enables a person to talk about the issues or emotional and behavioural
difficulties that are bothering them.
 The act of helping the client to see things more clearly, possibly from a different
viewpoint.
 This can enable the client to focus on feelings, experiences, or behaviour, with a goal
to facilitating positive change.
 Counselling depends on the creation of a relationship between two people, which is
sufficiently secure to allow the person seeking help to explore issues that are painful
and troubling.
Aims of counselling
The main aim of counselling is to:
 assist clients in exploring their problems and guide them to solutions.
 have clients become aware of the consequences of the experiences and situations they
have been/are going through.
 reduce worry, anxiety, or any other negative emotions.
 guide clients in their recovery from, and adaptation to, difficult circumstances.
Counselling as a process and relationship.
Counselling is a process, based on a relationship that is built on empathy, acceptance,
and trust. Within this relationship, the counsellor focuses on the client’s feelings,
thoughts, and actions, and then empowers clients to:
a) Cope with their lives,
b) Explore options,
c) Make their own decisions, and
d) Take responsibility for those decisions.
Counselling is a helping approach that highlights the emotional and intellectual experience of
a client, and how a client is feeling and what they think about the problem they have sought
help for. Developing a counselling relationship is like developing any other kind of

3. relationship, but the counsellor should take the lead. It is the counsellor’s responsibility to set
up the safe and trusting environment for the relationship to grow.
Counselling in a health setting is not / The don’ts of counselling:
 giving advice.
 teaching.
 interrupting.
 pretending to be interested;
 judging;
 interrogating;
 moralising;
 blaming;
 not being gender sensitive; and
 making a choice for a person.
 attempting to sort out the problems of the client.
 expecting or encouraging a client to behave in a way in which the counsellor may have
behaved when confronted with a similar problem in their own life.
 getting emotionally involved with the client.
 looking at a client's problems from your own perspective, based on your own value
system
Source: WHO, 2001: “The World health report: Mental health: new understanding, new hope”,
Geneva.
Characteristics of a counsellor
The role of the counsellor is to
a) enable the client to explore many aspects of their life and feelings by talking openly
and freely.
b) not emotionally involved with the client and does not become so during counselling
sessions.
c) avoid judging patients and not to give advice.

4. d) give the client an opportunity to express difficult feelings such as anger, resentment,
guilt, and fear in a confidential environment.
e) encourage the client to examine parts of their lives that they may have found difficult
or impossible to face before.
Key qualities and unique characteristics of the counselling relationship
Main qualities of a counsellor are:
a) Empathy
b) active listening
c) reflecting feelings
d) asking good questions
e) affirming and accepting
The benefits of counselling on the patient and family
Effective counsellors are responsive and creative in their capacity to find out what will be most
helpful for each individual client. There are many ways in which counselling can help people
to move on in their lives:
 Psychological education. Enabling the client to acquire ideas and techniques with
which to understand and control behaviour.
 Relating with others. Becoming better able to form and maintain meaningful and
satisfying relationships with other people: for example, within the family or workplace.
 Problem- solving. Finding a solution to a specific problem that the client and his/her
family have not been able to resolve alone. Acquiring a general competence in problem-
solving is critical in enabling the client and his/her family cope with the changes or
problems that they may be encountering.
 Empowerment. Working on skills, awareness and knowledge that will enable the client
to take control of his or her own life. The families are also empowered to be able to
take care of the client.
 Insight. The acquisition of an understanding of the origins and development of
emotional difficulties, leading to an increased capacity to take rational control over
feelings and actions.

5.  Self- awareness. Becoming more aware of thoughts and feelings that had been blocked
off or denied or developing a more accurate sense of how self is perceived by others.
 Self- acceptance. The development of a positive attitude towards self, marked by an
ability to acknowledge areas of experience that had been the subject of self- criticism
and rejection.
 Self- actualization or individuation. Moving in the direction of fulfilling potential or
achieving an integration of previously conflicting parts of self.
 Enlightenment. Assisting the client to arrive at a higher state of spiritual awakening.
 Acquisition of social skills. Learning and mastering social and interpersonal skills such
as maintenance of eye contact, turn- taking in conversations, assertiveness, or anger
control.
 Cognitive change. The modification or replacement of irrational beliefs or maladaptive
thought patterns associated with self- destructive behaviour.
 Behaviour change. The modification or replacement of maladaptive or self- destructive
patterns of behaviour.
 Systemic change. Introducing change into the way in those social systems (e.g.,
families) operate.
 Restitution. Helping the client to make amends for previous destructive behaviour.
 Generativity and social action. Inspiring in the person a desire and capacity to care for
others and pass on knowledge (generativity) and to contribute to the collective good
through political engagement and community work.
Counselling should be flexible enough to make it possible for the client to use the therapeutic
relationship as an arena for exploring whatever dimension of life is most relevant to their well-
being at that point in time.
Good qualities of a counsellor
Characteristics of a good counsellor
The role of the counsellor is to
a) enable the client to explore many aspects of their life and feelings by talking openly
and freely.

