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  1. 1. 1 Counselling: A Process View Priya Senroy, MA, DMT, CCC Anubhav
  2. 2. 2 Definition Of Counselling • 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. • Counselling is directed towards people experiencing difficulties as they live through the normal stages of life-span development.
  3. 3. 4 Counselling Functions • Remedial – Functional Impairment • Preventive – Anticipate and Accommodate • Enhancement – Human Potential
  4. 4. 5 Counselling And Theory • Negligible differences in effects produced by different types of counselling • Common elements between theories – Responding to feelings, thoughts and actions of the client – Acceptance of client’s perceptions and feelings – Confidentiality ( with exceptions)and privacy – Awareness of and cultural sensitivity to messages communicated in counselling
  5. 5. 6 Characteristics Of Effective Counsellors • Self-awareness and understanding • Good psychological health • Sensitivity • Open-mindedness • Objectivity • Competence • Trustworthiness • Interpersonal communication
  6. 6. 7 Components Of The Counselling Process • Relationship Building • Assessment • Goal Setting • Intervention • Termination, referral and Follow-Up
  7. 7. 8 Extratherapeutic Factors 40% Relationship Factors 30% Hope & Expectancy 15% Model & Techniques 15% What Works in Counselling: A Review of 40 Years of Outcome Research
  8. 8. Extra-therapeutic factors Client activities outside the therapy session, homework, support system, client attitudes and strengths. These factors can be things like knowing why a person wants counseling, what they want to work on or change about themselves, ability to follow through with practicing new skills, or willingness to try new thinking patterns or ways of experiencing feelings. Relationship Counselor and client connection or therapeutic alliance. Choosing a counsellor means feeling comfortable with is an important choice. One should feel like they can easily talk to their counsellor, learn to trust the counsellor, and know that the counsellor has experience with the issue that brings one to counseling.
  9. 9. Hope and/or expectancy that things will improve. Many clients experience this feeling of hope immediately after scheduling the first appointment. Some clients experience a flood of hope during or after their first few appointments. Structure, model, and/or technique used in therapy, such as cognitive, rational emotive, client-centered etc. The particular model of treatment is not as important as the therapeutic relationship or extra-therapeutic factors, but it does make a difference. The counsellor will be able to adapt the treatment to meet the specific needs and goals.
  10. 10. Relationship Building
  11. 11. 12 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
  12. 12. 13 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."
  13. 13. 14 Assessment
  14. 14. 15 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.
  15. 15. 16 Assessment Tools • Intake forms • Intake interview – Clinician questions • Formal instruments ( not used by this service) – ASAM PPC – DSM IV – DrInc – SASSI – SOCRATES – ………..
  16. 16. 17 Goal-Setting
  17. 17. 18 Goal Functions • Define desired outcomes • Give direction to the counseling process • Specify what can and cannot be accomplished in counseling • Client motivation • Evaluate effectiveness of counseling • Measure client progress
  18. 18. 19 Interventions
  19. 19. 20 Method Of Counselling Interventions • Client directed and collaborated • Strength based • Short term( 3 months or maximum 12 sessions) • Solution focused
  20. 20. Basic philosophy & assumptions of solution focused counselling: Change is constant and inevitable •Clients are the experts and define goals, it’s a collaboration •Clients have resources and strengths to solve problems •Future orientation - history is not essential •Emphasis is on what is possible and changeable •Short term •Clients want change Solution Focused Counselling Focuses on solutions and is goal-oriented, rather than problem focused as many other therapies are:
  21. 21. 22 Collaborative Therapy A collaborative counselling is one in which: • The expertise of clients is given at least as much weight as the expertise of counsellors. • Clients are regularly part of the treatment planning process. • Clients are consulted about goals, directions and responses to the process and methods of counselling. • The counsellors asks questions and makes speculations in a non-authoritarian way, giving the client ample room and permission to disagree or correct the therapist. • Counsellors give clients many options and let them coach the counsellors on the next step or the right direction. • Client status is elevated from passive needy recipients to active expert contributors.
