The document outlines the typical stages of counseling: immediate concerns, early stage, middle stage, late stage, and termination. The immediate concerns stage focuses on risk assessment, rapport building, and preliminary diagnosis. The early stage emphasizes in-depth assessment, goal-setting, and treatment planning. Key tasks in the middle stage include working towards goals, strengthening coping skills, and addressing underlying issues. The late stage helps clients understand root causes and apply skills to future problems. Termination addresses progress, consolidation of gains, and feelings around ending counseling.

1. Counseling Stages
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2. Objectives
 Review stages of treatment and tasks for each
stage
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3. Stages
 Immediate Concerns
 Evaluate risk factors for SI/HI
 Create a therapeutic framework
Elicit the presenting problem
Establish rapport
Enhance motivation
 Address management and practice issues (orientation)
 Make a preliminary assessment and provisional
diagnosis
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4. Stages
 Early Stage
 Main purpose is in-depth assessment and goal setting
 Assessment strategies
 Semi-structured interview
 Observation
 Testing
 Collateral sources
 Gather information about the client’s level of distress and it’s impact
on the client’s problem and overall situation
 Assess client’s coping skills
 Identify physical symptoms
 Identify psychiatric symptoms
 Gather information about the client’s experiences using a culturally
responsive framework. (What does this mean to you. Why do you
think this is happening?)
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5. Stages
 Early Stage
 Determine Diagnosis
 Formulate the problem
 Determine level of impairment
 Differentially diagnose
 Assign a diagnosis
 Develop a treatment plan
 Prioritize needs and services
 Develop mutually agreeable goals
 Develop sub-goals/objectives
 Select mutually agreed upon intervention strategies
 Make appropriate referrals
 Provide psychoeducation
 Assign homework
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6. Stages
 Middle Stage
 Work toward identified goals. Ensure the treatment plan is
sufficiently specific that the client understands who, what, when,
why and how
 Use a systemic approach as much as possible
 General tasks of the middle stage include
 Feelings identification and resolution
 Reducing core symptoms
 Identifying and strengthening client’s coping skills
 Decrease isolation
 Increase self-esteem
 Address family and environmental issues which may be maintaining the
problem
 Evaluate client progress
 Examine “resistance” and barriers to change
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7. Stages
 Late Stage
 After the goals have been accomplished, help the
client understand how the problem came to occur in
the first place (developmental roots)
 Assist client in generalizing skills and lessons learned
Review original problem and steps taken to resolve it
Hypothesize future problems and apply the method
 Develop relapse prevention strategies using
anticipatory and preventative guidance
 Connect the client to additional community resources
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8. Stages
 Termination
 Review progress
 Consolidate gains
 Enhance client’s self-efficacy
 Ensure the client has a support system and relapse
prevention plan
 Deal with client feelings about termination
Anxiety
Sadness
Abandonment
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9. Summary
 Early stages of counseling are good for enhancing motivation
and self-efficacy and developing the therapeutic alliance
 A thorough assessment takes several sessions to really
understand the breadth and causative factors
 Treatment planning needs to be culturally responsive and
individualized
 In order to increase client self esteem and confidence, it is
important to help him/her generalize new problem solving skills
to feel competent to handle issues in the future
 In the late stage of treatment it is important to develop a
relapse prevention plan to prevent and mitigate problems.
 Some clients will have a resurgence of symptoms just before
termination as a reaction to the end of the relationship. It is
important to deal with abandonment, anxiety and grief issues.
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