6. b) not emotionally involved with the client and does not become so during counselling
sessions.
c) avoid judging patients and not to give advice.
d) give the client an opportunity to express difficult feelings such as anger, resentment,
guilt and fear in a confidential environment.
e) encourage the client to examine parts of their lives that they may have found difficult
or impossible to face before.
The counselling process
 When a person seeks counselling, he or she suffers from something serious be it mental
issues, emotional problems, or family problems. The process isn’t rushed but rather
involves a systematic evaluation that includes a detailed process.
 The counselling process involves a step-by-step approach, and the counselor conducts
it in a way to make sure that his client is comfortable with the process. Lets have a look
at the five crucial stages of a counselling process.
The five phases/stages of the counselling session
There are five main stages or phases in the process of a counselling session:
1. Relationship building (Initial disclosure)
2. Problem Assessment (In-depth exploration)
3. Goal setting (commitment to action)
4. Counselling intervention (decision-making)
5. Evaluation, termination, or referral
Relationship building (Initial disclosure)
 The counseling process begins with relationship building. This stage focuses on
the counselor engaging with the client to explore the issues that directly affect
them.
 The vital first interview can set the scene for what is to come, with the client
reading the counselor’s verbal and nonverbal signals to draw inferences about

7. the counselor and the process. The counselor focuses on using good listening
skills and building a positive relationship.
 When successful, it ensures a strong foundation for future dialogue and the
continuing counseling process.
Problem Assessment (In-depth exploration)
• While the counselor and client continue to build a beneficial, collaborative relationship,
another process is underway: problem assessment.
• The counselor carefully listens and draws out information regarding the client’s
situation (life, work, home, education, etc.) and the reason they have engaged in
counseling.
• Information crucial to subsequent stages of counseling includes identifying triggers,
timing, environmental factors, stress levels, and other contributing factors.
Goal setting (commitment to action)
 Effective counselling relies on setting appropriate and realistic goals, building on the
previous stages. The goals must be identified and developed collaboratively, with the
client committing to a set of steps leading to a particular outcome.
Counselling intervention (decision-making)
 This stage varies depending on the counselor and the theories they are familiar with, as
well as the situation the client faces.
 For example, a behavioral approach may suggest engaging in activities designed to
help the client alter their behavior. In comparison, a person-centered approach seeks to
engage the client’s self-actualizing tendency.
Evaluation, termination, or referral
 Termination may not seem like a stage, but the art of ending the counseling is critical.
 Drawing counseling to a close must be planned well in advance to ensure a positive
conclusion is reached while avoiding anger, sadness, or anxiety.
 Part of the process is to reach an early agreement on how the therapy will end and what
success looks like. This may lead to a referral if required.
 While there are clear stages to the typical counseling process, other than termination,
each may be ongoing. For example, while setting goals, new information or
understanding may surface that requires additional assessment of the problem.

8. Importance of feedback in counselling
 Feedback is essential to effective counselling.
 Feedback provides the counsellor with valuable information to help him or her develop
essential counselling skills.
 Feedback also serves another purpose:
a) it helps counsellors learn how to reflect on their own skills and
development.
b) they will be in the counselling room by themselves and will need to
evaluate their own performance in order to continually improve their
counselling skills.
Factors important for counselling to be a success
1. Willingness
Being willing to seek and attend counseling is a crucial step for any individual.
It involves the recognition that they need to make changes and require help to do
so.
2. Motivation
Being willing to make changes and engage in them involves maintaining and
sustaining motivation. Without it, the counseling process will falter when the
real work begins.
3. Commitment
The client may be willing and motivated, but change will not happen without
continued patience and commitment. Commitment may be a series of repeating
decisions to persist and move forward.
4. Faith
Counseling is unlikely to succeed unless the client has faith in themselves, the
counselor, and the process. Taking the step to begin and continue with
counseling requires the belief that it can be successful.
Effective counsellor skills
Effective counsellor skills include the following key issues:

