Counselling is defined as a face-to-face helping process aimed at problem solving that can be done individually, with groups, or with couples. An effective counselor displays key qualities like genuineness, unconditional positive regard, and believing in the client. Counselors use microskills like active listening, open-ended questioning, reflecting feelings, and paraphrasing. Counseling follows stages including rapport building, assessment, goal setting, intervention, and termination/follow-up. Approaches can be directive, non-directive, or non-authoritarian. Peer counseling involves HIV-positive individuals sharing experiences. Counseling differs from health education in being confidential, focused, and goal-directed in facilitating behavior change.

1. Department of Community Medicine
Pt. J.N.M Medical College, Raipur (C.G)
Counselling
Guided by:-
• Dr. G. P. Soni
(Prof & Head)
•Dr. Shubhra A. Gupta
(Associate Professor)
Presented by-
Dr. Aditi Chandrakar

2. Content
• Definition
• Key qualities of counsellor
• Micro skills of counsellor
• Stages of counselling
• Gather approach
• Types of counselling
• Difference between counselling and health
education
• Conclusion

3. Definition
• Counselling is face to face communication by which
you help the person to make decision or solve a
problem and act on them.
• Counselling is a helping process aimed at- problem
solving.
• Counselling – done with individual , group or with
couple.

4. Counselling is
• specific to the need , issue and circumstances of each
individual client.
• Interactive , mutually respectful collarabarative process.
• Goal directed .
• Acceptable to social and cultural context.
• Bring changes in attitude.

5. Key qualities of counsellor
• Genuineness
• Listening
• Unconditional positive regard
• Believing in client
• Make client aware of various alternatives available and explain
advantage and disadvantage and implication
• Recognize your own limitations.
• Patience
• Donot block free expression of feelings
• Non-judgemental
• Being in control-stay focussed and donot wander all over the
place
• Knowledgeable.

6. Micro skills of counsellor
1. Listen Actively
how to listen actively ?????
• Accept the clients as they are.
• Listen to what your client say and how they say it. Notice the
tone of the voice ,facial expression and gesture.
• Keep silent sometimes. Give your client to think ,ask
question.
• Sit comfortably.
• Look directly into the client when they speak ,not on your
papers and windows.
• Ensure that you are continually involved in the conversation
by either “nodding head, saying then or oh”

7. • According to communication expert:-
10 % of our communication represented by words.
30 % are represented by sounds we make (by mimimum
verbal)
60 % are represented by body language ( eg- eye contact ,
body posture etc.)
• Once counsellor recognize client’s feeling let him/her know in
clear and simple words that he understood. This is know as
“reflecting feeling”.

8. 2. Questioning
• Ask the question to understand clearly the client problem or
worries to help the client go deeper into his/her own
awareness or insight.
• Question- centered around the concerns of client and open
ended.

9. S.No. Open ended Questions Closed ended Question Leading Question
1. Response more than
one
Limits the response of client
in one word answer
Unknowingly suggests
answer to the client
2. Invites the client to
continue talking and
helps in what direction
counsellor wants to take
conversation
Did not give opportunity to
think about what they are
saying
Questions are usually
judgemental.
3. Simple yes/no cannot
answer the question
Answer- very brief and do
not provide much
information
4. Ex- 1. what difficulties
do you experience in
practicing safe sex?
2. When did you think
would be right time to
disclose your test to
your spouse?
Ex- 1. Do you practice safe
sex?
2. Should I disclose your test
result to your spouse?
Ex-1. You do practice
safe sex , don’t you ?
2. Do you think that
your wife will abandon
you if she knows about
your HIV status?

10. • At the time of asking question: Remember
 Ask one question at a time.
 Look at one person
 Be brief and clear
 Ask question that serve for purpose
 Use question that enables clients to talk about their feelings
and behaviours.
 Use question to explore and understand issues and not to
collect juicy material for gossip.
• Don’t ask
 Irrevalent question.
 Too many question at one time.

11. 3.Using silence
• Give time to the client to think about what to say next.
• Provide space to experience feeling.
• Allows client to proceed at their own pace.
• Give the client freedom to choose whether or not to continue.

12. 4. Non-verbal behaviour
• It is not what you say but how you say is important.
• Majority –non verbal
• Person body language is not similar to what they are saying, it
results in verbal confusion/mis-interpretation.
• Effective counsellor-sensitive to nonverbal communication .
• Examples :-gestures, facial expression, posture, eye contact,
tapping fingers, change in voice pitch and fluency of voice.

13. 6. Accurate Empathy
• Empathy means- recognition and understanding of clients
thoughts and emotions.
• It is characterized by ability to put oneself into another's shoes
i.e experience the view point of another within oneself.
7. Paraphrasing
• Counsellor repeat in his/her own words what client has said to
show understanding.
• Say in few words so that it can give summary of client’s word.

14. Stages of counselling
• 1. Rapport-building
• 2. Assessment and analysis of the problem
• 3. Provision of ongoing supportive counselling
• 4. Goal setting.
• 5. Counselling intervention
• 6. Termination and follow-up

15. 1.Rapport building –
• Establishing a rapport by being genuine and extend warm
welcome to the client .
• Give introduction and orient the client.
• Assure confidentiality of the issue.
• Outline the counselling process fo the client like content,
duration, testing options and procedure.
• Facilitated by good atmosphere, adequate privacy, seating
arrangement and establishing eye contact with the client .

