Counselling process- establishing structure and therapeutic environment

1. ESTABLISHING
STRUCTURE
&
THERAPEUTIC
ENVIRONMENT
COUNSELLING PROCESS

2. ESTABLISHING STRUCTURE
 What is Structure?
 Clients sometimes have different perceptions about the purpose and
nature of counseling. They arrive with several feelings, attitudes and
expectations and are often nervous and wonders what is going to
happen.
 Therefore, many clients enter counseling reluctantly and hesitantly.
This uncertainty can inhibit the counseling process unless some
structure is provided.
 It is essential that the counsellor makes it very clear to the client
regarding what may take place in the counselling situation. This is
called 'structuring'.
 Structure in counselling is defined as the “joint understanding
between the counsellor and client regarding the characteristics,
conditions, procedures, and parameters of counselling.”

3.  Important Functions of Structuring
According to Brammer, Abrego, & Shostrom, (1993)
1. Structure helps clarify the counsellor-client relationship and give
it direction.
2. It protect the rights, roles, and obligations of both counsellors and
clients.
3. It ensure the success of counselling.
 Structuring concerns the practical mechanics of the counselling
relationship. It dispels many initial misconceptions about
counselling. This kind of initial understanding, could be of great
value to the clients. It is good if the client has some understanding
and grasp of the matter.
 For Example :
a) What does he expect from the counselling relationship?
b) What would be the responsibilities and commitments?
c) What is the amount of time that would be available to him?
d) What fees, if any, does he have to pay?
 When a client does not know anything about such matters, he is
obviously going to feel uncomfortable and anxious.

4.  Important part of Establishing Structure
 Practical guidelines are very important part of building structure.
 They include
1. time limits (such as a 50-minute session),
2. action limits (for the prevention of destructive behavior),
3. role limits (what will be expected of each participant),
4. procedural limits (in which the client is given the responsibility to
work on specific goals or needs).
 Guidelines also provide information on fee schedules and other
important concerns of clients.
 Hence, Structuring promotes the development of counselling by
providing a framework in which the process can take place.
 Structure is provided throughout all stages of counselling but is
especially important at the beginning.
 Its importance is most obvious when the client arrives for
counselling with unrealistic expectations or with no idea what to
expect.

5.  Counsellors need to move quickly to establish structure at such
times.
 One way is for counselors to provide information about the
counseling process and themselves with professional disclosure
statements that include details about the nature of counseling,
expectations, responsibilities, methods, and ethics of counseling .
 To help clients gain new directions in their lives, counsellors
provide constructive guidelines.
 Their decisions on how to establish this structure are based on
a) their theoretical orientation to counseling,
b) the personalities of their clients,
c) the major problem areas with which they will deal.
 Counsellors need to stay flexible and continually negotiate the
nature of the structure with their clients.

6. SAMPLE
Professional Disclosure Statement
Samuel T. Gladding, Ph.D.-Licensed Professional Counselor
I am glad you have selected me as your counselor. In considering our
professional relationship, I have written this document to describe my
background and my clinical approach.
Professional Background
I hold a Master of Arts degree in counseling from Wake Forest
University, a Master of Arts degree in religion from Yale Divinity
School, and a Ph.D. from the UNC-Greensboro in family relations
with cognates in counseling and psychology. In addition, I did a post
doctorate at UNCG (18 semester hours) in psychology. I have worked
in a public mental health center (Rockingham County, North Carolina)
and in a private clinical practice (Birmingham, Alabama). I have also
taught counseling at the graduate level in Connecticut (Fairfield
University), in Alabama (University of Alabama at Birmingham), and
in North Carolina (Wake Forest University).
I am a Licensed Professional Counselor (#636) in the state of North
Carolina, a National Certified Counselor (#334), and a Certified
Clinical Mental Health Counselor (#351).

