Module 5 counselling to suit the client learning resource 1.5.13

Counselling to Suit
the Client
CHC51712 Diploma of Counselling
Module 5

© Copyright CTA CHC51712 MODULE 5 Learning Resource Version Date: 1.05.13 P a g e | 2
Contents
Overview...................................................................................................................... 3
Unit Descriptions ....................................................................................................... 3
Learning Outcomes (Essential Skills)............................................................................ 3
Content Areas (Essential Knowledge) .......................................................................... 4
Module Duration and Workload................................................................................... 5
Required underpinning knowledge for this module........................................................... 6
1. Cognitive behaviour therapy ...............................................................................25
2. Person-centred therapy......................................................................................29
3. Behaviour therapy .............................................................................................30
4. Expressive therapies ..........................................................................................31
5. Family therapy ..................................................................................................32
6. Gestalt therapy..................................................................................................33
7. Narrative therapies ............................................................................................34
8. Solution focused therapy....................................................................................35
9. Transactional analysis ........................................................................................38
Steps in determining suitability of client for counselling services.......................................46
1. Obtain information about client's developmental and mental health status.................46
2. Clarify client suitability for service to be provided.....................................................47
3. Check for and respond appropriately to risk ............................................................48
Steps in applying counselling therapies to address a range of client issues........................50
1. Use techniques from a range of counselling therapies ..............................................50
2. Confirm suitability of counselling techniques in specific situations..............................52
3. Apply counselling techniques to address specific client issues and/or needs ...............53
READINGS & RESEARCH...............................................................................................55

MODULE 5 Counselling to suit the client
The two units of competency in this Module are:
CHCCSL512A: Determine suitability of client for counselling services and
CHCCSL506A: Apply counselling therapies to address a range of client issues
Overview
Unit Descriptions
CHCCSL512A — This unit describes a detailed knowledge of indicators of client’s mental
health status required to clarify client’s suitability for counselling services or need for referral
in the context of community services work.
CHCCSL506A — This unit describes the knowledge and skills relating to using a range of
counselling therapies to assist clients in dealing with a variety of life issues.
Learning Outcomes (Essential Skills)
At the end of this module of study you will be able to:
1. Observe and question clients appropriately in order to obtain information relating to
developmental status and actual or potential issues related to community services to
be delivered
2. Identify variations from normal developmental or mental health status using
standard methods and protocols and recognise and refer potentially serious issues in
line with organisation requirements
3. Identify potential factors responsible for significant variations from normal
developmental status and determine an appropriate response in terms of:
 appropriate referral and reporting in line with organisation requirements
 provision of appropriate services
4. Refer to or seek assistance from an appropriate person or authority in relation to
variations from normal functioning
5. Articulate scope of practice and boundaries in relation to response to client status
6. Comply with mandatory reporting requirements where appropriate
7. Apply high level counselling skills in a range of counselling situations using at least
five counselling therapies

8. Demonstrate the application of counselling techniques and processes from five
counselling therapies relevant to own work role
9. Analyse client information to clarify a range of client needs and issues
10. Identify suitability of a range of counselling techniques in identified situations to
address a range of client needs and issues
11. Use counselling techniques appropriately and effectively when assisting clients to
deal with a range of issues
12. Identify indicators of client issues requiring referral and make appropriate referral
13. Maintain confidentiality of client information
14. Demonstrate ongoing reflection on and development of capability to meet
professional standards. In particular, assessment must confirm the ability to:
 elicit, analyse and interpret feedback
 reflect on feedback and integrate learning to improve practice
 effectively use supervision and peer support to maintain self-awareness and
practice skills
15. Work with an awareness and sensitivity to conflict, culture and context
16. Analyse culturally different viewpoints and take them into account in personal
development and professional practice
17. Relate to people from a range of social, cultural and ethnic backgrounds and physical
and mental abilities
18. Maintain appropriate documentation in a counselling role
Content Areas (Essential Knowledge)
The following areas are the essential knowledge required for this module. These are
discussed in more detail in the following section.
 Detailed knowledge of aspects of development of the human being throughout the
lifespan, including:
o physical
o psychological
o cognitive
o social
o affective
 Behaviours and reported emotions that may indicate presence of a mental health
issue, including:
o suicidal ideation

o hallucinations or delusions
o excessive fears or suspiciousness (paranoia)
o confused thinking
o indicators or self-harm
 Knowledge of key factors that may impact on the individual at identified stages of
human development and their potential effects
 Understanding of legal obligations, particularly in relation to child protection and
elder abuse issues
 Appropriate range of referral sources and associated protocols
 Legislative requirements and provisions relevant to area of service delivery and
delegated responsibility
 Awareness of own values and attitudes and their potential impact on clients
 Indicators of significant issues including:
o child abuse (including different types of child abuse)
o child trafficking
o abuse, neglect or harm including self-harm
o domestic and family violence
o elder abuse
 Child protection policy of service
 State/territory requirements about responding to indications of abuse and reporting
process
 Relevant organisation standards, policies and procedures
 Historical development, terminology and underpinning concepts and principles
relating to a range of counselling therapies in common use and processes used in
their application
 Applications, benefits and limitations of at least five common counselling therapies
 Roles of counsellor and client in relation to a range of counselling therapies and
techniques
 Indicators of client issues requiring referral
 Legal and ethical issues relating to working as a counsellor
 Government legislation, regulations, policies and standards
Module Duration and Workload
This module is 4 months in duration. Learning and assessment should be completed within
this time frame.

Required underpinning knowledge for this module
The following points cover the required knowledge set out in the competencies for this
module.
Detailed knowledge of aspects of development of the human being
throughout the lifespan and knowledge of key factors that may
impact on the individual at identified stages of human development
and their potential effects
Stages of development may relate to:
 Stages of physical development
 Stages of psychosocial development
 Stages of cognitive development
 Psychosexual stages
 Stages of moral development
 Stages of ego development
These stages have been described by a number of authors, notably:
Psychosocial development – Erikson
Cognitive development – Piaget
Psychosexual stages – Freud
Stages of moral development – Kohlberg
Stages of ego development - Loevinger
This module is titled ‘Counselling to suit the client’. Our clients are all unique. As mentioned
in a previous module there are over 7 billion people on planet earth and each one is
different. These individuals have personality and physical features that differentiate them
but in addition each is at a particular stage of development as well. We are not of course
static in who we are throughout our lifespan. So if you thought that working with people
was complex because there are just so many different individuals, add to this the complexity
of human development across their lifespans!
Fortunately each of us has particular patterns that we follow in our development which are
common for all human beings. Even though this varies for each of us to some extent, these
patterns of development help us to know how to support our clients at their particular stage
of life in counselling.
It is important therefore for us to review some of these developmental stages and the key
features of these stages.
The changes that occur for us are along a number of different facets. These include:
 physical
 psychological

 affective
 cognitive
 social
Let’s look at each of them in turn.
Physical
The physical changes over our lifespan are quite remarkable.
 Womb development: During our first nine months in the womb we grow from a
single fertilised ‘egg’ cell to a fully functioning baby with 5 senses and thinking,
emotions and so forth. Most of us who have had children have marvelled at the
growth of babies in the womb. The excitement of birth provides for us a moment in
time when we consider the miracle of life. Probably the most important information is
that a great deal of our humanity is established very early and for most of the
duration of formation in the womb we are putting on weight. By 6 weeks after
fertilisation the foetus has arm and leg buds, eye spots and a heart starting to form.
Most women are just coming to the conclusion that they are pregnant at this stage.
By 10 weeks a baby has eyes, brain, fingers, legs etc.
 Infancy: From birth to 2 years of age, the human body quadruples in weight and
grows approximately 14 inches in length, reaching half the height of an adult. The
five senses including sight, hearing, touch, taste and smell as well as language skills,
and muscle control all develop rapidly during this time.
 Early Childhood: From age 2 to 6, the human body grows taller and slimmer, and
becomes more proportionate. (If babies simply grew in the same proportion to
adulthood, they would look possibly a lot cuter but not be able to do as many
things!) Large muscles become stronger, and skills are learned primarily through
play.
 School age: From the age of 7 to 11, our physical growth slows down. The body
develops increased control over fine muscle movements. In a sense this is when our
mind starts to grow in terms of curiosity and building a map of our world.
 Puberty: Around the age 10 until 19, human beings move through a significant
physical change. This period of development is characterised by emotional and
cognitive shifts and the physical maturation of the reproductive system.
 Early adulthood: From age 20 to 35, the human body is in peak physical health and
strength. The challenges of making an income, finding partners, establishing
housing, creating and nurturing new life, require peak human health and strength.
 Adulthood: Ages 35 to 65 span middle adulthood. This developmental period involves
physical changes such as wrinkles, menopause and a gradual dulling of the senses,
including eyesight and hearing.
 Late adulthood: From 65 onward, the body continues to change with dryer, thinner
skin, thinner hair, and bone and muscle loss. Late adulthood is also characterised by
a slowing of brain function, more physical signs of aging (deeper wrinkles), further
decline in visual functions, chronic disorders (such as arthritis) and a further decline