16. 2. Assessment and analysis of the problem:
• Defining and focusing specially on the problem.
• Identifying and assessing the gravity of the client’s problem.
• Assessing the impact of the problem on the client’s life
• Exploring the resources and support available to the client

17. 3. Provision of ongoing supportive
counselling
• Informing HIV-positive persons about the risks of developing
tuberculosis (TB) disease.
• Educating HIV-positive persons about the symptoms and
signs of TB
• Ensuring that each and every person attending the VCTC with
cough of more than three weeks’ duration is referred to the
designated microscopy centre .
• Tell the importance of sputum examination in the diagnosis of
TB.

18. • Ensure them TB can be cured through regular and complete
treatment and free of cost at government health centres .
• Confirm patients diagnosed with TB are put on treatment
under the RNTCP and patients with HIV/TB take the required
drugs regularly under direct supervision.
• Emphasizing the importance of directly observed treatment
(DOT).
• Emphasizing to all sputum-positive patients the importance of
getting their contact screened.

19. 4. Goal setting
Examples :- pretest counselling of HIV/AIDS
1.To get the test done.
2. If not undergone test, encourage them and ask them to come
when they are prepared.
3.Prepare the client for any type of test result i.e
negative/positive.
5.Counselling intervention
Key factors during post test counselling:-
• Cross check the result with the client .
• Provide result to the client in person.
• Ask the client to summarize what was discussed last time.

20. 6. Termination and follow-up.
• HIV counselling doesnot ends with the diagnosis of the client
HIV status.
• Ask the client to come with his/her partner.
• Counsel their family members to accept them as a part of
family member and help them to live comfortable life.
• Knowledge of HIV test results identifies not just one infected
person but several affected areas who are their close
associates.

21. Stages of Counselling -GATHER
• G = Greet client in a friendly, helpful, and respectful manner.
• A = Ask client about needs, concerns, and previous use.
• T = Tell client about different options and methods.
• H = Help client to make decision about choice of method s/he
prefers.
• E = Explain to client how to use the method.
• R = Return: Schedule and carry out return visit and follow-up
of client

22. • Greet
• Welcome and register client.
• Prepare chart/record.
• Determine purpose of visit.
• Give clients full attention.
• Assure the client that all information discussed will be
confidential.
• Talk in a private place if possible.

23. Ask
• Ask client about her/his needs.
• Write down the client's: age, marital status, number of previous
pregnancies and births, number of living children, basic
medical history, previous use of family planning methods,
history and risk for STDs.
• Assess what the client knows about family planning methods.
• Ask the client if there is a particular method s/he is interested in.
• Discuss any client concerns about risks vs. benefits of modern
methods (dispel rumors and misconceptions).

24. Tell
• Tell the client about the available methods.
• Focus on methods that most interest the client, but briefly
mention other available methods.
• Describe how each method works, the advantages, benefits,
possible side effects, and disadvantages.
• Answer client concerns and questions

25. Help
• Help the client to choose a method.
• Repeat information if necessary.
• Explain any procedures or lab tests to be performed.
Explain
• Explain how to use the method (how, when, where).
• Explain to the client how and when s/he can/should get
resupplies of the method, if necessary.

26. Return
• At the follow-up or return visit ask the client if s/he is still using
the method.
• If the answer is yes, ask her/him if s/he is experiencing any
problems or side effects and answer her/his questions, solve
any problems, if possible.
• If the answer is no, ask why s/he stopped using the method and
counsel her/him to see if s/he would like to try another method
or re-try the same method again.
• Make sure s/he is using the method correctly (ask her/him how
s/he is using it).

27. Approaches in doing counselling
1.Directive or Counsellor –centred or authoritarian style:-
• Simplest to do
• Counsellor give advices, make decision based on what she
thinks is in the the best interest of client.
• Expects the client to follow her advices
• Completely directed by counsellor.
2. Non-directive counselling or client-centred :-
• Counsellor is passive mainly listener.
• Client is active ,expresses herself freely and tells the
counsellor what he/she wants.
• After careful reflection and clarification , makes her own
decision.
• The main function of the counsellor is to create an
atmosphere in which the client can work out his problem.

28. 3.Non-authoritarian style:-
• Neither counsellor nor client controlled.
• Methods of counselling may change from client to client or
even with the same client from time to time.
• It is highly flexible.
• Freedom of choice and expression is open to both the
counsellor and the counselee.

29. Peer counselling
• Peer counselling are HIV positive men and women specially trained
to hear the concern of clients and offer support and referral services.
• In this, counsellor is open about his/her HIV positive status and
shares experiences with client.
• It is the process that is carried out as one to one interaction followed
by group approach.
• It addresses the client issue through following process:-
 Sharing feeling about similar experiences.
 Share information about availability of HIV/AIDS prevention,
treatment and care services.
 Narrate their success stories to the peers and convey messages of
positive thinking.
 Supports client in becoming more involved in community activities.

30. Counselling and health education
Counselling Health education
1. Confidential Not confidential
2. One to one process or a small group. For a group of people
3. Focused, specific and goal directed Generalized
4. Facilitates change in attitude and
motivates behavior change
Information is provided to increase
the knowledge
5. Problem oriented Content oriented
6. Based on needs of client Based on public health needs.

31. Conclusion
• Counselling is a process and not merely a technique through
which clients are helped to modify their behaviour and cope
with their status effectively.
 Counselling is not
• Telling or directing
• Giving advice
• A casual concern
• A confession
• Praying

32. Thank you