9.  Listening Skills
 Reflecting Skills
 Reframing Skills
 Affirmation Skills
 Summarising skills
Listening Skills
 Listening is a key counselling skill. It is the art of obtaining the information you need
from a speaker, whilst encouraging them to open up and share their issues
 Good listening skills in counselling establishes trust, helps the client disclose their
thoughts and encourages them to share their emotions, thereby facilitating the gathering
of valuable information about the client that would in turn aid the counseling process.
Reflecting Skills
 Reflection in counselling is like holding up a mirror: repeating the client's words back
to them exactly as they said them. You might reflect back the whole sentence, or you
might select a few words – or even one single word – from what the client has brought.
 Reflecting helps you to develop your skills and review their effectiveness, rather than
just carry-on doing things as you have always done them. It is about questioning, in a
positive way, what you do and why you do it and then deciding whether there is a better,
or more efficient, way of doing it in the future.
Reframing Skills
 Reframing is seeing the current situation from a different perspective, which can be
tremendously helpful in problem solving, decision making and learning. Reframing is
helping you or another person to more constructively move on from a situation in which
you or the other person feels stuck or confused.
 Positive reframing involves thinking about a negative or challenging situation in a more
positive way. This could involve thinking about a benefit or upside to a negative
situation that you had not considered. Alternatively, it can involve identifying a lesson
to be learned from a difficult situation.
Affirmation Skills

10.  Affirmations are positive statements about who we are and what our potential is. These
help us feel good about ourselves and focus on what we want. When children (or teens
or adults) hear words of encouragement, they learn to respect themselves.
 Affirmations are positive statements that can help you to challenge and overcome self-
sabotaging and negative thoughts. When you repeat them often, and believe in them,
you can start to make positive changes.
Summarising skills
 Reviewing the work done so far and taking stock. bringing a session to a close, by
drawing together the main threads of the discussion. beginning a subsequent session, if
appropriate. starting the process of focusing and prioritizing 'scattered' thoughts and
feelings.
 Summarizing lets the client know that the counsellor has heard and understood, and
enables the client to clarify thoughts, identifying what is most important. It is not
sufficient just to notice what the client has said, it is also important to notice what is
Summary
 Counselling is a professional relationship that empowers diverse individuals, families,
and groups to accomplish mental health, wellness, education, and career goals.
 A process of one-to-one interaction between a therapist and the patient. It is an act of
helping the client to see things more clearly, possibly from a different viewpoint.
 The main aim of counselling includes the need to assist clients in exploring their
problems and guide them to solutions. It also aims at having clients being aware of the
consequences of the experiences and situations they have been/are going through.
 Counselling is a process, based on a relationship that is built on empathy, acceptance,
and trust.
 Counselling does not include giving advice, teaching, interrupting, and pretending to
be interested. It also doesn’t include judging, interrogating, moralising, and blaming.
Counselling also does not include making a choice for a person, attempting to sort out
the problems of the client, expecting or encouraging a client to behave in a way in which
the counsellor may have behaved when confronted with a similar problem in their own
life and getting emotionally involved with the client.
 The role of the counsellor is to enable the client to explore many aspects of their life
and feelings by talking openly and freely.

11.  Main qualities of a counsellor include being empathetic, being an active listener and
being able to reflect on client feelings and being able to ask good questions.
 The benefits of counselling on the patient and family is that counselling enables the
client to acquire ideas and techniques with which to understand and control behaviour.
It also assists client to be able to relate with others, become competent problem solvers
among other things.
 The five main stages or phases in the process of a counselling session include
relationship building (Initial disclosure), problem Assessment (In-depth exploration),
 goal setting (commitment to action), counselling intervention (decision-making) and
evaluation, termination, or referral stage.
 The importance of feedback in counselling is that feedback provides the counsellor with
valuable information to help him or her develop essential counselling skills, helps
counsellors learn how to reflect on their own skills and development and is important
in making counsellors evaluate their own performance to continually improve their
counselling skills.
 The essential factors that are important for counselling to be a success include client
willingness, client motivation, client commitment and faith
 Effective counsellor skills include the need for good listening skills, reflecting skills,
reframing skills, affirmation skills and summarising skills.