in hearing. These symptoms are prevalent in both sexes, however women generally
have a life expectancy of six years longer than their male counterparts.
Psychological/Social
Probably the most pertinent information in terms of developmental changes for counsellors
is the psychological changes that occur for human beings. In our Module 4 we looked at a
number of theorists including Erik Erikson. Erikson developed a theory of psycho-social
stages roughly in line with Freud’s psycho-sexual stages. Erikson’s views however have been
more widely upheld and are still seen as incredibly valid when thinking about the
psychological development of human beings. The following eight stages are listed below:
1. Hope: Trust vs. Mistrust (Oral-sensory. Birth- 2 years)
In this stage the infant dependent particularly on his/her mother will develop or not develop
trust. Erikson links this to the capacity for hope that we experience as human beings. If your
client has little hope for themselves or their lives it may be that in their first two years of life
that they were not able to develop trust in their caregiver or themselves. Neglect, disruption
to connection to main caregivers or harsh treatment may contribute to this lack of hope and
trust in other people as well.
2. Will: Autonomy vs. Shame & Doubt (Muscular-Anal. 2-4 years)
In our very early development we are learning to do a few things for ourselves like play,
explore and feed ourselves. In our attempts to do this we can be encouraged or
discouraged. We are learning that we are a separate entity from our parents and caregivers.
We are developing will. This is often quite a hard stage for parents to manage as the young
child will play with the notion of resistance including saying ‘no’ a lot and running away
instead of coming when called and other equally frustrating behaviour. If parents are not
ready for this change in their offspring they may react with strong counter-resistance,
thereby stunting confidence in this essential stage of life. Parents who won’t let little
children try and fail themselves and who ‘take over’ at this stage (or those who have a
temper tantrum larger than the child’s) may hinder the child’s capacity for autonomy and
unknowingly instil shame and doubt. If however this challenging stage is met with
encouragement and containment so that the young child is not harmed through their
experimentation with exploration of the world then the child should learn autonomy. They
will learn, ‘I can do some things quite well myself!’ This is obviously a very important lesson
to learn. Adults who have not developed this capacity may well believe themselves to be
incompetent and not try new things. They may also see themselves as victims.
3. Purpose: Initiative vs. Guilt (Locomotor-Genital. Preschool. 4-5 years)
This next stage builds on the one before with more confidence for the young child in
initiating play and social relationships. Children start to play cooperatively, not just alongside
each other. This essential learning to interact cooperatively and socially (often learned with
siblings as well as at preschool) lets that young child understand that they can make friends
and initiate experiences that provide good feedback. If they are resisted or put down they
tend to use cognition to determine the reasons for this. It may well include ‘I have done

something wrong’ to ask to play right now. If mummy and daddy are always busy and
annoyed when the child initiates social interaction with them, then the child can feel guilt
and lose the capacity to initiate social relationships and become passive recipients of others’
interest.
4. Competence: Industry vs. Inferiority (Latency. 5-12 years)
In this stage children are learning to master primary schooling and developmental hurdles
such as copying adult tasks including tying shoes, dressing, making sandwiches, washing
up, helping around the home with chores as well as academic learning and sporting
activities. Will they feel that they are competent and hard working? Will they learn that hard
work has a payoff with reward? If there are no role models or children are forced to do all
things without support then hard work and consistency may not be something that the child
learns. Instead they may feel inferior in their capacity to do things and as a result not try.
They may also feel overwhelmed by responsibility. As adults they may require that their own
children do for them what they themselves feel incompetent to do. This can of course
impact full circle.
5. Fidelity: Identity vs. Role Confusion (Adolescence. 13-19 years)
In adolescence young people are learning more about who they are. They need support and
positive feedback about the changes in their body and in all aspects of their development.
Youth without this can feel confused about who they are. If young people are not validated
in their uniqueness but dominated by adults or systems so that they cannot flourish in their
unique identity, they may try extremely hard to enter a social group where all aspects of
identity are already established. For example ‘emo’ culture has dress codes, behaviour
codes, and music preference codes etc. Young people who have not found that who they
are is ‘sufficient’ and ‘good enough’ and ‘acceptable’ can find themselves only able to feel a
sense of fidelity (authenticity) by identifying with a group and group standard. This can of
course be quite dangerous if the group has adopted risky behaviours.
6. Love: Intimacy vs. Isolation (Young adulthood. 20-40 years)
Love appears to be the strongest drive in human beings judging by the proportion of song
lyrics dedicated to the topic! Biology and psychological needs drive us to find intimacy. If we
fail at this or are failed in this by others we can feel isolated and worse than this we can
believe we are meant to be ‘alone’. Intimacy allows us to partner safely and provides a place
of safety for our children. Happiness in adulthood is strongly linked to the capacity to be
intimate with at least one other human being. People who find themselves isolated may well
connect to animals, workplaces, job roles or even inanimate objects in order to find a way of
connecting.
7. Care: Generativity vs. Stagnation (Middle adulthood 40-64 years)
Our sense of wellbeing and care comes from the ability to generate new ideas, interests,
friends and experiences. If we are not able to move into new growth during middle
adulthood we can stagnate, feel trapped and depressed in our lives. While the challenges of
adapting to new situations can sometimes be overwhelming, its importance for this age

© Copyright CTA CHC51712 MODULE 5 Learning Resource Version Date: 1.05.13 P a g e | 1 0
group cannot be underestimated. Assisting middle adults to master new challenges through
creative strategies is part of the role of the counsellor for this age group.
8. Wisdom: Ego Integrity vs. Despair (Late adulthood 65-death)
Old age is a time to review life and consider the things that have been accomplished. It is a
time of contribution as well and it is important that those over 65 or retired still feel like they
are contributing and have contributed in their life to others in order to have a sense of
integrity. We want to ensure we are able to pass on the wisdom we have accumulated and
to know that it has a place. Without this we may despair. Assisting elderly people to
contribute and find ways to do this will provide a sense of peace and ensure that life has not
been lived without meaning.
Ego Development
Jane Loevinger developed a theory of ego development based on Erikson’s psychosocial
model and integrated the ideas of Harry Stack Sullivan where ‘the ego’ was theorised to
mature and evolve through stages across the lifespan as a result of a dynamic interaction
between the inner self and the outer environment. She saw personality as a whole.
Pre-social stage (E1)
Babies cannot differentiate themselves from the world and focus on gratifying immediate
needs. Their ego is therefore in Loevinger’s view ‘delusional’.
Impulsive stage (E2)
In the next stage of ego development a small child asserts his/her growing sense of ‘self’
and sees the world as relating to him/her and how it affects them. The small child is focused
on the moment and if someone or thing meets their needs they are ‘good’ and when they
don’t they are ‘bad’.
Self-Protective stage (E3)
This stage is characterised by the start of self control of impulses. This also incorporates
‘blame’ which is usually attributed to other people or circumstances. Morality is a matter of
anticipating rewards and punishments. Children at this stage crave unchanging order of
rightness and wrongness.
Conformist stage (E4)
The next stage occurs around school age where children start to see themselves and others
as conforming to socially approved norms. Rightness and wrongness apply to everyone at
the same time in the same way. Behaviour is not judged by intentions. Children may begin
to reject ‘outsiders’.
Self-aware stage (E5)
The next stage is self-awareness and is a transitional stage towards adulthood. The capacity
to imagine multiple possibilities in situations is now occurring. Conforming however is still
quite strong.

Conscientious stage (E6)
This is seen as the adult stage where internalisation of rules is completed and exceptions
and contingencies are recognised. Goals and ideals are acknowledged and a sense of
responsibility and guilt at hurting others is understood rather than life being about breaking
conventions or rules. Choices are very much part of the thinking of the adult at the
conscientious stage.
Individualistic stage (E7)
Loevinger feels that adults who move beyond the conscientious stage must become more
tolerant of themselves and others. They must be able to understand and accept the human
dilemma of lack of perfection but do so in growth. Individualistic egos are broadminded and
respect people’s needs for autonomy and choice.
Autonomous stage (E8)
The next stage is where people are free from the oppressive demands of the conscience and
are able to synthesise ideas. This person can understand that interdependence is inevitable.
There is a high toleration for ambiguity and conceptual complexity and an ability to embrace
complexity.
Integrated stage (E9)
At this stage people can understand that inner conflicts are unavoidable and to make peace
with them. It is also where a fully worked out identity is achieved and being reconciled to a
destiny. People are empathetic towards themselves and others.
Affective
Development of emotion or ‘affect’ is an interesting study. It is tied to development of
thought. As we have mature explanations for events and situations our emotions are not so
raw. The overwhelming emotions of a child who bursts into tears, has temper tantrums and
anger outbursts need to be tempered as adulthood approaches. Adolescence is a time of
significant turbulence of emotions due to hormonal changes. The ‘child’ and ‘adult’ are
fighting for dominance in physiology and thinking and emotion moves on these waves of
change.
Where we see ‘childlike’ emotional responses in adults we may be sure that as a child this
person experienced some trauma or lack of support or discipline in their family of origin
which stunted their emotional growth. Other disturbances including developmental disorders
like ADD and Autism also contribute to disturbance of emotional development and make it
much harder to cope with emotions.
In adulthood people may be emotionally damaged through traumatic events or too much
stress to their nervous systems resulting in disorders of thought and emotion.
Emotional maturity in adults is a sought-after capacity — that is being able to consider other
people’s feelings and thinking and being able to experience compassion and think logically.
Adults who mature emotionally are able to achieve and contribute and ultimately experience

