STUDENT

1. Counseling the patient with
chronic illness & Crisis
counseling
By Nabitaka Angella, Imalingat Rogers, Nansereko
Gloria & Kibwota Geoffrey

2. Introduction
• Chronic illnesses are those incurable conditions that are not contagious, but
have multiple risk factors and often involve extended periods of decline
resulting in increasing functional impairment.
• Living with a chronic illness presents many challenges, not only for the person
with the illness, but also for family members who must adapt to the changing
life circumstances that often accompany ongoing health concerns.

3. Why counsel people with chronic diseases?
Counseling is an essential part of the care of chronically ill clients. Beginning with diagnosis, counselors
can play a very important role in:
• Assisting patients and families with adjustment to chronic illness by making the aware of the impact
that chronic illness on the individual and recognizing the factors involved with adapting to chronic
illness
• assessing quality-of-life issues related to the illness
• developing interventions to help clients learn new skills and ways of coping with challenging situations.
• Counselors can also help physicians and the healthcare team to understand the multidimensional
psychosocial needs of patients and families

4. Strategies for counseling
• Reciprocal Trust: In order that the client feels comfortable in expressing him/herself in an uninhibited way,
the relationship between the client and the counsellor needs to be built on reciprocal trust. It is the
counsellor's responsibility to provide a safe, confidential environment, and to offer empathy, understanding
and respect.
• Rational –Emotive Therapy: It’s an approach that helps you identify irrational beliefs and negative thought
patterns that may lead to emotional or behavioral issues. It works to help the client challenge and question
negative emotions, behaviors, and thoughts. The overall goal is to help patients develop a more positive
outlook by restructuring these irrational thoughts and beliefs that they hold.
• Spiritual Care: Spiritual therapy is a form of counseling that attempts to treat a person's soul ,spirit and
body by accessing individual belief systems and using that faith explore challenges in life. Recommendations
for engaging in particular religious activities and practices such as meditation or prayer are made.

5. Counseling needs of clients with chronic
illness
• Gaining an understanding of the disease and treatment in relation to everyday life
• Handling of emotions patients and families may need assistance to look beyond disbelief,
denial, anger, and depression in order to adopt new ways of coping and more realistic goals
regarding their lives and the future.
• Social support; family relationships and perceived social support can be important
contributors to the effective management of chronic illness, reducing some of the stressful
impacts of the disease.

6. Counseling techniques
• Extended acknowledgment of the pain and listening for the roots of the trauma or concurrent emotional pain
builds a capacity within the client or patient for self-exploration and self-awareness. This longer process also
helps the client or patient look inward instead of outward, which will benefit the overall therapy process.
• Offer clients (or refer them to) group therapy in addition to your individual counseling. Group therapy,
particularly in a community of others dealing with chronic pain, can reduce these clients’ sense of loneliness,
shame and isolation and help them feel they are not alone. By seeing other chronic pain sufferers who are further
along in the process of emotional recovery, your client or patient will gain hope that the day might come when
he or she will experience less pain.

7. Continuation
• Look for signs of chemical addiction. As mentioned earlier, there is, unfortunately, a strong
correlation between chronic pain and addiction. Often the addiction is attributable to the pain
medication. Your clients or patients may be reluctant to address this issue.
• In addition to traditional emotional counseling, consider adding mindfulness exercises. These
allow the patients to slow down their minds, control their thoughts and gain confidence. Pain
literally steals this ability from people.

8. Counseling theory used
( cognitive behavioral theory)
• There differences in patient psychological responses and they can be understood by
examining patients' thoughts about their illness.
• This is a fundamental principle behind cognitive therapy—a focused, structured,
collaborative, and usually short-term psychological therapy that aims to facilitate problem
solving and to modify dysfunctional thinking and behavior.
• Clients under go, self-monitoring, experimentation and a stage of getting rid of distressing
thoughts.

