COTJNSEfuSNG TFqE BASSC SKSLLS TO

NFITROD{-SCE Btr A CCIqJNSETOR

dr. MarFarsfr SKF, SPKf"{K},
Dra Vayi SP, lvflSi & dr. Sanntosa ts., &i.Kes"

IF{TROMLJET!ON
Definitioar
Counseling is customarily defined as a form of interviewing in whictt
clients are helped to understand themselves rnore completely in order that
they may correct an environrnental or adjustment difficulty. Guiding and
helping people to make ratlonal decisions, to organize plans for constructive
pursuits, to seek out the best available comrnunity nesources to satisfy
irnmediate and future needs, and tCI overcorne reluctant toward and fears of
action are among of the tasks of the counselor" A. wide variety of professiona0
paid and volunteer workers function in this way as counselors. Clients seek
heNp for a host of problems, sorule rea[, some projections of inner distress"
And it is the duty of the counselon to distinguish between the two"

Re$atiunshsp hetweem eoumsef,on amd e8iestt

The relatlonship between client and eounseion, which is considered of
prime importance ln counseling, is used in different ways- fronn the offering
of suggestions as to available resourt;es to the lnterpretationr of the client's
attitudes and fee8ings" The dineetness of the counselon varies. In directive
eounseiing {Thorne, X950) the counsegor assuilles the role of an authority
offering the e$lent an evaluation of the partieu[ar pnoblenn and defining col.!!'ses
of aetiosl. !s.l nondireetlve eounsellng {Rogers, '! 942} tfie eocimse{on funetiosls
as an agent who eneourages the e$iemt's expressbn of fectlngs, neffieatlmg
these and help[ng fire elient to assume resporrsibE*lty fon thenn" ln thfls way
Block 11 - 201 'X

the client thisiks things out, develop goals, and plans the eourse of action.
Otl'ler forms of counseling draw frorn the field of dynamic psychology, seeking
to utilize the eounselon-ctient relationship to denrronstrate the operations of
the client's personality structure either in cneating the situations for urhich
help is being sought or in blocking the client frorn finding the appropniate
solutions.

Field of eounseling
counseling prograsns have advanced rapidly, partieularly in the
educatlonal, industnlai, socla! work, hcalth, and rnllltary fields. Counselors
inr prognessively langen nunnbers have heer"l utitized for guidanee activities
and pensonal eounseling in secondary sehools, eolleges, and universities,
for "eumplOyffiXent eggnseling" toward seleetion, plaeernent, and morale
buitding in industry, for "rehabllitationr eounseling" to enable handlcapped
persoris to make a tnansition froun disabitity to pnoduetiveness, forjob
reloaation senvlces fon netunnisrg vetenans, for "eoulnsellng psychology" in
Veteranrs Admlnistration hospitals and vanious cornnnunity agenclcs- Family
egerleies offer counseling serviees on nnatters of fanrily relationship and
social ad.!ustmemt sueh as the fo$lowing:
1. Diffiau$tiee ln intenpersonal nelationshiips rnanlfest withirc the tamity,
between tfre alient and patient, siblings, spg{.,sse, ehildren, and others,
resu[tinrg in anxiety, syl't'lptoms, or deviarlt behavlon.
Z" Difflaulties interpersonal adSustment in rclatiom to innen functrons, sueEt
as sexuality, educatlomal aahiever-nent and learning, and emp$oyment
acrd work abitlties.
3. Eglvinor"rrnental pnoblems, sucht as ecpriomie hardships and housing
deficiencles.
4. Health problerns, sucfu as dlsahiirties, physical handicaps, mental
retardatlon, henedity illness (genetie eounseling], ete"
 Faculty of Medicine UGM

Scope of eounseling serviees

The helping methods in the counseling seruices rendered include (1)
advice giving, environrnental manipulation, and ego suppor"t, such as
reassurance and encouragennent, (2) guidance in the client's roles in family
and society and in what can be done about a specific situation, and (3)
clarifications regarding the client's feelings and aftitudes and their deviations.
services are given not only to individuals and couples (marital counseling),
but also to the total family (family counseling) and to groups (group
counseling).