greater personal satisfaction in life. For counsellors, helping the ‘little child’ within an adult to
heal is a great gift. Helping that ‘hurt’ part of us to grow, heal and develop will bring
harmony and capacity for an enhanced human experience. The work of counselling is a
great privilege.
Cognitive
The development of cognition has possibly been best mapped by educational theorist Jean
Piaget. Piaget studied the way children develop thinking. This observation is particularly
helpful for us in counselling.
The first stage he called Sensori-motor and saw that the way young children from 0-2
understand their world is from movement and touch. It is important for children to be able
to use their bodies and move and touch things in order to learn. He felt that small children
in the first year of life failed to understand that when an object is taken away it is still there.
When mum or dad moves out of sight they may well fear that they are really alone. While
counsellors rarely ‘counsel’ babies, we are called upon to help young parents to support little
children. Encouraging parents to allow their children to move freely and to provide a rich
sensory environment is critical to cognitive development.
The second period of thinking he called ‘Pre-Operations’ and was observed as a stage of
development from 2-7 years of age. Piaget noticed that children of this age are ego-centric
and are only able to see things from their own point of view. Bad things happening around
or to a child from 2-7 may be interpreted as ‘something bad that I have done’. Parents
breaking up may be thought of as ‘I was a bad boy/girl and they left’. While this ego-centric
thinking may not be able to be corrected at this stage it will be important later on to ask
questions to understand the attribution that the child has given to negative events around
them. It is important to explain at this stage in simple language the meaning of events to
reassure them that bad things are not their fault.
For example: ‘Mum and dad have been angry with each other and we decided to spend
time apart so that we are happy and have more happy times with you kids.
We love you and it is not your fault. Sometimes grown-ups do fight and
get cranky, but we have to stop fighting as it doesn’t make anyone happy.
That’s a good idea isn’t it, because we all need to be happy’.
Death is also something that should be explained to a small child in simple language rather
than not talked aboutt. If a sibling dies for example the language and explanation that we
use is critical. There will be a couple of concerns for children in understanding grieving and
death. This includes a sense of place — where is that person now? Also a sense of safety is
important — is the child or person safe now? Why did this bad thing happen? Is this my
fault? Will we get better? By locating a place for the deceased person this provides a sense
of connection — adults benefit from this as well. By providing safety in concept for the
person who has died provides reassurance about death for the child that if they were to die
they would be safe too. Clearly stating that this is not anyone’s fault is important as well.

Explaining that grief is something that we feel but we can recover from is important
learning.
For example: ‘We are all really sad because Jeremy died. We miss him, that’s why we
cry sometimes. Jeremy got so sick that the doctors couldn’t get him better
even though they tried very hard. They were very kind to Jeremy.
Grandma is looking after him now and he is safe with her in heaven. That’s
good news isn’t it. One day when we are very old we will get to see him
again but right now we have some pictures. You have been a very good
brother. Mum and dad are sad right now but we will be happy again in a
while. We have a lovely family, one of our children is with us and one of
our children is in heaven with grandma. We’ll get used to this although
right now we do feel sad because we can’t see Jeremy now or play with
him.’
Small children will want to go over the story many times to get it fixed in their mind. It is
important also to allow smaller children to draw their representations of such events so that
they can get a sense of order. A child at this stage who has experienced death at close hand
may well worry if they get sick that they might die too. Reassuring them that they are
strong and it’s not the same kind of sickness if they get sick, and also that the deceased
person is safe now provides comfort and security. While these explanations may seem
common sense it is amazing how many times small children are no given explanations and
are left to their own devices. They may pick up snippets of information and come up with
some very wrong conclusions.
Piaget then observed 7-11 year olds and described this stage of thought capacity as
‘Concrete Operations’. Children are able to think more logically but they need the object in
order to think. In continuing our story we may be able to ask an older child where they feel
someone is when they have died, or why they think mum and dad have split up. A child of
this age will be able to explain logically what they think about the situation, they will be able
to describe feelings. In asking questions you can then help shape thinking positively.
For example an older child may say:
‘Jeremy died because he had a bad heart and it didn’t work very well. The
doctors didn’t help and now mum and dad are sad and won’t ever be
happy’.
You might be able to confirm the first part but help shape the second.
‘The doctors worked very hard, they cared for Jeremy but his heart was
just too sick, it just couldn’t keep up the work of pumping anymore. Mum
and dad are very sad now, and probably will be for a good while but they
will feel better in the future. They don’t want to be so sad, but they can’t
help it right now.’

Piaget saw that older children and adolescents at around the age of 11 started to move to a
new stage of thinking which he called ‘Formal Operations’. He observed that the thinking
continued to be logical however the person no longer needed to have a physical
representation in order to think. Conceptual thinking was now possible. Questions without
answers were possible. Death could be perceived for example as abstract.
The examples of family separation and death have been used here to help illustrate the
application of Piaget’s theory of cognitive development particularly for counselling
interventions. Our understanding of the client’s capacity to think will assist us in the support
we provide. For older youth and adults more open ended questioning to fathom their
meanings and struggles for meaning is appropriate. Commiserating about the dilemmas in
life will be more appropriate than having ‘pat answers’ and ‘simple black and white
explanations’. Adults can handle unanswered questions although it is important that in the
end we do have ‘mental solutions’ to difficult issues.
Our job as counsellors is to assist people to recognise their own culpability in situations and
then forgive themselves if this is appropriate or recognise when something is not their fault.
We aim to help them move away from the black and white thinking about breaking rules
towards considering the multiple factors involved in any situation — there are many shades
of grey. Possibilities ultimately provide hope, whereas black and white thinking, sticking to
right and wrong or good and bad leads to dead-end thoughts for adults. It’s where we start
as children but as adults we need to move beyond this to cope with our world.
An example of this is when adults are racially prejudiced. This may work in a limited
environment however it cannot work if we are to interact with people freely and start to
travel outside our own backyard!
Moral development
Kohlberg described six stages of moral development which can be roughly grouped into
three levels of two stages relating to Piaget’s notion of cognitive development. He felt that
stages couldn’t be skipped but that each step is necessary for the next to be successfully
built.
Level 1 (Pre-Conventional)
1. Obedience and punishment orientation
(How can I avoid punishment?)
2. Self-interest orientation
(What's in it for me?)
(Paying for a benefit)
Level 2 (Conventional)
3. Interpersonal accord and conformity

(Social norms)
(The good boy/good girl attitude)
4. Authority and social-order maintaining orientation
(Law and order morality)
Level 3 (Post-Conventional)
5. Social contract orientation
6. Universal ethical principles
(Principled conscience)
The understanding gained in each stage is retained in later stages, but may be regarded by
those in later stages as simplistic, lacking in sufficient attention to detail.
Behaviours and reported emotions that may indicate presence of a
mental health issue
As previously mentioned there are situations where we can recognise disorders in thought
and emotion.
These include:
 suicidal ideation
 hallucinations or delusions
 excessive fears or suspiciousness (paranoia)
 confused thinking
 indicators or self-harm
As counsellors if we recognise any of the above they are indicators for referral to a more
fully trained mental health practitioner including a psychologist, medical doctor or
psychiatrist. This is not to say that we cannot provide support and care but the importance
of referral cannot be more highly stressed.
Awareness of own values and attitudes and their potential impact on
clients
English writer Douglas Adams once wrote: ‘The most misleading assumptions are the ones
you don’t even know you’re making.’ He may not have been a counsellor, but this is
nevertheless an astute observation. Many of the things we ‘know’ about the world are
merely assumptions that are so deeply ingrained that we’re not aware of ever having
learned them and we may never question them. As a counsellor, you will encounter clients
from a host of backgrounds and cultures that might be different from your own. Some of the
assumptions you don’t even know you are making may conflict with some of the
assumptions your client does not even know he or she is making. In other words, our
perceptions about the world might clash with those of our client.