  22. 22. 23 Termination, Referrals and Follow-Up
  23. 23. 24 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
  24. 24. 25 Accountability For Mental Health Professionals • Continuing education • Paying attention to relevant research findings • Applying research findings to clinical practice • Validating efficacy of our work
  25. 25. 26 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. Relationship I 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 Method The therapist’s approach is not a good fit for me. The therapist’s approach is a good fit for me. I-------------------------------------------------------------------------I Overall There was something missing in the session today. Overall, today’s session was right for me. I------------------------------------------------------------------------I Institute for the Study of Therapeutic © 2002, Scott D. Miller, Barry L. Duncan, & Lynn Johnson
  26. 26. 27 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 to the 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----------------------------------------------------------------------I Interpersonally (Family, close relationships) I----------------------------------------------------------------------I Socially (Work, school, friendships) I----------------------------------------------------------------------I Overall (General sense of well-being) I----------------------------------------------------------------------I institute for the Study of Therapeutic Change © 2000, Scott D. Miller and Barry L. Duncan
  27. 27. Case study • 19 year old Amanda had lost her bother to an accident approximately one year ago. Her boyfriend suggested that attend Counselling because she still doesn’t seem to be able to cope with everyday living. For ease of writing the Professional Counsellor is abbreviated to C. • A précis of the session is as follows:
  28. 28. Relationship Building stage/Assessment stage • In the first session C concentrated on building rapport with Amanda and listening to her story. Amanda felt that it was the first time that anybody had really listened. She felt that her friends and family didn’t want to even mention her brother as they didn’t want to upset her. A lot of useful information was gathered throughout this session which is summarised below.
  29. 29. Essential Case Information • Her boyfriend feels that she should be more advanced in her recovery because he himself is coping much better and ‘getting on with life’. Amanda is dwelling on guilt prone thoughts such as “Why him , he was so young, I’m still alive”, “I didn’t tell him I loved him before he died” and “What did I do wrong”.
  30. 30. Goal setting • As Amanda was very talkative and needed to get a lot of things off her chest in the first session C just focused upon building rapport and trust by fully attending to what was said. Therefore at the beginning of the second session C started the process of establishing goals by asking the client what she wanted to achieve out of counselling. It was also determined when and how Amanda would know that counselling was no longer required.
  31. 31. Intervention stage • C then wanted to normalise some of Amanda’s responses by providing her with some information about the stages of Grief and Loss. C was careful to highlight that each individual moves through and expresses the stages differently.
  32. 32. • C then asked Amanda if she could identify with any of the stages and what stage she felt she was currently in. Amanda felt she could relate to the first four stages and that currently she was in the Guilt stage. C then asked Amanda what stage she felt her boyfriend was in. Amanda felt that he was in the Acceptance Stage or may have moved on to complete recovery.
  33. 33. • Again C highlighted to Amanda that it is normal for people to move through the stages of grief and loss at different rates. C then spent some time examining how Amanda felt about being in a different stage to Tom. • C also discussed the length of time (6 months) that Amanda had to come to terms with her impending loss before the loss actually occurred. Amanda felt more relieved by discovering that it can be normal for someone to become stuck in a stage when they have little time to come to terms with a death before hand.
  34. 34. • In the following sessions it was apparent that Amanda was feeling more comfortable with the stage she was at and was now accepting her feelings. Consequently, Amand could now be worked upon to assist her to progress smoothly through the remaining stages of the grief process.
  35. 35. • The discussion then moved to ways that Amanda could actually gain some need gratification now whilst she is still grieving. C made a point of acknowledging that Amanda is not going to be able to do all the things she used to as of yet. This lead quite nicely into an awareness of the need for time management training. C highlighted how a loss can upset routines and the loss of a routine can be a loss in itself. It was explained that time management training may assist Amanda in regaining a routine as people often need to relearn skills they had previously in order to help them get back on track.
  36. 36. • This left future sessions to explore what Amanda could focus to deal with the ‘void’ which the loss has created. Amanda agreed for her boyfriend to join the counselling process at this stage to explore the differences. Once they acknowledged each others thoughts and feeling about the loss of the brother and how this impacted on their thoughts and fears regarding having children of their own they were in a better position to co-develop a suitable solution.
  37. 37. Termination, referral and follow up • Once this was resolved there was no further need for counselling. It is important to note that Amanda has not finished the grieving process but now has more skills and resources to deal with the final stages without continued counselling support. • Amanda was also referred to bereavement support groups and was asked to come back for a follow up after 2 months to see how things were proceeding.