Qbjectives counseling topEcs on undergraduate medica! students

Because of the increasing need forcounselons, various tnaining couases
have been onganized on different levels of sopfiistieation" They range frorn
those that require only a few hours at an undengraduate level to those that
lead to a doetor's degree. l.{o unified currlculum eNists, but a trody of
information is gradually being organized from fields of psychology, psychiatry,
sociology, socia! work, and anthropology that are helpfu$ in understanding
personality developrnent and structure, hutrnan relationships, the vicissitudes
of adjustrnent, and the interviewing process. Goals in counseling have been
expanded from simple testing and advice giving to managing the individual's
generaladjustment problems with the realization that a sitr-lationaldifficulty
may be a rnere surface manifestation of a more widespread disturbance"
For example, the attempt to broaden a person's occupational perspective on
to outline a cuniculum in line with the person's abilities may fail because of
opposing personality forces. This has tended to shift the emphasis of the
interview in both individual and group discussions. The cgient's perceptions,
goals, and values as well as feelings about the self and the environment are
reflected in behaviora! choices- Therefore, they need to be a part of the
counseling operations (cottle, 1973). The counselor may thus act as a
catalyst to growth process within the client"
Block 11 - 201 1

Counseling and PsychothenaPY

The term counseling has become diffuse, covering inforrnation and
advice giving, and merging imperceptibly into psychotherapy (Patterson,
1966;Truax & Carkhuff, 1967; Osipow & walsh, 1970). Training for a modern
counseling role, accordingly, requires, in addition to supplying the counselor
with special knowledge and information about resources, a recognition of
symptoms of emotional illness, some comprehension of dynamics,
discernment of the forces of transference and resistance that apt to be
released during the counseling relationship, knowledge of how culturalfaators
influence value syStems, and, finally, an understanding of one's own emotional
shortcomings and prejudices (including destructive counter transference)
that are apt to release themselves during counseling. Particularly important
is sufficient diagnostic skill to discniminate depression, paranoiac projections,
and psychotic manifestations in their early stages" The counselor shsuld
know when, how, and where to refer cllents fon psychotherapeutie help when
their conditions require mone than eounseling and the eouriselor is not
equipped to funetion in a psychotherapeutle ro!e"
ln sumrnary, orne may easily dlscern fnonn the disaussion how diffieult it
is to separate the goals of eounseling fnom those of psyehotherapy. $onne
attempts have been made to distingulish ttre methodologies" Counseling
requires a relationship betweern a helping agent and a c!ient. ln this
relationship emotional inten cunrents openate that n'lay have a psyeho-
therapeutic effect on the individua!, with an infh"rence far beyond tfie punposes
for which help was sought. But while personality chanEe may be the outeome
of the counseling relationship, as it is in psychotherapy, tl'lere are centain
difirerences between tl"le two processes"

Counse[or and eoumselee

The reason a couRselee seeks help is hecause there !s generally sorne
situational difficuNty for whicl'l speelalized knowledge is nequired or because
 Faculty of Medicine UGM

the individual is unable to cope with a problem through personal resources.

The counselor then executes specialized knowredge of the area of coneern
to aid the counselee. Thus, the area rnay be educational, vocational, or
behavioral, as in marital rnaladjustrnents. objective inskuments, such as
psychologica[ tests, mray be enrployed.
The counseNee is thea'r gr.rided toward adequate cou!.ses of action. The
approach here is supportive, the eounseflor rnakirrg suggestions, offerinE
guidance, presenting to the counselee opportunities fonventilation of feelings,
and encouraging the counselee toward the proper acfions. sometirnes the
approach may, in addition, be re-educative, with an aftempt at explaining
the meaning of destructive behavisr patterns, helping thecounselee to clarify
feelinEs, and fostering an awareness of how the counselee behaves !n
relationships with family and other people. lf emotionalfactors seem to be
responsible for the counselee's inhibitions, this may be pointed out to the
counselee as wellas ways in which the counselee rnay overcome blocks.
The counselor neither handles resistance and mechanisms of defense
in terms of the total psychodynamic operations of the individual norfocuses
on early conditionings and the unconscious ficrces that play upon the person"
However, here counselors have received appropriate postgraduate
specialized training in psychotherapy, they may be qualified to add to the
battery of counseling methods the operations of psychotherapy. They wi$l
then function as psychotherapists rather than as counselors. Although
counseling borders closely on the domains of psychotherapy, unless some
demarcation is made in boundaries and responsibilities, inter professiona[
communication and cooperation are apt to suffen