For example, you might take it as self-evident that women share the same fundamental
rights as men, while your client has very different attitudes. Keep in mind that he or she
probably feels just as strongly about their values as you do about yours. Try to be aware
that your values are just that: your own, not theirs. What is ordinary to you might be
shocking to them and vice versa. No matter how strenuously you may object to their
attitudes or values, remember that their values are a product of the circumstances of their
upbringing, just as yours are.
Remember that as counsellors our role is to help clients, not to judge them or to foist our
values upon them.
Indicators of significant issues
These include:
 child abuse (including different types of child abuse)
 child trafficking
 abuse, neglect or harm including self-harm
 domestic and family violence
 elder abuse
Significant issues of harm for people need us to be clear in our responsibilities of care and
especially of reporting to the right authorities.
For example each state has different requirements in terms of reporting children at risk in
Australia. The following table provides information about these requirements for counselling
and other health care professionals. (Source: http://www.aifs.gov.au Australian Institute of
Family Studies updated June 2012)
State/territory requirements about responding to indications of
abuse and reporting and procedures process
Table 1: Mandatory reporting requirements across Australia*
Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
ACT A person who is: a doctor;
a dentist; a nurse; an
enrolled nurse; a midwife;
a teacher at a school; a
person providing education
to a child or young person
who is registered, or
provisionally registered, for
home education under the
Education Act 2004; a
A belief, on
reasonable
grounds, that a
child or young
person has
experienced or is
experiencing
sexual abuse or
non-accidental
physical injury; and
 Physical
abuse
 Sexual
abuse
Section 356 of
the Children and
Young People
Act 2008 (ACT)

Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
police officer; a person
employed to counsel
children or young people at
a school; a person caring
for a child at a child care
centre; a person
coordinating or monitoring
home-based care for a
family day care scheme
proprietor; a public servant
who, in the course of
employment as a public
servant, works with, or
provides services
personally to, children and
young people or families;
the public advocate; an
official visitor; a person
who, in the course of the
person's employment, has
contact with or provides
services to children, young
people and their families
and is prescribed by
regulation
the belief arises
from information
obtained by the
person during the
course of, or
because of, the
person's work
(whether paid or
unpaid)
NSW A person who, in the
course of his or her
professional work or other
paid employment delivers
health care, welfare,
education, children's
services, residential
services or law
enforcement, wholly or
partly, to children; and a
person who holds a
management position in an
organisation, the duties of
which include direct
responsibility for, or direct
supervision of, the
provision of health care,
welfare, education,
children's services,
Reasonable
grounds to suspect
that a child is at
risk of significant
harm; and those
grounds arise
during the course
of or from the
person's work
 Physical abuse
 Sexual abuse
 Emotional/
psychological
abuse
 Neglect
 Exposure to
family violence
Sections 23 and
27 of the
Children and
Young Persons
(Care and
Protection) Act
1998 (NSW)

Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
residential services or law
enforcement, wholly or
partly, to children
NT Any person with
reasonable grounds
A belief on
reasonable
grounds that a child
has been or is
likely to be a victim
of a sexual offence;
or otherwise has
suffered or is likely
to suffer harm or
exploitation
 Physical abuse
 Sexual abuse
 Emotional /
psychological
abuse
 Neglect
 Exposure to
physical
violence (e.g.,
a child
witnessing
violence
between
parents at
home)
Sections 15 and
26 of the Care
and Protection of
Children Act
2007 (NT)
Registered health
professionals
Reasonable
grounds to believe
a child aged 14 or
15 years has been
or is likely to be a
victim of a sexual
offence and the
age difference
between the child
and offender is
greater than 2
years.
 Sexual abuse Section 26 of the
Care and
Protection of
Children Act
2007 (NT)
QLD An authorised officer,
employee of the
Department of Child
Safety, a person
employed in a
departmental care
service or licensed care
service
Awareness or
reasonable
suspicion of
harm caused to a
child placed
in the care
of an entity
conducting a
departmental care
 Physical abuse
 Sexual abuse
or exploitation
 Emotional /
psychological
abuse
 Neglect
Section 148 of
the Child
Protection Act
1999 (Qld)

Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
service or a
licensee
A doctor or registered
nurse
Awareness or
reasonable
suspicion during
the practice of his
or her profession of
harm or risk of
harm
 Physical abuse
 Sexual abuse
or exploitation
 Emotional /
psychological
abuse
 Neglect
Sections 191-
192 and 158 of
the Public Health
Act 2005(Qld)
The staff of the
Commission for Children
and Young People and
Child Guardian
A child who is in
need of protection
under s10 of
the Child Protection
Act(i.e., has
suffered or is at
unacceptable risk
of suffering harm
and does not have
a parent able and
willing to protect
them)
 Physical abuse
 Sexual abuse
or exploitation
 Emotional /
psychological
abuse
 Neglect
Section 20 of the
Commission for
Children Young
People and Child
Guardian Act
2000 (Qld)
SA Doctors; pharmacists;
registered or enrolled
nurses; dentists;
psychologists; police
officers; community
corrections officers; social
workers; teachers; family
day care providers;
employees/volunteers in a
government department,
agency or instrumentality,
or a local government or
non-government agency
that provides health,
welfare, education,
sporting or recreational,
child care or residential
services wholly or partly for
children; ministers of
religion (with the exception
Reasonable
has been or is
being abused or
neglected; and the
suspicion is formed
in the course of the
person's work
(whether paid or
voluntary) or
carrying out official
duties
 Physical abuse
 Sexual abuse
 Emotional /
psychological
abuse
 Neglect
Section 11 of the
Children's
Protection Act
1993 (SA)

Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
of disclosures made in the
confessional); employees
or volunteers in a religious
or spiritual organisations
TAS Registered medical
practitioners; nurses;
dentists, dental therapists
or dental hygienists;
registered psychologists;
police officers; probation
officers; principals and
teachers in any educational
institution; persons who
provide child care or a child
care service for fee or
reward; persons concerned
in the management of a
child care service licensed
under the Child Care Act
2001; any other person
who is employed or
engaged as an employee
for, of, or in, or who is a
volunteer in, a government
agency that provides
health, welfare, education,
child care or residential
services wholly or partly for
children, and an
organisation that receives
any funding from the
Crown for the provision of
such services; and any
other person of a class
determined by the Minister
by notice in the Gazette to
be prescribed persons
A belief, suspicion,
reasonable
grounds or
knowledge that: a
child has been or is
being abused or
neglected or is an
affected child within
the meaning of the
Family Violence
Act 2004; or there
is a reasonable
likelihood of a child
being killed or
abused or
neglected by a
person with whom
the child resides
 Physical abuse
 Sexual abuse
 Emotional /
psychological
abuse
 Neglect
 Exposure to
family violence
Sections 13 and
14 of the
Children, Young
Persons and
Their Families
Act 1997 (Tas.)
VIC Registered medical
practitioners, registered
nurses, a person registered
as a teacher under
the Education, Training
and Reform Act 2006 or
teachers granted
Belief on
reasonable
is in need of
protection on a
ground referred to
in Section 162(c) or
 Physical abuse
 Sexual abuse
Sections 182(1)
a-e, 184 and 162
c-d of the
Children, Youth
and Families Act
2005 (Vic.)

Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
permission to teach under
that Act, principals of
government or non-
government schools, and
members of the police
force
162(d), formed in
the course of
practising his or her
office, position or
employment
WA Court personnel; family
counsellors; family
dispute resolution
practitioners, arbitrators
or legal practitioners
representing the child's
interests
Reasonable
grounds for
suspecting that a
child has been:
abused, or is at risk
of being abused; ill
treated, or is at risk
of being ill treated;
or exposed or
subjected to
behaviour that
psychologically
harms the child.
 Physical abuse
 Sexual abuse
 Emotional/
psychological
abuse
 Neglect
Section 160 of
the Western
Australia Family
Court Act 1997
(WA)
Licensed providers of
child care or outside-
school-hours care
services
Allegations of
abuse, neglect or
assault, including
sexual assault, of
an enrolled child
during a care
session
 Physical abuse
 Sexual abuse
 Neglect
Regulation 20 of
the Child Care
Services
Regulations
2006
Regulation 19 of
the Child Care
Services (Family
Day Care)
Regulations
2006
Regulation 20 of
the Child Care
Services
(Outside School
Hours Family
Day Care)
Regulations
2006
Regulation 21 of
the Child Care
Services

Who is mandated to
notify?
What is to be
notified?
Maltreatment
types for which it
is mandatory to
report
Relevant
sections of the
Act/Regulations
(Outside School
Hours Care)
Regulations
2006
Doctors; nurses and
midwives; teachers; and
police officers
Belief on
reasonable
grounds that child
sexual abuse has
occurred or is
occurring
 Sexual abuse Section 124B of
the Children and
Community
Services Act
2004
Note: * Section 67ZA of the Family Law Act 1975 (Cth) applies to all states and territories.
Child protection policy of service and relevant organisation
standards, policies
If in doubt about whether an issue or your position requires that you make a report,
remember it is not wrong to report an issue of concern to the Child Protective Agency in
your state or territory. However it may be wrong NOT to report. In other words your
legislative responsibilities in the area of Child Safety means that it may be useful to think of
how you go about reporting an issue rather than whether you should in the first place. Your
organisation may have associated protocols where you need to discuss an issue first with
your senior. It may be that your organisation requires them to make the report. Be careful
however that if your senior doesn’t appear to be following through you may still be liable.
Not all managers have made themselves aware of legislation.
Elder abuse
At the present time there is no Australian legislation which protects older people from abuse
and neglect in the home however general legislation with respect to Physical Abuse
reportable to the police is in place. There needs to be more exploration of this subject in the
future.
Historical development, terminology and underpinning concepts and
principles relating to a range of counselling therapies in common use
and processes used in their application
Any therapy has at its base, a model of the mind and a methodology for addressing any
problems it may develop. Not any one of them is more ‘right’ than another; it is probably
more accurate to say that all of them are right some of the time. Understanding the
theoretical and historical foundations upon which therapeutic techniques are based provides