9. Crisis counseling
• A crisis is a difficult or dangerous situation that needs serious immediate attention e.g.
natural disasters, suicide, accidents etc. it refers not only to a traumatic event or
experience but to an individual’s response to the situation.
• Crisis events may push the individual toward psychological disequilibrium and this is
characterized by feelings of anxiety, helplessness, fear, inadequacy, confusion, agitation,
and disorganization
• Crisis counseling is a time limited intervention with a specific psychotherapeutic
approach to stabilize those in crisis. It is focused on minimizing the stress of the event,
providing emotional support and improving the individual’s coping strategies in the here
and now.

10. Responses to crisis that counselors have to
address
• Cognitive responses: Blame themselves or others for the trauma. Disoriented, becomes
hypertensive or confused, has poor concentration, uncertainty, and poor trouble shooting.
• Physical responses: Increased heart rate, traumas, dizziness, weakness, chills, headaches,
vomiting, shock, fainting, sweating, and fatigue
• Emotional responses: The person may experience apathy, depression, irritability, anxiety, panic,
helplessness, hopelessness, anger, fear, guilt, and denial.
• Behavioral response: Difficulty eating or sleeping, conflicts with others, withdrawal from social
situations, substance abuse and addictions and lack of interesting social activities.

11. The goals and purposes of crisis counseling
purposes
• Reduce the intensity of an individual's
emotional, mental, physical and behavioral
reactions to a crisis.
• Help individuals return to their level of
functioning before the crisis.
• Improve functioning above and beyond this by
developing new coping skills and eliminating
ineffective ways of coping, such as withdrawal,
isolation, and substance abuse.
• Assist individual in coping with future
difficulties more effectively.
goals
• Safety: Ensures the individual is safe and resources if available,
have been provided
• Stability: Ensures the individual is stable and has a short-term
plan which includes mastery of self and the emergency or
disaster situation
• Connection: Helps connect the individual to formal and informal
resources and support. If resources and supports are not readily
available, crisis counseling helps the individual pursue potential
natural supports or resources.
• Strategies: Aims to relieve current symptoms and helps develop
adaptive coping strategies for current and future situation.

12. Elements of crisis counseling
Assessing the Situation
• The first part of crisis counseling involves assessing the client’s current situation.
• This involves listening to the client, asking questions and determining what the individual needs to
cope effectively with the crisis.
• counselor needs to identify the problem while at the same time acting as a source of empathy,
acceptance, and support. Ensure client safety, both physically and psychologically.
Education
• People who are experiencing a crisis need information about their current condition and the steps
they can take to minimize the damage. Clients need to understand that their reactions are normal
but temporary.

13. continuation
Offering Support
• Providing support, stabilization, and resources.
• Active listening is critical, as well as offering unconditional acceptance and reassurance.
• Offering this kind of nonjudgmental support during a crisis can help reduce stress and improve coping.
• Unlike unhealthy dependency, these relationships help the individual become stronger and more independent.
Developing Coping Skills
• Crisis counselors also help clients develop coping skills to deal with the immediate crisis.
• It involves helping the client explore different solutions to the problem.
• Practicing stress reduction techniques
• Encouraging positive thinking.

14. Crisis counseling strategies
• Creating awareness: showing purpose and changing one’s perspective about life e.g. client wanting to commit suicide.
• Allowing catharsis (expression of emotion) for the therapeutic purposes i.e. crying, yelling, swearing about what they are
going through.
• Providing support from the counselor, friends and family
• Increasing expansion by providing alternative perspective thus helping the client see that their situation can be
• Emphasizing focus; this helps the client focus on the specific causes of the crisis and break solutions into manageable
steps that helps client be able to handle.
• Providing guidance;- it involves providing information and referral services to clients, to help them fix issues in their life.
• Promoting mobilization; this involves helping crisis workers access external support and resources.
• Goal making; helps clients break their problem down into manageable pieces and coping plans.
• Providing protection; it involves protecting clients from their own self, injurious behavior and potentially harmful behavior
towards others.

15. References
https://ct.counseling.org
https://vestibula.org
http://psychology.iresearchnrt.com
https://www.goodtherapy.org
Happily-Cox J, Fielding K, Pringle M. Depression as a risk factor for ischemic heart disease in
men: population based case-control study. BMJ 1998;316: 1714-1719 [erratum published in
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Thank You