7. Counseling Services Offered
As a licensed professional counselor with a specialty in mental health, I
am interested in the growth, development, and wellness of the whole
person. I respect the uniqueness of each per- son and his/her life journey
where applicable. My responsibility is to facilitate and empower your use
of thoughts, feelings, and behaviors to achieve healing and wholeness in
your life. I have offered outpatient, fee-based counseling services since
1971, although not sequentially. I have worked with individuals, couples,
families, and groups in areas such as depression, anxiety, grief, abuse,
career exploration, situational adjustments, life development, and crises.
Counseling presents you with the opportunity to invest in your personal,
emotional, cognitive, behavioral, and spiritual well-being and growth in
the context of a helping relationship. Your goals for seeking counseling,
which I will explore and update with you frequently, will give direction to
our work together and will influence the therapeutic approaches that I will
use. My style of counseling is based on person-centered, gestalt,
existential, family systems, and cognitive-behavioral theories. Although
some counseling changes may be easy and rapid, others are slow and
deliberate. These latter changes will require considerable proactive
commitment on your part. This commitment may involve work outside of
our sessions such as reading, reflecting, journaling, and working on
cognitive-behavioral assignments.

8. At the outset I will listen carefully to your story and take a history to
learn the specific initial therapy goals that emerge. I will work closely
with you to evaluate and fine-tune together these goals as the process
unfolds. At any session each of us may evaluate how the process is
unfolding and where we may need to make revisions. At the end of the
counseling process, you will be provided with an evaluation form to
reflect on our work together. Coming to know yourself in greater depth
and make changes can be inspiring as well as painful. You may
experience a myriad of thoughts and feelings during this process,
including but not limited to, frustration, sadness, anxiety, guilt, and
anger. I will typically make a diagnosis regarding your situation, which
will become a part of your record.
Professional Ethics
For our relationship to be respectful and effective, confidentiality is a
must. I will not discuss the content of our work outside of our sessions.
State law and the ethical principles of my professional organizations
(the American Counselling Association, the National Board for Certified
Counselors, and the North Carolina Board of Licensed Professional
Counselors) mandate confidentiality except under two circumstances:
(1) when I believe you intend to harm yourself or another person,
(2) when I believe a child or elderly person has been or will be abused or
neglected.

9. In rare circumstances, a court of law can mandate me to release
information on you. Otherwise, I will not disclose anything about your
history, diagnosis, or progress. I will not even acknowledge our
professional relationship without your full knowledge and a signed
Release of Information Form. Such a form must be signed to release
information to your insurance carrier as well.
Ethical and legal standards mandate that even though our relationship
might be intense and intimate in many ways, it must remain
professional rather than social. You will be served best in our sessions
and relationship concentrate exclusively on your concerns. Thus, I will
not attend social events, receive gifts, or relate to you in any way other
than in the professional context of our sessions.
Length of Sessions
My services will be rendered in a professional manner consistent with
the accepted clinical standards of the American Counseling
Association, National Board for Certified Counselors, and the North
Carolina Board of Licensed Professional Counselors. Sessions will last
fifty (50) minutes. We shall schedule sessions by mutual agreement.
Often persons prefer to maintain a standard appointment time. A
twenty-four (24)-hour notice is required for cancellation unless there is
a sickness or emergency.

10. Without these exceptions, payment for missed sessions is required.
Every effort will be made to start and stop sessions on time. Each of us
has the responsibility of being prompt.
Fees and Methods of Payment
The fee for initial intake sessions is $115.00 with each subsequent
session being $95.00. Sessions are payable by personal check or in
cash at the beginning of each appointment. Our office will provide you
with a super bill for your records or to submit to your insurance
carrier. Some insurance companies will pay for counseling services;
others will not. Please remember that you and not your insurance
company are responsible for paying in full the fees agreed upon.
Complaint Procedure
If you have difficulty with any aspect of our work, please inform me
immediately so that we can discuss how we might work better
together. This discussion is an important aspect of our continuous
evaluation of this process.
Should you feel treated unfairly or unethically by me or another
counselor, you may make a formal complaint to the following
licensure board and associations.