a context and a framework for working with those techniques. It also helps you to
accurately and efficiently communicate information to other therapists.
In Module 4 we looked at a range of therapies and models and the historical context for
these. As you continue to learn about new ways of working with clients it will be important
to connect these back to the possible base model that they relate to. In this way we can
also judge the possible effectiveness and appropriateness of the therapy for the client we
are working with.
Applications, benefits and limitations of common counselling
therapies
There are three main pathways for counsellors to use in the task of supporting change in
people’s lives for the better;
1. through the mind (thoughts)
2. through the emotions (feelings) and
3. through the body (behaviour).
Depending on the therapist’s own philosophical and experiential preferences they may
choose one of these ‘gateways’ over others. Some therapists are purists and stick with the
one way of working with clients as they are convinced of the benefits and feel comfortable
with this way of working. Others choose strategies that seem to fit the client best and mix
and match techniques and models to suit the moment and the purpose of the intervention.
Those that forge new therapeutic models of working with people tend to be purists as they
believe in the therapy that they have discovered or pioneered and are most convincing in
their discourse on its use. They will often gather research to prove that their model and
therapy is the ‘better’ one compared to previously used strategies.
Strangely enough, new therapies are often vehemently argued against by those using pre-
existing therapies as they have much to gain from holding their popular position. An
example of this is Eye Movement Desensitisation and Reprocessing (EMDR). This therapy
utilises the body as the gateway to change emotions, thoughts and behaviour through using
eye movement as the name suggests. At first the author of EMDR, Francine Shapiro, met
with scorn and ridicule but gradually as the evidence has been gathered through research
and successful outcomes it has had more acceptance in mental health circles.
However we choose to work with our clients we need to understand that all three of the
aforementioned ‘gateways’ need to be impacted in a therapeutic intervention for lasting
change to occur. If we work though helping a client to change their negative thoughts it will
of course impact their emotions and hopefully this in turn will impact behaviour. We may
choose simply to work through changing client’s behaviours which will impact thoughts and
emotions as well or we may use an emotionally based therapy which will lubricate thoughts

and modify behaviour in turn. Possibly however it makes the most sense to work on all three
at the same time!
Some who consider ‘spiritual’ or ‘intuitive’ practices wonder how this would fit into this
overview. Quite simply, unless the counsellor is sensitive to others in the first place, no
matter what strategy or therapy they choose, they may never be able to be an effective
counsellor. We shouldn’t forget about the simple act of caring for our clients and being ‘in
tune’ with them. You just have to imagine for yourself going to see a counsellor who is
insensitive to you. You won’t be tempted to go back to see them and, regardless of any
evidence on the effectiveness of the therapy they use, if you do not see that counsellor
there will be no effectiveness!
Some common modern therapies include but are not limited to:
1. Cognitive behaviour therapy
2. Person-centred therapy
3. Behaviour therapy
4. Expressive therapies
5. Family therapy
6. Gestalt therapy
7. Narrative therapies
8. Solution focused therapy
9. Transactional analysis
Each one of these therapies has a particular scope of use. None of them is adequate to treat
every problem a client may present; however by acquiring competency in several of these
therapies you will be able to address most of the problems you will encounter. Let’s take an
overview of each of these therapies.
emotions
behaviour
thoughts

1. Cognitive behaviour therapy
Cognitive Behaviour Therapy or CBT combines the strategies and tenets of Cognitive
Therapy and Behaviour Therapy. It has become one of the most well-known and utilised
therapies in counselling practice today. It stresses the importance of changing people’s
cognitions (thoughts) through bringing to their awareness the negative impact of unhelpful
or irrational thoughts on emotions and behaviours and then assists the client to change
these through practice of new behaviours particularly new thought behaviours. CBT has a
large range of strategies that fit under this umbrella. One of the important things to note is
that it deals with the present and the future, not so much the past. It is action-centred. It is
also fairly balanced in its emphasis on shared responsibility for outcomes between the
counsellor and the client.
Therapy Orientation Movement Responsibility Duration
CBT Present & future Action/goal
orientated
Cognitive
Behavioural
Shared Short term
CBT includes a range of other therapies including Rational Emotive Behaviour Therapy
(REBT), Cognitive Therapy (CT), Rational Behaviour Therapy (RBT), Rational Living Therapy,
Schema Focused Therapy and Dialectical Behaviour Therapy.
Albert Ellis is considered to be the father of CBT with his brand of therapy which he called
Rational Emotive Therapy in the mid-1950s. Ellis believed in the notion ‘Men are disturbed
not by things, but by the view which they take of them’ (Epictetus, stoic philosopher). Ellis
reacted to the psychoanalytic tradition which he felt was inefficient and non-directive. The
approach was further developed by Alfred Adler. Although Adler classed himself as a neo-
Freudian (out of psychoanalytic tradition) he too stated that, ‘I am convinced that a person’s
behaviour springs from his ideas.’
Ellis was also impacted by the behaviourists who were much more directive in their
approach in therapy. Ellis developed the ABC model of working with people. A stood for
Activating event, B for Beliefs and C for Consequential actions. Later Ellis reworked this
model adding D and E for Disputations to challenge irrational beliefs and Effective new
beliefs to replace the irrational ones. By this Ellis identified that all of us are impacted by
events in life, however the beliefs we have about these events will influence our actions. To
assist clients, therapists need to help them to dispute irrational and unhelpful beliefs and put
new and better beliefs in place. The following illustrates this.
Activating events: Marty’s car has finally broken down. He had planned to buy a new car
and had imagined himself in this car feeling important and powerful. His
flatmate has moved out and has left him with some unpaid debts and the
other half of the rent to pay.

Beliefs: Marty believes that everything always goes wrong for him and that no
matter how hard he tries bad things will always happen to him. He has
used the events to extend the likelihood in his mind that further and more
negative situations would come and never allow him to live his dreams.
Consequential actions:
As a result of his thoughts his feelings are impacted and he is feeling angry
and aggressive but at the same time powerless. He imagines yelling at his
old flatmate, putting thumb tacks under the wheels of his flatmate’s car
tyres and feeling frustrated and glum. He decides not to go out with
friends on the weekend and stays at home and drinks himself into a
stupor.
Disputations to challenge irrational beliefs:
Marty’s counsellor identifies with Marty where the idea that nothing will
ever work out for him has come from. Marty has had a number of negative
early life events that have contributed to this ‘mind set’. Marty’s counsellor
also identifies with Marty other times in his life where things have gone
extremely well and other situations in his life that are currently fine.
Marty’s counsellor talks him through the effects of his thoughts and offers
more helpful thoughts.
Effective new beliefs:
The counsellor helps Marty to work on new ‘mantras’ that can be used
when he feels low and when any negative event occurs including ‘most
negative events are short lived’ and ‘I am incredibly resourceful’, and one
that Marty liked in particular ‘what doesn’t kill you makes you stronger’.
The counsellor helps Marty to commit to different thinking and to practise
this between sessions and coaches him in the benefits to his life of more
positive beliefs.
Dr Marsha Linehan, also a CBT proponent and author of Dialectical Behaviour Therapy, has
added to traditional CBT by an insightful statement: ‘you are loved the way you are,
however you must strive to change’. By this she meant that at the heart of therapy there
must be acceptance by the therapist and the client that they are worthy, and from that
position it is then possible to work on areas of change in life. Linehan has been fundamental
in forging treatments for people with Borderline Personality Disorder who have been most
difficult to help because they have developed a self-hatred in childhood as a result of
mistreatment or neglect by parents and caregivers. If people have an unrealistic view of
their need to be positive and perfect then the ‘work’ of change becomes self-defeating. It
merely proves to the client that they are a mess and any homework and practice reinforces
a self-hatred. Linehan realised that all clients need to come to a peace with the fact that
they are human and need to accept this as first base.

Three examples of CBT that are particularly useful are:
 Mind Mapping or Life Maps
 Behavioural Experiments
 Thought Stopping
Life Maps
Life Maps involve mapping the various areas of a person’s life visually and identifying the
domains where there may be problems occurring for a person. By mapping all domains you
are also able to predict what might become a problem. It also assists the counsellor and the
client to begin to set small goals to solve or reduce the problems that might be facing a
client. We covered Life Maps in Module 3.
Once the domains are listed you can begin to ask questions about each area of the person’s
life and ask how the person would rate each of these. You can then find out which one
might be worked on first and together with the client create goals for growth and success in
each of these domains. While this method doesn’t specifically target thought change with
the client, it does present a new way of thinking about issues for the client simply through
presenting an overview. It is therefore a great way of working with very distressed clients as
it is behaviour focused and doesn’t require any mental gymnastics. The life map below is an
example of how this works.
Finances
Exercise &
food
Friendships
Relationship
with family
Relationship
with partner
Growth
education
Work
Recreation
Jay is
depressed,
not sleeping,
not coping

Life Maps for kids
Another way of working with Life Maps is to draw a stick person to represent the client and
draw a line representing water across the middle of the person representing the waterline
that they don’t want to sink beneath. Attached to the hands of the person are balloons
which are keeping them afloat — representing good things in their life — and attached to
the legs are weights which are weighing them down. The client identifies the strengths they
have in the balloons, both personal strengths and other things going well, and also the
issues that are pulling them below the water level. The counsellor then works with the client
to come up with strategies to cut off the weights and to provide goals and strategies to
meet those goals.
Again while this technique doesn’t specifically target thoughts, it does so generally through a
visual arrangement of the way someone sees their life and provides mastery through a step
by step strategy to make things better. This technique may be used for someone who is
quite low emotionally as it visually presents their resiliencies and also the issues that are
currently weighing them down with the focus on the strategies to reduce these.
Behavioural experiments
In Cognitive Behavioural Therapy behavioural experiments are designed to test the validity
of thoughts. For example for a client who wants to lose weight and is experiencing
depression you may set up an experiment with them to test the power of self-criticism or
self-kindness in reducing over eating. You may set homework for a period of time to allow
them to think critically about themselves and their weight and overeating and see what
impact this has on their overeating. It would be important to record this daily. In another
period you might look at more helpful thoughts that they could use for themselves and see
how that impacts overeating.
Individuals may believe by criticism of a partner or child they will be able to influence them
to do better in a particular area. Behavioural experiments test the validity of these kinds of
thoughts.
Thought stopping
Thought stopping is nearly impossible. If a client has a nasty or negative thought the simple
command to stop it will not happen. It is like saying to someone don’t think about the purple
rabbit. Once it is identified it actually becomes MORE of a focus.
Thought stopping therefore needs some strategy. One such strategy is outlined below.
Recognise – the negative or nasty thought
For example thinking ‘I am stupid’ causes me emotional pain and its probably not a good
thought to have.
Refuse – to tolerate this kind of thought
It’s time to change this thought for good.

