1. The document discusses various procedures and skills involved in the counseling process. It defines counseling, outlines the typical counseling process structure, and describes important skills at each stage like rapport building, assessment, goal-setting, interventions, and termination. 2. Key counseling skills discussed include active listening, asking open and closed questions, using encouragers, paraphrasing, reflecting feelings, and summarizing. The document also covers methods for influencing behavior like directives, reframing, advice, feedback, and logical consequences. 3. The full counseling process involves assessment, conceptualization of problems, mutually defining goals, selecting interventions, and termination when goals are achieved. Building rapport, understanding the client's perspective,

1. Counselling
Procedure/Skills
Hitha.P.S
II MSc Clinical Psychology

2. Counselling - Definition
• An interactive process characterized by a
unique relationship between the counselor and
client that leads to change in one or more of
the following areas:
 Behavior
 Beliefs or emotional concerns relating to
perceptions
 Level of emotional distress

3. Counseling Process Structure
1. Rapport and Relationship
Building
2. Assessment / Problem Definition
3. Goal-setting
4. Initiating Interventions
5. Termination

4. Rapport and Relationship
• Psychological climate resulting from the
interpersonal contact of client and counselor.
• Living and evolving condition.
• Relationship includes respect, trust, and relative
psychological comfort.
Impacted by
• Counselor’s personal and professional
qualifications.
• Client’s-interpersonal history,
– anxiety state,
– interrelation skills, and
– previous ability to share,

5. Clinical Assessment
Involves specific skills
• Observation
• Inquiry
• Associating facts
• Recording information
• Forming hypotheses (clinical “hunches”)

6. Observation
1. Take notice of the client’s general state of
anxiety.
2. Establish sense of client’s cultural context.
3. Note gestures / movements that denote
emotional / physical dysfunctions.
4. Hear how the client frames his / her
problems.
5. Note verbal and non-verbal patterns.

7. Formal Diagnostic Assessment
Interview format:
• Focus
• Basic Screening Questions
• Detailed Inquiry

8. Focus
Presenting problem and context
Basic Questions
• What concerns brought you
here?
• Why now?
• Has this happened before?
• How is it impacting your daily
life?
Detailed Inquiry
• Clarify stressors
• Elicit
– coping skills,
– social support,
– and resources
• Clarify life function
– work
– family
– health
– intimacy

9. Focus
Mental status
Basic Questions
• How do you feel now?
• How is your mood affected?
• Had any unusual experiences?
• How is your memory?
• Do you think that life isn’t worth
living?
Detailed Inquiry
• Note
– age & mannerisms
– dress & grooming
– orientation
• Probe
– anxiety symptoms
– form, content, thought.
– suicidal ideation
– violent impulses

10. Focus
Developmental history and dynamics
Basic Questions
• How would you describe
yourself as a person?
• Shift to the past, how
were things when you
were growing up?
Detailed Inquiry
• Clarify
– current self-view
– level of self-esteem
– personality style
• Note
– developmental milestones
– experience in school
– best friends
– educational level

11. Focus
Social history and cultural dynamics
Basic Questions
• What is your current living
situation?
• What is your ethnic
background?
• Detailed Inquiry
• Elicit
– job or military
– legal problems
– social support system
– race, age, gender
– sexual orientation
– religion
– language
– dietary influences
– education

12. Focus
Health history and behaviors
Basic Questions
• Tell me about your
health?
• Health habits?
Detailed Inquiry
• Identify
– prescriptions
– substance usage
– health status
– health habits

13. Focus
Client resources
Basic Questions
• How have you tried to make
things better? Results?
• How do you explain your
symptoms?
• What is your / my role in
your treatment?
• When will things change /
get better?
Detailed Inquiry
• Probe
– Efforts to change
– Efforts vs. successes
• Clarify client explanatory
model
• Identify treatment
expectations
• Specify readiness for
change

14. Focus
Wind down and close
Basic Questions
• What else would be
important for me to
know?
• Do you have any
questions for me?
Detailed Inquiry
• Use an open-ended
query
– Allows the client to add
information.
– Creates sense of
reciprocal and
collaborative
relationship.

15. Conceptualizing Problems
• Recognize a client need.
• Understand that need.
• Meet that need.
1. Beliefs may
• Contribute to the problem.
• Impede the solution.
• Become the problem.
2. Feelings / responses often
• Exaggerate the problem.
• Impede comprehension of the problem.
• Become the problem.

16. 3. Behavior / responses may
• Be inappropriate.
• Contribute to the problem.
• Complicate the problem.
4. Interaction patterns include
• Miscommunication channels,
• Expectations,
• Self-fulfilling prophesies.
• Coping styles.
5. Contextual factors
• Time
• Place
• Cultural and socio-political issues.

17. Goal Setting
1. Indicates how well counseling is working.
2. Indicates when counseling should be concluded.
3. Prevents dependent relationships.
4. Determines the selection of interventions.
5. Mutually defined by the client and counselor.
• Counselor
 Greater objectivity
 Training in
Normal and
Abnormal behavior
 Process experience
• Client
 Experience with the
problem
 History of the problem
 Potential insights
 Awareness of personal
investment in change

18. • Process goals
 Related to establishing
therapeutic conditions
for client change.
 Includes:
Establishing
rapport,
Providing a non-
threatening setting,
and
Possessing and
communicating
accurate empathy
and unconditional
regard.
• Outcome goals
 Are different for each
client and directly
related to clients’
changes.
 Always subject to
modification and
refinement.
 To begin, formulate
tentative outcome
goals.
 Modify goals as
needed to support
effective change.