A doctor as a counse8sr
A doetor who explained tfre pnoblern of illness, the course of treatrnent
and te8ls patients what to do, actually has done the counseling. !n view sf
public and mentalhealth, approach thnouglr counseling process is needed
to pensuade tN're indivldual patients of the cldnical encounter, also society.
Block 11 - 201 '1

An effective client counseling has thrree characteristics example:

empathy, place oneself in the side of cNient; appneciate feeling or attltude
of
others; honest with care, questions, and feeNing of otlrens. A counseling
process may be summarized as GA-['l-{ER:
G Greet, give warn greeting ta client
A Ask, ask client what happens to thern
T Telt, tell client alternative
[4 Hetp, help elient in choosing
E Exptrain, explain the c,lient
R Return, return for follow wP

Besides GATHER, two things should be considered:

s CLEAR, a p!-ocess that includes clanifying, listening, encouraging,
asking
fon feedback, and nePeatinrg.
m RQl.-Es, a prOcess fnogn relaxlng, operting up to elient, geaning towand
alient, establishimg eye coaatact, amd ss'mllirng and sitt$ng squarely.

TA"{E M&.JffiCTflVE$ OF GOTjN$ffiLBNG ARffi:

'1. Faailitate for behavions ehanges
2. Ernpnove the abillty to dealwith the problems
3. lrnprove ttre abllity to make declsions
4. Showing the irnportance of the relationship
5. Facilitate to improve the abllity of the clBents

STEPS !F,, eOUNSEL[${G:

QpenrEng
t,lsually earnled out with t['le ob.fiectives: to stirnulate openness, t"lonesty
and futl connmunieatlons so the problenn and nelated backgnound can be
expnessed;to do aetivities for inereasinE undenstanding, seif-va$ue, and self
eonfidenee between interviewen and client; to enable the client to think that

6
 Facrlty of Medicine UGM

they will get something useful during counseling; to formulate problem and
to take care of everything yvorth caring; to form a whole opinion that
counseling is a process requiring both sides;to obtain information aboutthe
client related to their needs and effective solutions to problem. Afterwards:
decide and fornnulate the ob.lective of counseling; understanding the client's
need: built sr.rpportive relationship.

Exploratio:rs and rea! eounseling

To beconne a successful interyiewer, following things be noted: avoid
questions with yes on no ansffirer;avoid questlon obscuring the freedonr to
answer;avoid talking too much; avoid temptation to get inforrnation too fast;
ask question directly with face to face contact; it is recommended to have an
immediate note. Whereas the steps are: exBlore and formulate problern,
plan a strategy; collect f;act, feeling; consolidate to explore alternatives.

Closing and furthen plan

Closing is not only end counseling process, but it also has three function:
to checkclient's readiness in facing the end of counseling and to consolidate
the learning process; to overcorne the rernaining affection fucton and to setfle
down things with important significance and possibility intensive things in
relationship of interviewer and c!ient"; to rnaxirnize the transfer of learning
process and to increase self confidence about their abitity in keeping up
with changes durlng counseling and when the counseling ends" step of final
stage of counseling: to explaln sorne solutions to problern; to make a plan to
do the step witl'r a strategy to decnease hurting feeling and to consolidate
and to collect skill and behavior fur continuing directed activlties for them; to
investigate {both by interviewer and client} ways to solve the problem and to
make an agreement to do activlties based on the chosen method; to end
counseling by assessing the result obtained"
Block 11 - 201 1

Code of eth!c of eounselinq

Things that should be award when interviewer do counseling are ethics
and growing attitude. Code of ethic of counseling based on the American
Personnel & Guidance Association are:
1" Behavion based on code of ethic sllould be shown by pnofesslonals,
botli foe rnernber and non-rnernber of an associatlon.
2" Member responsibiXity is to appreelate integnity and to inerease client's
we$fare, either the c[iesrt is he|ped in gnoup or individually
3. lnforrnation neveafed fnom the eomnc'$unlcation in eounseling slrould be
kept confldentiality.
4. The alient is infonrned about smethods used befone or durEng the process
of counsel!nug.
5. lf the rnennben of lnterviewen cannot help, they should nefer the client to
othen expert based on specialization fon further treatrnent.