Relax – don’t tense when you recognise the thought in its various forms – after all it’s been
there for a while, it might take some time to see it leave.
Reframe – make the thought situational and non-permanent.
For example ‘any one of us can feel stupid in a particular situation’ ‘I’m a motor mechanic. If
I compare my knowledge of computers to an IT consultant I will feel stupid, but perhaps the
IT consultant will feel stupid if he compares his knowledge of car engines to me’.
Resume – note the things you don’t feel stupid about.
2. Person-centred therapy
PCT Present Reflective/
accepting
Affective/Cognitive
Shared however
the client takes
the lead
Medium
term
‘It is that the individual has within himself or herself vast resources for self-understanding,
for altering his or her self-concept, attitudes and self-directed behaviour - and that these
resources can be tapped if only a definable climate of facilitative psychological attitudes can
be provided.’ Source: Carl Rogers, The Foundations of the Person-Centred Approach 1979.
PCT is a form of talk-psychotherapy that was developed by psychologist Carl Rogers in the
1940s and 1950s. The goal of this therapy is to provide clients with an opportunity to
develop a sense of self, to help them realise how their attitudes, feelings and behaviour are
being negatively affected, and make an effort to find their true positive potential.
Counsellors adopt this technique to create a comfortable, non-judgmental environment by
demonstrating congruence (genuineness), empathy, and unconditional positive regard
toward their clients while using a non-directive approach. This aids clients in finding their
own solutions to their problems.
The primary objective of PCT is therefore to resolve the incongruence of clients and help
them be able to accept and be themselves.
Unlike many other therapies, PCT maintains that the client, not the counsellor, is responsible
for improving his or her life. This is a shift away from psychoanalysis and behavioural
therapies where the patient is diagnosed and treated by a ‘doctor’. Instead, the counsellor
guides clients to consciously and rationally decide for themselves what is wrong and what
should be done about it. The counsellor takes on the role of a friend who listens and
encourages on an equal level.
PCT requires the counsellor to Listen, Accept, Understand and Share. However owing to the
unique nature of each counselling relationship, PCT does not propose a pre-defined or pre-
set methodology that can be applied to a range of cases. Of utmost importance is the
quality of the relationship between the client and counsellor.

Carl Rogers identified six key factors that stimulate growth within an individual. He
suggested that when these conditions are met, the person will gravitate toward a
constructive fulfilment of potential. These six factors are:
1. Counsellor-Client Psychological Contact: there must be a distinct and
recognizable relationship between the therapist and the client and it must be
validated by both parties.
2. Client Incongruence, or Vulnerability: a client is vulnerable to fears and anxieties
that keep them from leaving a relationship or situation and that there is clear
evidence of incongruence between what a client is aware of and the actual
experience.
3. Counsellor Congruence, or Genuineness: it is evident that the counsellor is
involved in the relationship with the client for the purpose of healing. Counsellors
should be genuinely interested in their clients’ recovery and can access their own
experiences as an aid in the recovery process.
4. Counsellor Unconditional Positive Regard (UPR): there is an element that
supersedes all others, and that is the element of unconditional acceptance. By
providing a platform of openness and acceptance, the client can begin to dispel
their skewed perceptions of themselves that they have gathered from others.
5. Counsellor Empathic understanding: a client feels genuine empathy from the
counsellor with regard to their internal construct and perception. This feeling of
empathy helps reinforce a sense of trust, understanding and unconditional love.
6. Client Perception: the perception of unconditional positive regard and complete
empathic acceptance and understanding is perceived by the client, if even only
minimally.
3. Behaviour therapy
Behaviour
Therapy
Present Dynamic
Behaviour
Counsellor Short to
Medium
Term
The key assumption behind all forms of behaviour therapy is that behaviour is learned from
the environment, and symptoms are acquired through classical conditioning and operant
conditioning.
As we saw in Module 4, the occurrence of a stimulus unconditionally, naturally, and
automatically triggers a response. For example, when you smell one of your favourite foods,
you may immediately feel hungry. In this example, the smell of the food is the
unconditioned stimulus.

The response occurs naturally as a reaction to the unconditioned stimulus. In our example,
the feeling of hunger in response to the smell of food is the unconditioned response.
A second layer is added to this initial concept with the conditioned stimulus and conditioned
response.
The conditioned stimulus is previously neutral stimulus that, after becoming associated with
the unconditioned stimulus, eventually comes to trigger a conditioned response. In our
earlier example, suppose that when you smelled your favourite food, you also heard the
sound of a whistle. While the whistle is unrelated to the smell of the food, if the sound of
the whistle was paired multiple times with the smell, the sound would eventually trigger the
conditioned response. In this case, the sound of the whistle is the conditioned stimulus.
The conditioned response is the learned response to the previously neutral stimulus. In our
example, the conditioned response would be feeling hungry when you heard the sound of
the whistle.
Behaviour therapy is driven by this entire concept of Classical conditioning. It involves
learning of a particular behaviour by way of association and is typically the cause of phobias
in human beings.
This also implies that if behaviour can be learned, it can also be ‘un-learned’. The aim of
behaviour therapy is to help clients understand how changing their behaviour can lead to
good changes about how they are feeling. Behaviour therapy is usually based on increasing
client engagement in positive or socially reinforcing activities.
This kind of therapy is a methodical approach that identifies what the client is currently
doing, and then seeks to increase the chances for a positive experience by helping to
change behaviours.
Typical tools for behaviour therapy are diaries where clients are encouraged to map
differences in behaviours and the results. Therapists look to build in rewards to reinforce
certain desired behaviours and to extinguish undesirable behaviours through various
consequences.
4. Expressive therapies
Expressive
Therapy
Present Reflective
Affective
Shared Short term
Expressive therapies make use of the creative arts as a therapeutic process. They employ a
range of self-discovery processes to bypass the logical mind and tap into that world we
know exists but cannot seem to comprehend consciously. This experiential and holistic way
of working involves more than ‘just talking about the problem’ and provides the opportunity

for real and lasting change. It is based on the belief that each person has their own inner
wisdom and that the expert on who we are and what we need is actually inside us.
Expressive therapies allow a client to not just express in words a particular issue, but to also
feel the energy of their inner experience. When we connect with and really feel this energy
we become open to new ways of understanding the problem. This method allows a feeling
of release, insight, increased energy and a sense of well-being and resolution.
Expressive therapies include, but are not limited to:
 Art therapy
 Dance therapy
 Drama therapy
 Music therapy
 Poetry therapy
Any form of creative expression can be used as an expressive therapy. The important aspect
is allowing what’s happening inside the client to come out, not whether or not one produces
a ‘good’ drawing. It’s about self-discovery through the expressive process, not the end
result.
Just as other therapies listed use gateways for change so do expressive therapies. These
therapies use the ‘emotion’ or affective gate to foster change for a client.
5. Family therapy
Family Therapy Present Goal Oriented
Cognitive
Behavioural
Counsellor Short
Family therapy is a branch of psychotherapy that works with families and couples in intimate
relationships to nurture change and development. It tends to view change in terms of the
systems of interaction between family members. It emphasises the role of family and
relationships as an important factor in psychological health.
Family therapy maintains that, regardless of the origin of the problem, and regardless of
whether the clients consider it an ‘individual’ or ‘family’ issue, involving families in solutions
often benefits clients. Families are therefore asked to directly participate in the counselling
session.
An important concept in family therapy relates to the illness of family members. Particularly
an issue of one family member may be a symptom of a larger family problem. To treat only
the member who is identified as ill is like treating the symptom of a disease but not the
disease itself. It is possible that if the person with the illness is treated but the family is not,

another member of the family will become ill. This cycle will tend to continue until the
problems are examined and treated.
A family therapist:
 Teaches family members about how families function in general and, in
particular, how their own functions.
 Helps the family focus less on the member who has been identified as ill and
focus more on the family as a whole.
 Assists in identifying conflicts and anxieties and helps the family develop
strategies to resolve them.
 Strengthens all family members so they can work on their problems together.
 Teaches ways to handle conflicts and changes within the family differently.
Sometimes the way family members handle problems makes them more likely to
develop symptoms.
During counselling sessions, all participating members of the family take responsibility for
the family’s issues. The family’s strengths are used to help them handle these issues and
problems. It might be discovered in these sessions that some family members may need to
change their behaviour more than others.
Typical family therapy sessions are quite active in that family members are often given
meaningful assignments. For example, parents may be asked to delegate more
responsibilities to their children.
The number of sessions required may vary, depending on the severity of the problems and
the willingness of the members to participate in therapy. The family and the counsellor set
mutual goals and discuss the length of time expected to achieve the goals.
6. Gestalt therapy
Gestalt Therapy Present Existential/
Experiential
Affective/
Behavioural
Client Short to
long term
Gestalt therapy focuses heavily on increasing one’s self-awareness. Fritz Perls, the founder
of Gestalt therapy, famously said: ‘Lose your mind and come into your senses’.
This is a type of therapy used to deepen our awareness about ourselves and our feelings in
a less intellectual manner than the more traditional forms of therapy. ‘Gestalt’ means the
whole; it implies wholeness.

