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Counselling Procedure/Skills. Hitha.P.S II MSc Clinical Psychology. Counselling - Definition. An interactive process characterized by a unique relationship between the counselor and client that leads to change in one or more of the following areas: Behavior - PowerPoint PPT Presentation

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

  • Counselling - Definition

    An interactive process characterized by a unique relationship between the counselor and client that leads to change in one or more of the following areas:BehaviorBeliefs or emotional concerns relating to perceptionsLevel of emotional distress

  • Counseling Process StructureRapport and Relationship BuildingAssessment / Problem DefinitionGoal-settingInitiating InterventionsTermination

  • Rapport and RelationshipPsychological climate resulting from the interpersonal contact of client and counselor.Living and evolving condition.Relationship includes respect, trust, and relative psychological comfort.Impacted byCounselors personal and professional qualifications.Clients-interpersonal history,anxiety state,interrelation skills, andprevious ability to share,

  • Clinical AssessmentInvolves specific skillsObservationInquiryAssociating factsRecording informationForming hypotheses (clinical hunches)

  • ObservationTake notice of the clients general state of anxiety.Establish sense of clients cultural context.Note gestures / movements that denote emotional / physical dysfunctions.Hear how the client frames his / her problems.Note verbal and non-verbal patterns.

  • Formal Diagnostic AssessmentInterview format:

    FocusBasic Screening QuestionsDetailed Inquiry

  • FocusPresenting problem and context

    Basic QuestionsWhat concerns brought you here?Why now?Has this happened before?How is it impacting your daily life?

    Detailed InquiryClarify stressorsElicit coping skills,social support, and resourcesClarify life functionworkfamilyhealthintimacy

  • Focus Mental statusBasic QuestionsHow do you feel now?How is your mood affected?Had any unusual experiences?How is your memory?Do you think that life isnt worth living?

    Detailed InquiryNote age & mannerismsdress & groomingorientation Probeanxiety symptomsform, content, thought.suicidal ideationviolent impulses

  • FocusDevelopmental history and dynamics

    Basic QuestionsHow would you describe yourself as a person?Shift to the past, how were things when you were growing up?

    Detailed InquiryClarifycurrent self-viewlevel of self-esteempersonality styleNotedevelopmental milestonesexperience in schoolbest friendseducational level

  • FocusSocial history and cultural dynamics

    Basic QuestionsWhat is your current living situation?What is your ethnic background?

    Detailed InquiryElicit job or militarylegal problemssocial support systemrace, age, gendersexual orientationreligionlanguagedietary influenceseducation

  • FocusHealth history and behaviors

    Basic QuestionsTell me about your health?Health habits?

    Detailed InquiryIdentifyprescriptionssubstance usagehealth statushealth habits

  • FocusClient resources

    Basic QuestionsHow have you tried to make things better? Results?How do you explain your symptoms?What is your / my role in your treatment?When will things change / get better?

    Detailed InquiryProbeEfforts to changeEfforts vs. successesClarify client explanatory modelIdentify treatment expectationsSpecify readiness for change

  • FocusWind down and close

    Basic QuestionsWhat else would be important for me to know?Do you have any questions for me?

    Detailed InquiryUse an open-ended query Allows the client to add information.Creates sense of reciprocal and collaborative relationship.

  • Conceptualizing ProblemsRecognize a client need.Understand that need.Meet that need.1. Beliefs mayContribute to the problem.Impede the solution.Become the problem.2. Feelings / responses oftenExaggerate the problem.Impede comprehension of the problem.Become the problem.

  • 3. Behavior / responses mayBe inappropriate.Contribute to the problem.Complicate the problem.4. Interaction patterns includeMiscommunication channels,Expectations,Self-fulfilling prophesies.Coping styles.5. Contextual factorsTimePlaceCultural and socio-political issues.

  • Goal Setting 1. Indicates how well counseling is working.2. Indicates when counseling should be concluded.3. Prevents dependent relationships.4. Determines the selection of interventions.5. Mutually defined by the client and counselor.

    CounselorGreater objectivityTraining inNormal andAbnormal behaviorProcess experienceClientExperience with the problemHistory of the problemPotential insightsAwareness of personal investment in change

  • Process goalsRelated to establishing therapeutic conditions for client change.Includes:Establishing rapport, Providing a non-threatening setting, andPossessing and communicating accurate empathy and unconditional regard.

    Outcome goalsAre different for each client and directly related to clients changes.Always subject to modification and refinement.To begin, formulate tentative outcome goals.Modify goals as needed to support effective change.

  • InterventionsObjective -- initiate and facilitate client change.After assessment and goals setting, answers the question, How shall we accomplish these goal?Must be related to the problem.Selecting an intervention may become an adaptive process.Skills to initiate includeCompetency with the intervention;Knowledge of appropriate uses;Knowledge of typical client responses;Observation skills to note client responses.

  • No clear cut ending, but no need to continue beyond usefulness.Awareness by the counselor and the client that the work is accomplished.May take the same number of sessions as rapport building. Types of TerminationSuggested termination, with client agreementImposed terminationContinuing is against client best interestClient is deteriorating, not progressingIncompatibility with the therapistClient using therapy in place of life

    Termination

  • 3. Situational terminationClient movesEmployment changes4. Early termination, clients just dont return.

    Methods Gradual tapering off of sessions.Therapeutic vacations, taking a break without breaking the connection.Direct (imposed) termination.

  • Basic skills of Counselling Listening is not passive. It is important to indicate that the person is being heardGood counselling skills means listening before acting to solve problemsVerbal listening skillsShow interest Gather information Encourage speaker to develop ideas Communicate our understanding of ideas Request clarification of understanding Build the therapeutic alliance

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

  • Non verbal attending and observationTake notice of the clients general state of anxiety.Establish sense of clients cultural context.Note gestures , movements that denote emotional / physical dysfunctions. Non verbal behavior include eye contacts, head nods, facial discrimination, body posture and physical distance between counselor and clientHear how the client frames his / her problems.Note verbal and non-verbal patterns.

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

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

  • Looking Like Your Listening is Not Enough

  • RespondingAsk open and closed questions Use encouragers Paraphrase what you have heardReflect on feeling Summarize

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

  • Closed QuestionsGenerally start with is, are, or do Serve to: Gather lots of specific information quicklyTend to close down discussion Eg:Nurse: Are you giving the medicine every day?Nurse: Is the baby able to tolerate the medicine in the morning?

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

  • Reflection of FeelingsFocus on feelings (stated and unstated) Serves to: Communicate understanding of emotions When combined with a paraphrase, confirms the accuracy of understanding (Check out the the other person) Encourages discussion of feelings

  • ParaphrasingBriefly summarize the content of the discussion Reflective listening Check your understanding Show that you heard what was saidAcknowledge and accept feelings without judgingEg:Patient: I am worried that the medicine is making my baby sickNurse: It sounds like you are worried about how the baby is reacting to the medicine.

  • Summarizations Finally pull together ideas from the interview Serves toOrganize the structure of the interview Check the accuracy of understanding

  • Influencing or Changing Behavior

  • Influencing or Changing Behavior DirectivesReframes and interpretationsAdvice FeedbackLogical consequences