11. North Carolina Board of Licensed Professional Counselors
PO Box 2105
Raleigh, NC 27619-1005
919-661-0820
National Board for Certified Counselors
3 Terrace Way
Greensboro, NC 27403
336-547-0607
American Counseling Association
5999 Stevenson Avenue
Alexandria, VA 22304
1-800-347-6647
Please sign and date both copies of this form. A copy for your records will be
returned to you. I shall keep a copy in my confidential records.
Signature of Client/Parent/Guardian Date
Signature of Counselor Date

12. THERAPEUTIC ENVIRONMENT
 According to the American Psychological Association's Dictionary
of Psychology, Therapeutic Environment is an environment of
acceptance, empathic understanding, and unconditional positive
regard in which clients feel free to verbalize and consider their
thoughts, behaviors, and emotions and make constructive changes
in their attitudes and reactions.
 The concept of Therapeutic Environment stems from the fields of
a) environmental psychology (the psycho-social effects of
environment),
b) psychoneuroimmunology (the effects of environment on the
immune system), and
c) neuroscience .
 A good therapeutic environment has a profound effect on feelings,
behaviours and general health of clients.

13.  Hence Counsellor should know how to create a therapeutic
environment that will facilitate psychological adjustment and
independence of the client.
 In order for the counselling to be effective, the process through which
counseling takes place needs to be effective and fulfill certain
conditions to create a proper therapeutic environment so that the
counselling goals can be reached.
 The ultimate aim of the counselling is the well-being of the client.
 It is very important to create a therapeutic environment in the
counseling situation which will help create trust and confidence in the
client, and encourage him/ her to explore things from different
perspectives.
 There are certain basic or core conditions which are important for
creating the therapeutic environment in which counseling will take
place.
 In absence of this therapeutic environment, counseling will not be
effective.

14.  These core conditions are trust, acceptance, genuineness,
unconditional positive regard and empathy.
i) Trust: The counselor aims at creating a trusting and safe
environment for the client so that the latter feels assured enough to
share his/ her thoughts and feelings with the counselor. The client is
in a state of anxiety and disturbed feelings, with a lack of confidence
and trust. The foremost requirement in a counseling relationship is
to build up trust in the client for the counselor and the counseling
situation. This should be established in the first session itself. As
clients perceive the counselor as trustworthy, they will take greater
emotional risks of expressing their inner anxieties, worries, and
fears.
ii) Acceptance: The client has come to the counseling situation
feeling rejected, devalued and abandoned of his/ her perceptions,
feelings and values. Counselor conveys to the client a sense of
acceptance irrespective of the client’s views, behaviours and actions.
The client is accepted as he/ she is, without any judgement or
criticism. This conveys respect for the client as an individual. Trust
and acceptance are the starting points in any counseling relationship.

15. iii) Unconditional positive regard: The counselor has positive
regard or respect for the client which should not be base on any
condition. The client is accepted and respected for what he/ she is.
There are no conditions put on the relationship. The counselor
accepts the client in total. Unconditional positive regard
communicates caring, worth and dignity to the client. It is an
attitude of valuing the client as a unique and worthwhile person.
Being respected for without any conditions or judgements attached
frees the individual and opens up possibilities of change within the
individual.
iv) Genuineness: It refers to being genuine or real about who we
are. The counselor comes across to the client as being a person who
is genuinely interested in the client’s welfare. He/ she does not put
up a mask. This is crucial to create trust in the relationship. The
counselor also needs to be congruent with his/ her feelings;
expressing his/ her feelings and attitudes at the moment. There is
consistency in the counselor’s words, actions and feelings. Such
transparency also encourages the client to get in touch with his/ her
own real feelings.

16. v) Empathy: The counselor is able to show empathy towards the
client by experiencing the client’s world as he/she experiences it. It
communicates a real understanding of the client’s situation, thus
fostering trust in the client.
The above are the key elements of a counseling relationship
which leads to an effective counseling environment.
According to Rogers (1957), unconditional positive regard,
genuineness, congruence and empathy are the necessary and
sufficient conditions for all good interpersonal relations and for all
therapeutic change.
These are also the basic skills for effective counseling.