Counselling involves building an empathic relationship to explore emotions, behaviors, and thinking with the goal of facilitating healthy changes. The counselling process includes relationship building, assessment of the client's situation, setting goals for the work, providing interventions, and terminating or making referrals when appropriate. Key factors in effective counselling include the therapeutic relationship, client strengths and resources, and the client's hope that change is possible.

1. 1
Counselling: A Process View
Priya Senroy, MA, DMT, CCC
Anubhav

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.

4. 4
Counselling Functions
• Remedial
– Functional Impairment
• Preventive
– Anticipate and Accommodate
• Enhancement
– Human Potential

5. 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

6. 6
Characteristics Of Effective Counsellors
• Self-awareness and understanding
• Good psychological health
• Sensitivity
• Open-mindedness
• Objectivity
• Competence
• Trustworthiness
• Interpersonal communication

7. 7
Components Of The Counselling Process
• Relationship Building
• Assessment
• Goal Setting
• Intervention
• Termination, referral and Follow-Up

8. 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

9. 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.

10. 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.

11. Relationship Building

12. 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

13. 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."

14. 14
Assessment

15. 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.

16. 16
Assessment Tools
• Intake forms
• Intake interview
– Clinician questions
• Formal instruments ( not used by this service)
– ASAM PPC
– DSM IV
– DrInc
– SASSI
– SOCRATES
– ………..

17. 17
Goal-Setting

18. 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

19. 19
Interventions

20. 20
Method Of Counselling Interventions
• Client directed and collaborated
• Strength based
• Short term( 3 months or maximum 12
sessions)
• Solution focused

21. 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:

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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.

23. 23
Termination, Referrals and
Follow-Up

24. 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

25. 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

26. 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 Changewww.talkingcure.com © 2002, Scott D. Miller, Barry L. Duncan, & Lynn Johnson

27. 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 www.talkingcure.com
© 2000, Scott D. Miller and Barry L. Duncan

28. 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:

29. 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.

30. 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”.

31. 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.

32. 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.

33. • 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.

34. • 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.

35. • 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.

36. • 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.

37. • 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.

38. 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.