19. Interventions
• Objective -- initiate and facilitate client change.
• After assessment and goals setting, answers
the question, “How shall we accomplish these
goal?”
• Must be related to the problem.
• Selecting an intervention may become an
adaptive process.
• Skills to initiate include
1.Competency with the intervention;
2.Knowledge of appropriate uses;
3.Knowledge of typical client responses;
4.Observation skills to note client responses.

20. Termination
• No clear cut ending, but no need to continue
beyond usefulness.
• Awareness by the counselor and the client that
the work is accomplished.
• May take the same number of sessions as
rapport building.
Types of Termination
1. Suggested termination, with client agreement
2. Imposed termination
• Continuing is against client best interest
• Client is deteriorating, not progressing
• Incompatibility with the therapist
• Client using therapy in place of life

21. 3. Situational termination
• Client moves
• Employment changes
4. Early termination, clients just don’t return.
Methods
• Gradual tapering off of sessions.
• Therapeutic vacations, taking a break
without breaking the connection.
• Direct (imposed) termination.

22. Basic skills of Counselling
• Listening is not passive. It is important to
indicate that the person is being heard
• Good counselling skills means listening
before acting to solve problems
• Verbal listening skills
 Show interest
 Gather information
 Encourage speaker to develop ideas
 Communicate our understanding of ideas
 Request clarification of understanding
 Build the therapeutic alliance

23. Listening Skills
• Using good verbal listening skills, you
increase the chances that:
 You will understand what the other is
saying and they will understand you
 You will create a situation where you will
be able to develop a helping relationship

24. Non verbal attending and observation
1. Take notice of the client’s general state of
anxiety.
2. Establish sense of client’s cultural context.
3. Note gestures , movements that denote
emotional / physical dysfunctions. Non verbal
behavior include eye contacts, head nods,
facial discrimination, body posture and physical
distance between counselor and client
4. Hear how the client frames his / her problems.
5. Note verbal and non-verbal patterns.

25. A Good Listener
• Maintains eye contact
• Makes few distracting movements
• Leans forward, faces speaker
• Has an open posture
• Allows few interruptions
• Signals interest with encouragers and facial
expressions

26. Bad listening
• Makes little eye contact
• Makes distracting movements
• Faces away from speaker
• Has a closed posture (eg:arms crossed)
• Interrupts speaker
• Does too many other things while
listening
• Has a flat affect, speaks in a monotone,
gives few signals of interest

27. Looking Like Your Listening is
Not Enough

28. Responding
• Ask open and closed
questions
• Use “encouragers”
• Paraphrase what you
have heard
• Reflect on feeling
• Summarize

29. Asking questions
Open Questions
• Open questions
 Generally start with “what”, “how”, “why” or
“could “
• Questions serve to:
 Gather lots of general information
 Encourage discussion
Eg:
• Nurse: “How has the baby been eating?”
• Nurse: “What is the bedtime routine?”
• Nurse: “Could you tell me about giving the baby
medicine in the morning?”

30. Closed Questions
• Generally start with “is”, “are”, or “do”
• Serve to:
 Gather lots of specific information quickly
 Tend to close down discussion
Eg:
• Nurse: “Are you giving the medicine every day?”
• Nurse: “Is the baby able to tolerate the medicine
in the morning?”

31. Encouragers
• There is a category of responses that fall
between non verbal attending and actual
responses ,termed by Ivey & Ivey(1999) as
minimal encouragers.
• Eg: “Yes, I understand” or repeat a word or two
of what was said, “uh-huh”, “hmn
hmn””and…?”and “then..?”
• Serves to:
 Encourage further discussion

32. Reflection of Feelings
• Focus on feelings (stated and unstated)
• Serves to:
 Communicate understanding of emotions
 When combined with a paraphrase, confirms
the accuracy of understanding (“Check out”
the the other person)
 Encourages discussion of feelings

33. Paraphrasing
• Briefly summarize the content of the discussion
• Reflective listening
 Check your understanding
 Show that you heard what was said
• Acknowledge and accept feelings without judging
Eg:
• Patient: “I am worried that the medicine is
making my baby sick”
• Nurse: “It sounds like you are worried about how
the baby is reacting to the medicine.”

34. Summarizations
• Finally pull together ideas from the interview
• Serves to
 Organize the structure of the interview
 Check the accuracy of understanding

35. Influencing or Changing Behavior

36. Influencing or Changing Behavior
• Directives
• Reframes and interpretations
• Advice
• Feedback
• Logical consequences

37. Directives
• Requests to clients to perform some actions.
• Counselors might give home assignments to keep
track of times when clients felt on the verge of
losing control or to note what conditions seemed to
lead to a greater sense of productivity at work.
• Works best if clear and concrete
• Serves to:
 Move a person to take a specific act

38. Reframing and Interpretations
• Attempts to replace an old, maladaptive
response with a newer, more useful
(usually positive) one
• Serves to
 Increase insight and understanding
 Shift emotional or intellectual response

39. Advice
• Provides information to help client make a
decision. Can be very directive or less so
• Serves to:
 Share information that would be relevant
for a person’s decisions, actions, or
understanding
• Disadvantages of advice
 It’s often disempowering (You can’t solve
this on your own)
 People may say (but not really mean) that
they want advice

40. Feedback
• Gives information about how the person is
experienced by others
• Serves to:
 Help client see self more objectively (as
others see him or her)
• Feedback works best when
 It is requested or desired
 It is concrete
 It is positive
 If negative, it addresses something
changeable or controllable

41. Logical Consequences
• Focuses on the logical consequences of a
person’s behavior, actions, thoughts, or
feelings
• Serves to:
 Increase awareness of consequences

42. thank youuu..