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COUNSELLING

INTERVENTION PROCESS

Dr. Manoj Fernando


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WHAT IS COUNSELLING ?

• Counselling is a sensitive and understanding approach


that helps clients to accept and deal with their
problems; communicate their anxieties and fears;
derive comfort from a gentle, empathetic, caring
person; and increase their ability to care for
themselves.
THE PROCESS OF COUNSELLING 3

CONSISTS OF FOLLOWING MAJOR STEPS


1. Good rapport and building understanding and lasting
relationship.
2. Assessing the client and diagnosis
3. Setting goals to be achieved.
4. Conceptualizing the Client’s Problems
5. Therapeutic interventions.
6. Arranging for next meeting/follow
up/termination/evaluation
7. Referral for additional support when needed.
GOOD RAPPORT AND BUILDING 4

UNDERSTANDING AND LASTING RELATIONSHIP


• Your first contact with the client is very important.
• Ask others not to interrupt you during the counselling session.
• Introduce who you are a and your responsibilities.
• It is important to welcome them by their name. That will ease their
stress for a moment.
• Talk to them nicely and help them to relax.
• Explain to the client how you ensure privacy and confidentiality.
• Extend unconditional acceptance of your clients story.
Stage One
Relationship Building
Tasks here include…

*Laying foundations for trust


*Establishing the structure and form the relationship will take
*Informed consent process
*Articulating roles of counselor and client –
developing a collaborative working alliance
Stage One
Relationship Building
Consider how do we develop rapport, create relationship with our clients?
What is it that we bring to the relationship that helps us create a foundation of
trust and willingness to work collaboratively toward goals?

Core Conditions Necessary for Successful Counseling


Originally proposed by Rogers (1957)
*Empathetic understanding
*Unconditional positive regard
*Congruence

Carkuff (1969) adds to these…


*Respect * Confrontation *Immediacy * Concreteness *Self disclosure
The Purpose Served

Empathy  promotes rapport and relationship


Unconditional Positive Regard  Client as person of worth – separate from
actions
Congruence  Genuine self in client interaction
Respect  Strength focus
Immediacy  Here and Now
Confrontation  Promotes realistic, accurate view
Concreteness Attention on what is practical
Self disclosure -->Promoting positive perception and appropriate focus in
counseling relationship
Nystul (2003)
Using Counseling Skills
Effective Listening
Early stages of the counseling relationship afford the chance to build
counselor understanding of client and issues faced. Using counseling
skills to gather information, to begin to formulate impressions

Do…
Use listening skills and attend to nonverbals
Listen for the underlying communication

Don’t…
Be a judgmental counselor
Jump to conclusions
Make language errors (e.g.parroting, jargon)
Stage Two
Assessment and Diagnosis
Gathering information to promote understanding of client’s
situation and perspective…..phenomenological

Completion of intake/of psychosocial


Standardized (e.g. psychological tests) and
Non standardized (e.g. clinical interview) tools

Completion of Risk Assessment where appropriate

Diagnosis
Stage Two
Tasks of this Stage
Identifying the nature of the presenting
problem – what kind of change is sought

Counselor role moreso in helping the client articulate than in pronouncing for
them

Seeing problem in-context to the client’s larger world. Keeping an eye on


strengths and resources.

Counselor builds hypotheses during this stage and


throughout
CONCEPTUALIZING CLIENT’S 11

PROBLEMS
• Usually the immediate issue (Eg: Abuse) seen as the major
problem.
• There may be several other problems linked with the immediate
problem of the client.
• Although client seeks an answer for all problems there may not
be solutions for some of the problems.
• Discuss this in detail with the client to identify factors for the
problem/s client have.
• Help the client to identify measures to deal with her/his
problems.
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HOW TO SET GOALS WITH THE
CLIENT
• Keep it simple when you set targets to achieve.
• Break it in to number of steps.
• Choose a starting point with the client by getting the
consent of the client.
• Set a time frame which is approved by the client.
• Try to take the client forward according to the plan
• Encourage the client with motivational support for
making progress
Stage Three
Formulation of Client Goals
The client articulates where they want their counseling journey to
take them