The idea in Gestalt therapy is that at some point in time all of us have had to repress or
supress aspects about ourselves because they were not accepted or supported by those
around us, especially those who matter. It is these aspects of one’s self or our feelings that
end up in the background and can become unfinished business.
Gestalt therapy can help shed light on such unfinished business by helping us to focus our
awareness on our feelings (or lack of feelings) moment to moment. Once we recognise our
unfinished business (i.e. uncomfortable feelings, stuck patterns of behaviour, or ways in
which we perceive ourselves and others that are based on our experiences as opposed to
reality), we become better equipped to understand ourselves and to choose whether we
want to make changes or not. This awareness includes insight, self-acceptance, knowledge
of one’s environment, a responsibility for choices and an understanding of the concept of
change.
For the client — they will experience a discovery — they will realise new things about
themselves, see old situations in a new light and look differently at significant others. They
will additionally recognise that they have a choice in their lives and that they may behave
differently, influence their own environment, deal with daily surprises and have the
confidence to improve and improvise.
The signature technique of Gestalt therapy is the ‘empty chair’ exercise. It is a method of
facilitating the role-taking dialogue between the client and others; or dialogue between
different parts of the client’s personality. Two chairs are placed facing each other: one
represents the client or one aspect of the client’s personality, and the other represents
another person or the opposing part of the client’s personality. As the client alternates the
role, he or she sits in one or the other chair.
The counsellor may simply observe as the dialogue progresses or they may instruct the
client when to change chairs, suggest sentences to say, call the client’s attention to what
has been said, or ask the client to repeat or exaggerate words or actions.
7. Narrative therapies
Narrative
Therapy
Present, Past,
Future
Reflective
Cognitive
Shared Medium
Narrative therapy was developed by Michael White and David Epston. It is a respectful and
collaborative approach to counselling and community work. It focuses on the stories of
people’s lives and is based on the idea that problems are manufactured in social, cultural
and political contexts. Each person produces the meaning of their life from the stories that
are available in these contexts.
A wider meaning of narrative therapy relates significantly to a relatively recent way of
thinking about the nature of human life and knowledge which has come to be known as

‘postmodernism’ which maintains there is no one objective ‘truth’ and that there are many
multiple possible interpretations of any event. Thus within a narrative approach, our lives
are seen as multi-storied vs. single-storied. These stories both describe and shape people’s
perspectives on their lives, histories and futures. They may be inspiring or oppressive.
Often by the time a person has come to therapy the stories they have for themselves and
their lives become completely dominated by problems that work to oppress them. These are
sometimes called ‘problem-saturated’ stories. Problem-saturated stories can also become
identities (e.g. ‘I’ve always been a depressed person’, or seeing an adolescent as a young
offender vs. a young person who has been in trouble with the law). These kinds of stories
can invite a powerful negative influence in the way people see their lives and capabilities
(e.g. ‘I’m hopeless’). Counsellors and therapists interested in narrative ideas and practices
collaborate with people in stepping away from problem saturated and oppressive stories to
discovering the ‘untold’ story which includes the preferred accounts of people’s lives (their
intentions, hopes, commitments, values, desires and dreams). Counsellors are listening to
stories of people’s lives, cultures and religions and looking for clues of knowledge and skills
which might assist people to live in accordance with their preferred way of being.
In essence, within a narrative therapy approach, the focus is not on ‘experts’ solving
problems, but on people discovering through conversations, the hopeful, preferred, and
previously unrecognised and hidden possibilities contained within themselves and unseen
story-lines. This is what Michael White would refer to as the ‘re-authoring’ of people’s stories
and lives.
An example of narrative therapy would be when a counsellor allows a client to verbalise
their problems and then re-phrases the narrative in a disconnected way. For instance, if a
client believes he/she suffers with depression and feels like a failure, a narrative therapist
may offer the suggestion that rather than being a failure, the client had succeeded in living
with depression. Narrative therapists give credibility to emotions by naming them, but at the
same time place them in the desired place on their client’s landscape. When a client feels
like a failure, the therapist may acknowledge that the job they were employed at ended and
it caused a sense of failure, thus removing the feeling of failure from the client and
externalising it.
8. Solution focused therapy
Solution focused brief therapy (SFBT) can be termed solution focused or brief therapy
interchangeably.
A solution focused strength based approach is compatible with Marsha Linehan’s notion of
building self-love as part of a program of change. The key proponents of SFBT has been
Steve de Shazer and his wife Insoo Kim Berg who created the term in the 1980s. However
they built on the work of Milton Erickson and others who termed ‘Brief therapy’ in the 1950s.
Richard Bandler, John Grinder and Stephen R Lankton have also been credited with the
inspiration and popularisation of Brief Therapy.

SFBT has been used in addictions counselling very successfully and also in the field of
Christian pastoral counselling as well.
It is particularly useful for clients who have a very low self-esteem and are normally not able
to build successes in their life although it makes sense for all clients and is a popular therapy
as it provides ways to build confidence.
SFBT Present and
future
Goal action
orientated
Cognitive
Behavioural
Shared Short term
SFBT has many techniques, many of which take the form of questions. The client is asked to
explore an aspect of themselves, or their life or goals. There are no right or wrong answers
to these questions, rather the client is encouraged to put as great and vivid detail as
possible into their responses. Two examples of solution focused strategies to use with clients
are The Five Column Approach and the Miracle Question.
The Five Column Approach
The Five Column Approach requires you as the counsellor to discuss with your client the
areas that are causing them distress or concern ‘The Problem’, you then move to discuss
what they would imagine would be the ‘Ideal Picture’ or how they would prefer their life to
look. Then you would discuss with the client their strengths in great detail and draw these
out. You would then ask your client whether they have exhausted all their strengths in
addressing their problem.
In approaching the problem from the base of talents, gifts, skills or attributes particularly
that haven’t been utilised to date the client begins to see that they have more resources
than they first thought. Once ideas are generated you can talk about what else is needed to
assist the client and then you can assist the client to put in a plan of action. The strategy is
visual, goal orientated (fixing the now for the future) and requires implementation of
strategies or homework. The strategy is Cognitive Behavioural as the client is changing their
thinking particularly on the basis of reviewing their assets and strengths in meeting a
challenge. It is also asking them to put in a plan and an action towards change.
The Issue/Story Strengths/
Resources
What is still
needed
First steps
towards the
goal
Ideal Picture
Do this first Do this third Do this fourth Do this last Do this second
The Five Column Approach is very helpful for couples in conflict or family therapy as well.

The Miracle Question
Like the Five Column Approach this technique focuses on what clients want to achieve in the
end rather than on the problem or problems for any length of time. It focuses on the
present and the future. The counsellor uses ‘respectful curiosity’ to question the client about
a possible preferred future. Discussion follows about strategies large and small in terms of
getting to this future. The counsellor in a similar way talks about the client’s strengths and
resources and about when the problem isn’t showing up. The counsellor gets the client to
notice what is happening when the problem is not a problem.
The counsellor also helps the client to notice small successes. SFBT counsellors will often
use ‘scaling questions’ to help clients to notice those changes and to bring encouragement.
For example: ‘When we first got together Ben, out of 10 how close to the goal do you
feel you were? What about now: how much further do you feel you have
come towards getting to that goal?’
The Miracle Question technique can help the client to envision a future where the problem is
no longer present. A typical version of the miracle question would be:
‘I want you to imagine something a bit strange if you wouldn’t mind.
Imagine after leaving here you go home and nothing much has changed at
all and you feel a bit daunted by the problems that you are living with. But
imagine that something weird happened, a miracle if you like, and when
you woke up the problem was gone. It no longer existed. I want you to
describe to me when you fully realised that a miracle had happened what
your day was like and what you might do differently.’
If, for example, the client’s issue is anger management, they might say that they no longer
lose their temper. The counsellor would then probe the client with questions about what
difference that would make and how they would feel. The counsellor wants the client to
develop positive concrete goals and things that they would do differently, rather than focus
on the bad feelings and limitations. They might also add, ‘What would you be doing instead
of being angry when someone called you names, for example?’.
Part of the SFBT strategy is to help the client to notice the exceptions that they can build
on. In the example above the counsellor may ask the client about times when they don’t get
angry and what is happening in these situations that is different. These are called ‘Exception
Seeking Questions’. Another form of this is to find out times when the person is coping well.
When the counsellor uses curiosity and admiration about the client’s successes and
strengths in a particular situation this provides encouragement. People have greater capacity
to change when they feel they are on a roll rather than a complete mess.
To a Solution Focused Brief Therapist it is important to have quite a lot of problem free talk
where conversation might focus on leisure activities and what might look like irrelevant
conversation. However when clients are focusing on what is going well and noticing their