Guidanee and cournsefi Eng

Crow & Crow (1960),define the guidance is assistance rnade available
by personality qualified and adequately trained men orwornen to anlndividual
of any age to help lrirn rnanage his own life activlties, develop his points of
vieq nnake his own declsions, and carny his owrs burdens".Accordlng Shierley
liarnrin (1947), guidanoe is helplng John to see throuEh hirnself in onder
that he may see himself thrrough". Ruth Stnang (1958), "Guidance in broader:
counseling is the nnost impontant tool of gr.ridance".
Monntensen & Schrnu[[er ('! 0M): "Couarseling ls the heart of the guidance
pf'og!'arn". Rogers fi44\: "counseling is a series of dlrect contaets with the
individual which aims to offer him assistance in changing his attitude and
behavior''. Robinsog'r (1050): "the tenrn counseling, as used here, covers all
types of two-person sltuations in which one person, the client is helped to
ad.fiust nnore effectively to himself and to his envlnonrvrents" lt includes the
use of the intenview to obtaisr and give infonnnation, to coac!'l or teach, to
 bring about increased maturity, and toaid with decision-making
and therapy.
Typical counseling areas are also broadly conceived. Thus mental
hygiene
should mean the devirmentof effective adjustmentskiils as weil as providing
psychotherapy. counseling in industry and in athletics
includes handling
individuals, personal problems as wellas instructing them in skills.
Finally,
scholastic difficulties contains elements of skills deficiency, study habits,
i
cunicular planning, and emotional problems".
Mortensen & schmuiler (1g64): "counsering rnay, therefore, be
defined as a person-to-person process in which one person is helped by
another to increase in understanding and ability to meet his problems',.

SCEhJARIOS FOR COUNSEIjI,JG TRA!ilI!${G

General Brastnietions:
The role-play rnethod, one student as a clienucounselee and other
one
as doctor (counselor), the client tell the pn"oblems, and the doctor give
advice"
As a counseron, you shourd show youe'empathy and nnake a good
interpersonal nelationship (the basio skills in communication) and
take the
information of the problem, followed by giving alternative and explanation.
Your implementation base on the counseling check [ist.

Case f:
Counselee:
Male or female student (23 yrs) member of the public relations
class
has already measure his/her anthropometrics measurements:
weight (gOkg)
and height (165), girths of hip and waist, and the skin folds thickness.
The
result of hisiher body mass index is over 30, her hip and waist ratio
is over
0,9, and the fat percentage is over than 35, his/her instructor
said that he/
she was obese. Because of this diagnose he/she fell sad, and
usually thinks
bad effect and confuse to choice the way out among diet, sports,
blood test
Block 11 - 2011

for lipids, take ant! obesity drugs, her/his wrong behavior or psychological
problern

Case 2:
Gounselee:
Mother confuse and wor!'y about the physical condition of her first ssn/
daughter, narned July. Hersom/daughterage 7 years old, rveigh 15ltg, height
'tr'tr0 cm.l-{er husband (45 yrs) is a city bus driven, and she is a housewife (37

yrs). hiis/her bnother/sister (named Agtlstlis 5 yns old and has normal physical
growth" July has no appetlzer, alnrost suffer conne and go diarnhea, and
cougfi" Thre son/daughter diseases $rave alneady rnanaged by doctor of the
prin"rany health servlces (Pl-jSKESMAS), but client stil! has in conftlse, abor'tt
many priorities sueh as lg'lerease the ap'petizer, good diet, environment
hygiene, and routine taking drugs.

References
Kaplan, Hl, Sadock, BJ, Grebb, JA, 1994, Synopsis of Psychiatric, The
D octor- Patie nt Re I atio n s h ip a n d t ntervi ewi ng Te ch n i q u e s, v e d, wi lliams
& Wilkins, USA
l-ewis RWoiber MD, 1988, Ihe technique of psychotherapy,Grune & Stratton,
lnc, PhiladelPhia, PA 19105
MacKinnon, Michels, 1971, The Psychiatric lnterview in Clinical Practice,
General Principtes of The lnterview, Saunders Company, US'A
othmer, EK, Othmer, sc, 1994, The ctinical lnterviewing using DsM-lv,
Arnerican Psychiatric lnc, Washington
Rickey L George, Therese stridde cristiani 1981, Theory Methods and
processes of counseling and psychotheraBy, Prentice Hall lnc,
Englewood Cliffs, NJ 07632 USA
Rollo ["4ay 1967, The Art af counse/ingr, A bing don Fress, NewYork

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