*Client role as one of driving the bus


*Enhances sense of ownership and motivation – factors important in
the change process

Well identified goals help create a roadmap and means to evaluate

Goals may change, evolve as therapy progresses


Five Categories
Counseling Goals
1. To change an unwanted or unwelcome behavior

2. To better cope

3. To make and implement decisions

4. To enhance relationships

5. To help client’s journey of growth toward achieving potential


Nystul (2003)
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THERAPEUTIC SESSIONS
• After initial dialogue you need to help the client to
overcome the challenges and go for best possible options
available.
• For this you might have to spend more than one session
with them.
• There are certain principles and techniques that you need
to follow to get optimum results.
• Specific therapeutic interventions. (Will be discussed
separately)
Stage Four
Intervention and Problem Solving
Begins as soon as goals are established – this is
plan for how to achieve them

Action…directed in accord with new perspectives


Talked about…but lived

Collaboratively established plan works best

Educational in that client is offered information regarding options, and


advantages/disadvantages for each
Stage Four
Intervention
New perspectives on both the way clients
have looked at the problem and ways they
might approach it
*Confrontation vs Carefrontation
*Self Disclosure as appropriate
*A clear, simple plan toward goals
Stage Four
Intervention
Characteristics of a good treatment plan…
*goals are clearly defined and reachable
*plan able to be adapted with time
*positive and action-oriented focus

Essential to an effective plan…is client’s


motivation and willingness to follow it
Prochaska’s Stages of Change
Pre-Contemplation
Contemplation
Preparation/Determination Action
Maintenance
Relapse

See this resource for addictions focus:


http://www.addictioninfo.org/articles/11/1/Stages-of-
Change-Model/Page1.html
Crafting a Treatment Plan
Begins with clearly articulated problem and
priority from client’s perspective
*primary (presenting) vs underlying

Clearly defined, broad goals – global

Objectives – behaviorally stated, steps on way to broader goal – mindful of


accountability

Interventions to be utilized by counselor


Example from Knapp & Jongsma (200 )
Child with Anger Management Issues
Problem: Repeated angry outbursts out of proportion to
precipitating event

Goal: Significantly reduce intensity and frequency of angry


outbursts

Objectives: Parents clearly define rules and boundaries and follow


through with child

Intervention: Assist parent in the process of identifying and


presenting rules and consequences to child
MAIN PRINCIPLES OF COUNSELLING THAT
YOU NEED TO KNOW
 Make the client comfortable – Attending
behaviour
 Show empathy
 Ensure confidentiality
 Active listening to be practiced
 Facilitate story telling
Maintain correct body language and tone
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Be non judgmental


Question harmful opinions and
belief’s
Show available options
Support the client to take positive
decisions
MAKE THE CLIENT COMFORTABLE – 24

ATTENDING BEHAVIOUR
• You must orientate yourself physically and
psychologically towards the client.
• This encourages the patient to talk.
• Lets the other person know you’re listening.
• Conveys empathy.
ATTENDING BEHAVIOUR IS LOOKS 25

LIKE ……………
• Face the other
• Head nods – Non verbal communication
• Adopting an open posture
• Verbal following
• Lean toward the other
• Make eye contact
• Be relatively relaxed
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ALWAYS CONVEY EMPATHY TO YOUR


CLIENT AND OTHERS IN THE FAMILY

• Empathy is an emotional response to the feelings of


another
• Try to understand people who come to speak to you
• Try to look at their problems and concern from their
ideas not from yours
• Try to see the world through their eyes
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NEED TO ENSURE CONFIDENTIALITY AT
ALL TIMES
• Your discussion with client and the family members should be
treated as confidential at all times.
• You better inform the survisour about this at the outset.
• Explain the client how you prepared to preserve the confidentiality
of the information provided and records maintained.
• Never share stories of clients even without mentioning the names
of them with other people.
• Inform the client about the need of sharing some information for
relevant officials such as police.
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ACTIVE LISTENING IN COUNSELING

• It is a way of listening and responding to your client


attentively that improves mutual understanding.
• In active listening eye contact, non verbal
communication and your body language play a vital
role.
• You can ask relevant questions without disturbing
the flow of the dialogue to get more information
from the person.
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YOU NEED TO KNOW HOW TO FACILITATE
THE STORY OF YOUR CLIENT