‘normality’ they have greater inner strength to manage the changes that are needed to
really move their life in a positive direction.
In Module 11 we will talk more about ‘body state’. When we feel good we can tackle the
world. When we feel bad we want to retreat. Our body state and the feelings that
counsellors facilitate within a session are extremely important. In counselling we often have
only ‘one bite of the cherry’ in other words if a client doesn’t experience encouragement
with us in the first session and hope for the future they may not return again for a second
session. For this reason a strengths-based approach using Solution Focused Brief
Intervention is a good way to begin a counselling intervention.
9. Transactional analysis
Transactional
Analysis
Past, present and
future
Goal action
orientated
Cognitive
Behavioural
Shared Short term –
medium and
long term
Transactional Analysis (or TA as it is often called) is a model of people and relationships that
was developed during the 1960s by Dr. Eric Berne. It is based on two notions, first that we
have three parts or 'ego-states' to our 'personality, and secondly that these converse with
one another in 'transactions' (hence the name). TA is a very common model used in therapy
and a variety of information about it is available.
Parent, Adult and Child
We all have ‘internal models’ of parents, children and also adults, and we play these roles
with one another in our relationships. We even do it with ourselves, in our internal
conversations.

Parent
There are two forms of Parent we can play.
The Nurturing Parent is caring and concerned and often may appear as a mother-figure
(though men can play it too). They seek to keep the Child contented, offering a safe haven
and unconditional love to calm the Child's troubles.
The Controlling (or Critical) Parent, on the other hand, tries to make the Child do as the
parent wants them to do, perhaps transferring values or beliefs or helping the Child to
understand and live in society. They may also have negative intent, using the Child as a
whipping-boy or worse.
Adult
The Adult in us is the 'grown up' rational person who talks reasonably and assertively,
neither trying to control nor reacting aggressively towards others. The Adult is comfortable
with themself and is, for many of us, our 'ideal self'.
Child
There are three types of Child roles we can adopt.
The Natural Child is largely un-self-aware and is characterized by the non-speech noises
they make (yahoo, whee, etc.). They like playing and are open and vulnerable.
The cutely-named Little Professor is the curious and exploring Child who is always trying out
new stuff (often much to their Controlling Parent's annoyance). Together with the Natural
Child they make up the Free Child.
The Adaptive Child reacts to the world around them, either changing themselves to fit in or
rebelling against the forces they feel.
Communications (transactions)

When two people communicate, each exchange is called a ‘transaction’. Many of our
problems come from transactions that are unsuccessful.
Parents naturally speak to Children, as this is their role as a parent. They can talk with other
Parents and Adults, although the subject still may be about the children.
The Nurturing Parent naturally talks to the Natural Child and the Controlling Parent to the
Adaptive Child. In fact these parts of our personality are evoked by the opposite. For
example, in acting as an Adaptive Child, a person will most likely evoke the Controlling
Parent in the other person.
We also play many games between these positions, and there are rituals from greetings to
whole conversations (such as the weather) where we take different positions for different
events. These are often 'pre-recorded' as scripts we just play out. They give us a sense of
control and identity and reassure us that all is still well in the world. Other games can be
negative and destructive and we play them more out of sense of habit and addiction than
constructive pleasure.
Conflict
Complementary transactions occur when both people are at the same level (Parent talking
to Parent, etc.). Here, both are often thinking in the same way and communication is easier.
Problems usually occur in Crossed transactions, where each is talking to a different level.
The parent is either nurturing or controlling, and often speaks to the child, who is either
adaptive or ‘natural’ in their response. When both people talk as a Parent to the other’s
Child their ‘wires get crossed’ and conflict results.
The ideal line of communication is the mature and rational Adult—Adult relationship.
Roles of counsellor and client in relation to a range of counselling
therapies and techniques
Therapy requires that counsellor and client adopt roles. These roles are essential to the
functioning of the therapy and vary between therapies. Failure to maintain the boundaries
imposed by these roles can render the therapy ineffective. As we have seen above the
various ways of working with clients may mean that the client takes a more active role or
the therapist does. Behaviour Therapy may be considered to be a therapy which has a more
dominant therapist role whereas with Person Centred Therapy the client takes the more
dominant role. Other therapies may be seen as more equal with the therapist and client
working together equally to move the client forward towards their goals.
Indicators of client issues requiring referral
Therapeutic counselling can only address so much. Some clients will present you with
problems or behaviours that you might not be able to deal with in your role as counsellor
and will require urgent intervention because they may be a danger to themselves or others.

Alternatively, they may be in danger at the hands of others. Sometimes a client will disclose
such issues to a therapist.
While clients might confess to hurting someone or planning to hurt someone or themselves,
often they are unwilling or unable to tell a therapist about it. In cases where the client is not
forthcoming, some risk factors may be deduced by observing the client. In any case, there
are circumstances that counsellors are unable to deal with on their own and require the
notification of proper authorities.
Here are some examples, along with their indicators:
Suicidal tendencies
 A previous suicide attempt, even if it seemed staged or designed to get attention, or
boasts of past or secret suicide attempts.
 Talking about being dead or wishing they were dead, how others would be happier if
he/she were dead or how much better off others will be when he/she is gone.
 Repeatedly engaging in very risky or dangerous thrill seeking behavior.
 ‘Getting the house in order’ – making plans for the care of loved siblings, parents,
relatives or pets and giving away cherished belongings to close friends.
 Extreme mood swings; very depressed episodes followed by happy episodes with no
clear reason for the change.
 Regular expressions of worthlessness, helplessness, sadness and/or loneliness.
Drug abuse
 Sudden change in attitude, work, or behavior – a new, ‘I don’t care’ attitude
 Sudden deterioration of long friendships, relationships
 ‘Explosive’ arguments and disagreements over small matters
 Frequent hangover symptoms
 Using drug culture jargon
 Secretive behavior
 Avoiding ‘straight’ (non drug-users) co-workers or classmates
 Erratic behaviour, forgetfulness, indecisiveness
 Deterioration in personal appearance and hygiene
 Hyper-activity, constant toe or heel-tapping and/or ‘drumming’ of fingers
 Easy excitability
 Restlessness, increased physical activity
 Wearing of long-sleeved garments in very warm weather
 New financial problems or frequent borrowing of money
 Small blood spots or bruises on skin
 Bloodshot or watery eyes
 Runny or irritated nose, irritating cough, sore throat
 Speech pattern changes, slurred speech, faster speech, slower speech
 Tremors or jitters
 Constant scratching of skin, ‘picking’ at skin and hair on arms, etc.

 Poor coordination, tripping, spilling, bumping into things and other people
 Large or small (dilated) pupils
 A faint skin odour – either sweet or acrid
 Easily fatigued or constantly fatigued
Sexual abuse
 Unusual interest in or avoidance of all things of a sexual nature
 Sexual acting out on other children
 Unusual disclosures about their genitals
 Depression or withdrawal from friends or family
 Unusual anger or oppositional type behaviours
 Unusual soiling or wetting problems
 Sleep problems or nightmares
 Fire setting, stealing, and/or other angry anti-social behaviors
 Unusual aggressiveness
 Seductiveness or sexually odd behaviors
 Statements that their bodies are dirty or damaged
 Fear that there is something wrong with them in the genital area
 Refusal to go to school
 Unexplained or unusual drop in grades
 Unexplained drop in interest in activities they used to enjoy
 Unusual avoidance of a particular person or place
 Unusual delinquency and/or conduct problems
 Unusual level of or increase in secretiveness
 Aspects of sexual molestation in drawings, games, fantasies
 Excessive masturbation
 Regressed behaviors (acting like a younger child)
 Excessively mature behaviour
 Suicidal thoughts, statements or behaviour
 Disclosures of sexual abuse even if they seem unlikely
Physical abuse
 Signs of injury including but not limited to bruises, cuts, scratches, welts, abrasions,
broken bones, punctures, burns, and bite marks.
 Unusual way of physical contact with adults or is overly-friendly to adults. In other
words, is not aware of social boundaries.
 Has a low frustration level, becomes upset very easily or is far too tolerant or
patient.
 Seems frightened of parents or other adults.
 Afraid to go home, or is overly compliant with authority.
 Wet the bed and exhibit regressed behavior.
 Shy, withdrawn, and uncommunicative or hyperactive, aggressive, and disruptive.
 Do not show emotion when hurt.
 Offer implausible explanations of injuries.

Module 5 counselling to suit the client learning resource 1.5.13

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