• Encourage the client both verbally and non verbally to maintain


the flow.
• Nonverbal communication includes head nodding, smiling, saying
( hmm hmm).
• Pausing or maintaining silence when the client speaks especially
about important or emotionally charged topic and especially in the
first few minutes of the interview is recommended.
• Questioning at the right time to get more information and address
negative opinions and believes is recommended.
MAINTAINING A CORRECT BODY 30

LANGUAGE AND A TONE IN VOICE ALSO


MATTERS
• The dress you wear, the way you talk and the way you behave in
front of your client could affect the out come.
• It is advisable to talk in moderately loud voice and to have a
friendly talking style.
• Please be aware of their language.
• Do not touch the client unless you really need to do so. If you feel
it is necessary get the consent from the client.
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ALWAYS HAVE A NON JUDGMENTAL


ATTITUDE TOWARDS YOUR CLIENTS

• Whatever said and done during the discussion, you are


not expected to judge your client as it could hinders the
outcome.
• If the client is withholding information probe further to
get enough information.
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QUESTIONING HARMFUL OPINIONS AND BELIEF’S OF
THE CLIENT SHOULD BE DONE TO FURTHER EXPLORE
THE MATTER AND TO TAKE BETTER DECISIONS

• This is one of the principles in counselling which would help


the client to find better options/solutions and see the issue with a
open mind.
• Harmful opinions includes opinions about whether to look for
help or not, about marriage, about life, about alcohol related
behaviour.
• Addressing these belief’s need to be done in an empathetical
manner and based on evidence.
SHOWING AVAILABLE OPTIONS IS 33

ONE OF YOUR RESPONSIBILITIES


• Available options ‘Solutions’ may vary depending on the
seriousness of the issue and individual limitations.
• Client may or may not be ready to see best possible options
available for that moment.
• You can suggest options if the client is not aware of possible
options she/he has.
• With time and the level of empowerment they might change the
earlier option which is indeed acceptable.
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ALWAYS SUPPORT THE CLIENT TO TAKE
POSITIVE DECISIONS REGARDING THE MATTER

• Most of the time clients need help in shared decision


making.
• You are expected to help the client to identify the best
option after analyzing available options with them.
• If the decision is risky or dangerous probe further to
minimize the harm.
• Support the client to go along with the best possible options
while addressing barriers.
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DEVELOPING A SOLUTION OR AN OPTION


SHOULD BE DONE WITH THE CLIENT

• Try to understand the situation of each client.


• Find out what the client’s goals are
• Help them to develop a step-by-step plan to reach above
goals
• Get an agreement from the client to reach the first step
• Set a time frame to get the first step done
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PLANNING FOR NEXT MEETING WITH YOUR


CLIENT IS IMPORTANT AFTER EACH
SESSION
• After each session you need to assess the need of a second
meeting.
• If so, discuss with your client about the need and mutually agree
a date and time.
• You can always suggest the vitality of meeting certain high risk
clients immediately and more frequently.
• If you satisfy with the improvement you can terminate the
relationship after making the client aware of the decision.
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OFFER REFERRALS TO YOUR CLIENT


WITHOUT A DELAY
• You need to refer your clients to specialists and other services
without a delay.
• Some of your clients need immediate attention. Ex- Clients who
are having strong suicidal feeling or symptoms of psychiatric
diseases.
• It is advisable to have equipped your self with the necessary
details of such specialists and services to send your clients without
any delay.
Termination
Collaboration with client in identifying a date in advance –
Note that today, Managed care may dictate

Role to review progress, create closure in client counselor


relationship and plan for future

Think of this as a means of empowering client


Stage Five: Termination
Counselor Considers
Counselor always mindful of avoiding fostering dependency and is
aware of own needs

Preparation for termination begins long before

Open door / plan for possibility of future need

Termination considered not just at end of successful relationship,


but also is considered when it seems counseling is not being
helpful
Research / Evaluation

Really completed throughout the counseling process –


reflected in…
*Generating hypotheses
*Trying intervention strategies
*Determining if/when goal is met

A plan for evaluation